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Hello. It seems you have found my humble new article. If you find anything you think needs correcting (unreliable source, incorrect formatting, etc.) please either correct it or leave a comment here so I can fix it. Specificity is appreciated.

Thanks :) Urchincrawler (talk) 00:19, 17 August 2024 (UTC)[reply]

Nice article, I added some links and minor copyediting for readability. Raladic (talk) 01:39, 20 August 2024 (UTC)[reply]

@Raladic I saw the link changed you made (the change for hormone therapy was especially appreciated I forgot that one goes to menopause). Thanks for contributing. Urchincrawler (talk) 04:05, 21 August 2024 (UTC)[reply]

@Urchincrawler Hi I saw your earlier comment about some points you wanted to expand on in this article. While I don't really have the time to add content right now I did find some studies that might intrest you!

• Furtado, Paulo Sampaio; Moraes, Felipe; Lago, Renata; Barros, Luciana Oliveira; Toralles, Maria Betânia; Barroso, Ubirajara (2012-10-09). "Gender dysphoria associated with disorders of sex development". Nature Reviews Urology. 9 (11). Springer Science and Business Media LLC: 620–627. doi:10.1038/nrurol.2012.182. ISSN 1759-4812. Talks about gender dysphoria in the context of different disorders.
• Beale, Jennifer M.; Creighton, Sarah M. (2016). "Long-term health issues related to disorders or differences in sex development/intersex". Maturitas. 94: 143–148. doi:10.1016/j.maturitas.2016.10.003. ISSN 0378-5122. Talks about more of the long term effects.
• Thyen, Ute; Lux, Anke; Jürgensen, Martina; Hiort, Olaf; Köhler, Birgit (2014-07-17). "Utilization of Health Care Services and Satisfaction with Care in Adults Affected by Disorders of Sex Development (DSD)". Journal of General Internal Medicine. 29 (S3): 752–759. doi:10.1007/s11606-014-2917-7. ISSN 0884-8734. PMC 4124114. PMID 25029980. Talks about patient satisfaction and issues with healthcare (I think this study is super important as it found that half the participants scored below the cut-off indicating low quality of care.)
• Rapp, Marion; Mueller-Godeffroy, Esther; Lee, Peter; Roehle, Robert; Kreukels, Baudewijntje P. C.; Köhler, Birgit; Nordenström, Anna; Bouvattier, Claire; Thyen, Ute (2018-04-03). "Multicentre cross-sectional clinical evaluation study about quality of life in adults with disorders/differences of sex development (DSD) compared to country specific reference populations (dsd-LIFE)". Health and Quality of Life Outcomes. 16 (1). doi:10.1186/s12955-018-0881-3. ISSN 1477-7525. PMC 5883311. PMID 29615040. Found that QOL was significantly poorer compared to healthy and non-healthy reference populations in social relationships. Based off my brief scan of the article you didn't discuss social relationships so this might be important to add.

CursedWithTheAbilityToDoTheMath (talk) 03:55, 21 August 2024 (UTC)[reply]

@CursedWithTheAbilityToDoTheMath Thanks for the sources ^_^. I ran into the article in Maturitas quite a bit while working on this article, but unfortunately I've been unable to find a place where I can access it for free. I'll definitely look through the rest though when I get the chance. Feel free to add to the article if you'd like when you get the time. There's no rush. :) Urchincrawler (talk) 04:02, 21 August 2024 (UTC)[reply]

That one is available through the Wikipedia library. I just searched for it and got access to the full article through it - Wikipedia:The Wikipedia Library in case you didn’t know yet. Raladic (talk) 04:30, 21 August 2024 (UTC)[reply]

I actually didn't know about the Wikipedia library. Thanks for the tip. Urchincrawler (talk) 01:39, 22 August 2024 (UTC)[reply]

I'm not allowed to link the website here but there is a site called sci-hub (ends in .ru) that allows you to copy and paste a doi into the site and most of the time it will give you access to the article for free. CursedWithTheAbilityToDoTheMath (talk) 04:41, 23 August 2024 (UTC)[reply]

