Letter to Editor on “Standardized multidisciplinary care for children and adolescents with differences of sex development: a health intelligence approach”

We read with great interest this comprehensive and meticulously structured follow-up protocol, which offers a harmonized, multidisciplinary care pathway for children and adolescents with Disorders of Sex Development and sex chromosome trisomies.1 The longitudinal integration of validated psychosocial metrics such as the Strengths and Difficulties Questionnaire and Patient-Reported Outcomes Measurement Information System instruments, along with condition-specific survey modules, marks a notable advancement in delivering developmentally appropriate, person-centered care. The authors’ effort to map International Classification of Diseases, 10th Revision codes to ORPHA codes also enhances diagnostic specificity, particularly for rare endocrine and chromosomal conditions. However, the protocol’s strict age-based timing for assessments may limit adaptability to clinical trajectories that diverge from normative developmental milestones. For instance, in children with delayed pubertal onset or atypical gender identity consolidation, fixed intervals for sexual health screening or psychological review may not align with their readiness or clinical need.2 A flexible, readiness-based trigger system, rather than rigid age anchoring, could allow more individualized timing of assessments and interventions, especially in the 11- to 16-year period when key transitions in identity, schooling, and somatic development occur.