About the STRIVE Program

The STRIVE for Kids Program (Supportive Team approach to ReproductIVE variations) was founded at Children’s Hospital of Philadelphia (CHOP) with the goal of providing comprehensive, expert and compassionate care for children with differences of sex development (DSD), variations of sex characteristics, differences of the gonads or genitalia at birth, and other conditions that can affect genitourinary (GU) or reproductive function.

The interdisciplinary STRIVE team includes experts from Endocrinology, the Adrenal and Puberty Center, Urology, Psychology, the Roberts Individualized Medical Genetics Center (IMGC) and other specialties, such as radiology, gynecology, reproductive medicine, oncology and ethics. This program delivers diagnostic, management and treatment services to individuals with DSD and other variations in sex characteristics (VSC) throughout childhood and adolescence, while also providing support and addressing the individual needs of patients and their families.

What are differences of sex development (DSD)?

“Differences of sex development” (DSD) is an umbrella term that describes a group of conditions that occur early in pregnancy and result in the development of sex organs that are different than typical.

There are many types of DSD. They can present as differences in the external genitalia that are noticed at birth, or in differences to internal reproductive body parts or sex hormones that are noticed later in childhood, in adolescence, or even in adulthood. These alterations can present as differences in pubertal development, hormone differences or infertility. Some people with differences of sex development have other health issues, while many individuals are otherwise healthy.

The causes of these differences vary. Many types of DSD have a genetic or hormonal (i.e., endocrine) basis. A change or alteration of a gene or part of a gene can lead to different instructions for their body during development. Genetic and hormone testing can help us determine a specific DSD diagnosis, determine if there are additional health concerns, alter medical management, and provide appropriate counseling.

To learn more about genetic testing, see IMGC’s educational module: Understanding Genomics and Genetic Testing.

Initial evaluation and follow up

At the STRIVE program, we evaluate children and adolescents with concerns about DSD, variations in sexual characteristics (VSC) and other concerns related to GU development or reproduction.

• We work with patients and families from infancy through early adulthood.
• The first evaluation usually includes consultations with genetics, endocrinology, urology and psychology. We then plan genetic, hormonal or additional testing (such as the need for X-rays or sonograms) and future treatment plans. Your child’s follow-up schedule with the STRIVE for Kids Program will depend on their specific condition. In general, patients will follow up with an endocrine provider every 3 months, 6 months or yearly; with a genetic physician or genetic counselor yearly, and with a psychologist or social worker as needed. We will try to coordinate your child’s visits so they can see multiple specialists on the same day in the STRIVE for Kids clinic. Psychology and genetics follow ups may also be available by telemedicine. Urology visits and follow up depend on the need for surgery.
• In certain occasions, we also provide consultations to parents who are expecting a baby with DSD or GU differences (diagnosis made before the baby’s delivery) to discuss what to expect when having a child with DSD and how to coordinate care around the birth.