Hi, it appears most other articles we have on Health care or Transgender health care use "health care" as two separate words, should we move this one to fix that pattern as well? Raladic (talk) 00:35, 20 August 2024 (UTC)[reply]

I don't think it really matters. After all, articles like Healthcare and the LGBT community and Healthcare in the United States don't use a space between health and care. Urchincrawler (talk) 03:53, 20 August 2024 (UTC)[reply]

Yeah I guess that’s fair. I’ll make the other title redirect to this one then, just in case someone searched using the space :) Raladic (talk) 04:20, 20 August 2024 (UTC)[reply]

Sounds good 👍 Urchincrawler (talk) 05:00, 20 August 2024 (UTC)[reply]

Should there be a redirect from "intersex health" to intersex healthcare the way "LGBT health" goes to healthcare and LGBT? Or would that be confusing due to the intersex medical interventions page? Urchincrawler (talk) 05:04, 20 August 2024 (UTC)[reply]

Yes that’s a good idea as well - created Intersex health to redirect here as well.

This page here links to the Intersex medical intervention page, so I think it will be fine.

if confusion arises in the future, we can always add a disambiguation or other HAT note to the top of the article here. Raladic (talk) 05:43, 20 August 2024 (UTC)[reply]

I suggest renaming the other page to remove the space instead. Jruderman (talk) 18:38, 20 August 2024 (UTC)[reply]

There are some topics that I think would fit in this article well. Hopefully either future me or another helpful editor will fill these in.

1. (Complete!) Expand advocacy section. Note: I would really appreciate another editor's help with this since that section is giving me difficulty.
2. (Complete, but can be further expanded.) Added gender dysphoria to mental health as intersex people are more likely to experience gender dysphoria than general population. Here's a starting source I found.
3. (Complete, but could be expanded) Look into hypertension, diabetes, and obesity as some intersex people can experience a higher likelihood of developing these conditions.
4. (Complete!) If possible, expand on treatments for associated congenital anomalies such as renal and heart defects. (Congenital anomalies is currently the last paragraph of the physical health section.)
5. (Complete!)Expand on cancer risks if possible.

Urchincrawler (talk) 03:44, 21 August 2024 (UTC)[reply]

Should the healthcare needs subsections each be made into their own section or be left as is? Urchincrawler (talk) 23:48, 22 August 2024 (UTC)[reply]

I think it's fine to leave them as subsections. CursedWithTheAbilityToDoTheMath (talk) 04:39, 23 August 2024 (UTC)[reply]

This review is transcluded from Talk:Intersex healthcare/GA1. The edit link for this section can be used to add comments to the review.

Nominator: Urchincrawler (talk · contribs) 18:11, 27 February 2025 (UTC)[reply]

Reviewer: Czarking0 (talk · contribs) 19:02, 13 March 2025 (UTC)[reply]

This is fairly good to start. I'll take this one. Czarking0 (talk) 19:02, 13 March 2025 (UTC)[reply]

Thanks for reviewing. Just replying to let you know I have addressed some of the concerns and plan to address more as soon as possible. (I'm thankfully relatively unbusy this week.) I responded to some of the points in your comment. I know wikipedia can be weird about notifications when editing the comments of others, so I wanted to leave a message just incase. Urchincrawler (talk) 10:46, 15 March 2025 (UTC)[reply]

I appreciate that, your responses, and your good work here. I will hold off on reviewing the next section until you have at least indicated you read this round of comments or you say otherwise. Czarking0 (talk) 03:58, 16 March 2025 (UTC)[reply]

Thanks. I will let you know when I have addressed all of your comments thus far. Your feedback has been quite thorough. I am currently touching up the presentation section to include things like classical vs non-classical CAH so it is more clear later in the article. Have a nice evening (or perhaps morning? I'm unsure of your time zone.) Urchincrawler (talk) 07:15, 16 March 2025 (UTC)[reply]

Thanks, FYI for your replies it is better to use colons : than carrots ^ . This is in part because disabled editors use e-reader extensions that integrate with that syntax Czarking0 (talk) 23:21, 16 March 2025 (UTC)[reply]

Noted. Thanks for the tip. Also, I didn't mean to come across as a Debby-downer in regards to sarcasm. I edit for fun as well. If you feel sarcasm is necessary for your morale while reviewing I will respect that. Urchincrawler (talk) 03:48, 17 March 2025 (UTC)[reply]

• copyvivo looks good

• Australia's National Health and Medical Research Council describes varia these are factual claims that should be presented in WP's voice without attribution and preferably without quote.

Corrected

• can be inherited This is a little vague. To many readers any genetic disorder could be understood as inherited.

specified

• For those using in vitro fertilization is this due weight ?

• can be treated during pregnancy using a medication does not belong in presentation and diagnosis

• Will go back to check if DSD is due weight

• people is this better than "patients"? Wouldn't "persons" be the correct grammar?

I went with "people" because to what extent intersex variations should pathologized is a touchy subject (see medical characterization and nomenclature). That's why I went with "people" unless patients seemed necessary. It comes across as more neutral. As for people vs persons: I think either would be fine. People is growing in common use as any plural of individuals. Merriam Webster has a page on this here: https://www.merriam-webster.com/grammar/people-vs-persons

It mentions, "The AP Stylebook flatly states 'The word people is preferred to persons in all plural uses.'" So I think in this case people vs persons is a matter of preference rather than strictly grammatically right or wrong.

• People with androgen insensitivity syndrome is this different from CAIS? If so that difference should be clarified. If not, the acronym which as just introduced should be used.

Explained different types of AIS in presentation and diagnosis section.

• People with androgen insensitivity syndrome who have undergone a gonadectomy(having gonads surgically removed) no longer produce their own sex hormones. Is the androgen insensitivity syndrome even necessary here? Do not all persons with without gonads fail to produce sex hormones?

Removed redundancy.

• The undescended testes of those with androgen insensitivity syndrome also pose a cancer risk. Those with complete androgen insensitivity syndrome have a 3.6 percent chance of developing a malignant tumor by age 25 and a 33 percent chance by age 50, though malignancy before adulthood is rare.[36][38] In contrast, partial androgen insensitivity syndrome poses a higher cancer risks if undescended testes are present.[38] The risk for germ cell tumors from undescended testes is 15 to 50 percent, but the risk for testes surgically moved to the scrotum is unknown. This is not super clear. Would a table be fitting here?

Unsure how this is unclear and not sure how a table would be better. Please specify.

higher cancer risks if undescended testes are present how much higher? Are you saying that undescended testes in CAIS patients with are not associated with higher cancer risks or that is is not a possible combo? What about PAIS patients with descended testes?

• orchiopexy is done to lower the risk of malignancy Is that the primary motivation?

I did a quick check through a few more articles. From what I have seen that tends to be the most common rationale. Whether or not doctors or parents of children with PAIS do so with other primary goals is not discussed in the literature I've read.

Ok this would usually be a sufficient answer but I am little concerned that the sources appear to be only journal publications. Have you checked other types of sources?

• TODO: spot check FN 38, 44, 45, 50, 65, 70, 71, 74, 79, 85, 88, 89

• Some intersex variations are associated with metabolic and cardiovascular conditions. Those with XY DSD Why DSD here? I'd try to keep the same term throughout unless there's a reason.

I referred to that specific condition as XY DSD since that's how it's mostly commonly referred to based on what I've read. It doesn't tend to go by a common name like Swyer syndrome, Turner syndrome, etc.

 Done

• is also associated with hypertension This is overly vague, what is the degree of association ?

Removed since it seems to be based primarily on corelation without clear causation.

 Done

• suspected MRKH what would lead to the doctor suspecting this? Should this be mentioned in the diagnosis section?

Moved to diagnosis section and explained further.

• Fertility counseling is a desired option for intersex people and families This seems like an odd statement.

Agreed. Rephrased to be less clunky.

• Since 2015, uterus transplants have allowed women with MRKH to give birth without a surrogate. This is not really a historical point being made so I question if this is a good place for the date

• There seems to be little to no mention of cost? Even if the cost to the patient is zero in some areas I would presume many treatments are prohibitively expensive for systems? I understand there is a difficult geographic component for covering this.

Since my sources didn't mention it as a main issue I didn't include it. I presume that is a likely barrier, but I would not add anything based on my personal presumptions. I will explore this further and see if it should be added.

• There appears to be an overall lack of pictures and diagrams

I felt 4 was sufficient, especially since some sections like nomenclature and mental health aren't really visual things. (I tried finding images if intersex focused therapy groups but came up empty.) How many would suggest I am for?

I'll take this into consideration. I wouldn't fail GAR on this point that was more an editorial thought for which I value your input. I think one good example would be like an ultrasound (I assume X-ray can't show this?) of undesended testes potentially with tumors if you can find those pictures. I would at least try to reference a med school textbook that covers this. It may have diagrams which I expect to be too technical for WP purposes but they could be reproduced with less detail.

Two more images added (one with a diagram of how AIS can impact genital appearance, another of a gonadoblastoma.) May add more as I correct other issues. Thanks for the feedback.

• A lot of the sexual health section discusses outcomes in a binary manner such as In vitro fertilization with donor eggs allows people with a uterus but no ovaries to give birth, such as in some cases of Swyer syndrome. I think covering the actual likelihoods of desired outcomes would be more complete.

Unfortunately I have not seen many sources place specific numbers like "in vitro fertilization would be a physically viable option for X percent of people with Swyer syndrome." This is still very much developing field which is why I put the 2015 year to demonstrate that. Each specific condition only occurs in a small amount of the population, only some of whom use IVF. As mentioned in later sections, intersex people are often under-represented in research and potential fertility considerations can end up taking a back seat to normalizing procedures.

I might want to come back to this point from a due weight perspective but that is all for now.

• Cryopreservation is being developed as an option for intersex people whose testes are removed due to cancer risk or gender reassignment.[56] Prepubertal testicular tissue can be cryopreserved and may have potential for fertility based on animal and human studies.[56] As of 2023, this approach remains experimental and it will produce biological offspring is still unclear. This seems out of scope/undue weight

Removed

 Done

• spontaneous puberty you didn't really explain this term

Replaced with clearer description.

• It is unclear what some of these more experimental fertility treatments really mean in terms of intersex patients actually getting healthcare. My guess from reading this is that if I am a patient presenting 45X/46XX mosaicism having my eggs cyropreserved is not a realistic fertility treatment. I think some of this is better covered in section on active research rather than Healthcare needs. Further, I think you should explain here why any fertility treatment belongs in Healthcare needs. Maybe that is not the right title?

• Classic CAH what is Classic CAH? Is this another type of CAH?

Added explanation of types of CAH to presentation and diagnosis section.

• Young intersex people often experience sexual anxiety, and a quarter of intersex adults have not been in a romantic or sexual relationship. This probably needs a year on it. Gen pop celibacy has been increasing. Also for 65-67 I am bit concerned about citing stats from a single study. I have not looked into these studies yet.

Year added. For what it's worth, the DSD-Life study is the biggest cross-sectional study ofintersex people in Europe. (Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC5562972/)

• Intersex people are at a high risk of developing mental health disorders. A review of 18 studies found that intersex people were more likely to have depressive and anxiety disorders. I would put this more solidly in WP voice and quantify it.

• cause of trauma maybe this can be more clear that you are talking about mental trauma? There is probably a good bluetext here?

clarified and bluetext added.

 Done

• A survey of intersex adults for context I think this is the right voice for this claim

• Intersex students are often the target of abuse at school, especially in bathrooms and changing rooms.[73] Students whose appearance do not fit expected gender norms are at even greater risk of mistreatment.[73] Intersex students are often told to keep medical treatments secret by family members or clinicians, leading to further isolation and untreated trauma.[73] I have been mosly clearning this up as I go, but see how in this paragraph you cite the same thing 3x. This should be single cite.

Fixed. It is single site now.

• risk of suicidality why not suicide ?

Seems like a mild dislike of phrasing. Remember, reviewing articles is not about personal writing preference per WP: GACN

1. For one WP:GACN is an essay not a guideline.
2. My spellcheck marks it as not a real word.
3. You cite a single source for this term. If you want to make an argument that this is common term then you should have multiple sources
4. Let's look at real guidelines like MOS:JARGON
5. MOS:EUPH
6. Any level of intellectual honesty will recognize that the suicide is the more common term
7. The meaning of suicidality is unclear. Does that include suicidal ideation, attempted suicide?

^^Removed, but a few comments on this. I wasn't arguing that it is the most commonly used term, but it is a real term so I don't know why your spell check is saying it isn't. Here is in the APA Dictionary (https://dictionary.apa.org/suicidality). Yes I know WP:GACN is an essay, but it is important for the interpretation of GAC criteria. For example, it goes over the "Well-written" criteria saying "The five particular pages listed (out of about 50) of the Manual of Style are complied with [refering to guidelines for lead sections, layout, words to watch, fiction, and list incorporation]. (The "Fiction" and "List incorporation" guidelines do not apply to many articles.) Note that the main Manual of Style page is not in the list of required MoS pages. It may, however, be a useful page to look at if you have questions about spelling and grammar for point (a). For the purpose of a GA review, all other parts of the MoS are optional except captions and image relevance, which are discussed in part (6) of the GA criteria."

If you look at GA criteria, you will see which MOS pages must be abided by. If you are concerned with clarity, that's more understandable for GA criteria, so I changed it accirdingly. However, that wasn't the intent I got from your initial message.

• control group idk about calling this a control group

• high prevalence of gender how high?

specified 53 percent

• this aids in preventing secrecy about the child's intersex status seems like a strong claim for a single source. Geographic bias?

• Trained facilitators are able to help participants process health information Is the pope catholic? FN80 overall seems questionably summarized.

In online or local groups, it is possible for an untrained person to volunteer to facilitate. The training matters. Also, the sarcasm comes off as unintentionally rude. Please avoid it.

There's more important points but this is a "dogs have tails" statement. If they were not able to help participants process health information then they would not be called trained facilitators. I'll be continuing the sarcasm at my usual pace.

Understood. That sentence has been rephrased.

I maintain my request that communications proceed without sarcasm going forward as it can come off a needlessly mean due to the lack of auditory or visual cues present in real life interaction. Please see WP: EQ. As a fellow Wikipedian, you are a respected colleague and I believe it would be beneficial to communicate accordingly. 

Look, I don't care if you respect me. This is a hobby that I do for fun. I am not going to go out of my way to change the way I write when on talk pages. I think jokes and sarcasm are fun. Sorry you have a problem with that. I won't review your articles in the future.

• A lot of the information comes from one off studies. This is a bit concerning. Can you highlight for me here some of the sources that are not one off studies. I am thinking things like a medical textbook?

Here are some of the literature reviews, concensus statements, and protocols used in the article rather than one off studies:

1. Ageing in obscurity: a critical literature review regarding older intersex people
2. Endocrine Management of Ovotesticular DSD, an Index Case and Review of the Literature
3. A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance
4. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association
5. Disorders of sex development and female reproductive capacity: A literature review
6. Bone Health in Disorders of Sex Differentiation
7. Caring for individuals with a difference of sex development (DSD): a Consensus Statement
8. Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): A systematic review and meta-analysis
9. A Management Protocol for Gonad Preservation in Patients with Androgen Insensitivity Syndrome
10. Consensus statement on management of intersex disorders

I also used more broad medical information from professional or government organizations like NHS, Victoria Health Department, Endocrine Society, etc.

• The term was adopted for pediatric use until 2005. This is vague and feels out of place. What took its place in 2005? Why did that only change in pediatrics? What is the new term? Why is it important to switch to talking about 2005 now?

• Intersex conditions have been documented since antiquity, and began to be studied by doctors in the late 1800s. This feels like a strong claim for a single source. I followed the link but I don't see how to view the source, is it not actually available here?

There was some kind of handle (I think called an hdl handle), but yeah it wasn't super clear so I linked to a publicly accessible pdf. Should be more easily viewable now. I also expanded that section and added other sources to further describe intersex people being documented further back in history.

• lose their acquired male characters, and revert to their normal feminine ones...[and] return to normal sexuality psychologically Am I to understand that there were no surgeries to make intersex patients more male at this time? Side note: I hate this way of phrasing it so if there is a better way let me know.
• boundaries were created vague

Fixed. Specified that the "boundaries" (the seperation of trans and intersex people) were put forward in 1940 by Broster's colleague Clifford Allen.

• In the 1950s, John Money theorized that children were gender neutral until the age of two I question the due weight of this. Also I think more commentary would be served if this important. Was this a popular theory? For how long? Where was it popular? Theorized is also vague. I suppose this is more meant to be an RSOPINION or something? Then, it should be more clear? Can This further pushed surgeries for intersex people, young children in particular be quantified? Also was this really worldwide phenomenon?

Fleshed this out more. Mostly was popular around countries in the global north. There has been considerable commentary on Money's work with intersex people (it's even mentioned in the lead of his wikipedia page.) Added more sources to better demonstrate weight. In some ways it's arguably influential into modern day considering intersex corrective surgeries on infants are still a major concern for intersex activists.

• Side note, I like the one paragraph per decade approach. I assume this is not supposed to be an exhaustive section or else it would be the page on History of Intersex Healthcare
• During the 1990s So we have one paragraph on the 30s, one on the 40s, one on the 50s, 0 on the 60s,70s,80s ? That seems hard to justify
• Feminists used the term "intersex" while criticizing Johns Hopkins medical policy for using gender norms to make predictions about the gender of intersex infants and medically alter their bodies to fit those norms. Uh ok, but is that actually one of the most important things in intersex healthcare in the 1990s? Also is the point here that they used the term intersex? Or that Johns Hopkins medical policy for using gender norms to make predictions about the gender of intersex infants and medically alter their bodies to fit those norms. Seems like maybe this is trying to make a point about the history of the word intersex and the section is more about history of intersex healthcare. History of the word intersex may be an important discussion point for this article but it is probably better made on its own stage. Also MOS:QUOT violation.
• In a 2006 consensus statement, the adoption of the term DSD was purposed Similar gripe as above. So reading this there are no notable historical events in intersex healthcare since 2006?

I guess I was thinking how old something should be to count as history. Yes there have been new developments (like the previously mentioned uterus transplants for people with MRKH in 2015). Where would you recommend the cut off be?

• Gonadoblastomas are precancerous lesions that predominantly form in intersex people with gonadal dysgenesis and a Y chromosome. Verified, added a second source.
• This includes conditions such as Swyer syndrome or Turner syndrome with Y chromosome mosaicism. Verified. I wanted to point out the use of "indivduals" here which may be relevant to the people/persons/patients discussion?
• Most people born with campomelic dysplasia have micrognathism, a small lower jaw, and laryngomalacia, floppy cartilage in the larynx that obstructs one's airway. I would say this is verified but reading the sources confused me on why the material is presented this way. The symptoms presented here are not the first/main things mentioned in the sources. I assume this paragraph it trying to summarize campomelic dysplasia which is relevant due to the common intersex presentation of these patients? If so I would refocus this on the most important symptoms mentioned at the beginning of these sources. If there is a second goal here, it went over my head.
• Fertility counseling can be provided by a clinician to address fertility complications caused by the patient's intersex variation and what treatment options are available. This is not really the right kind of source for a claim like this. The source used to say: "This counseling can be provided by a clinician, though gaps in knowledge about intersex fertility are common." However, this is really just one study assessing doctors in a particular health system. I think the larger point you are trying to make here is an important one for this article and recommend finding better sources. The point about gaps in knowledge is also somewhat relevant; however, I question the significance of this single study for this article. For example, a doctor being examined on their knowledge of rare diseases and treatment options might have much lower performance than if the same doctor actually had a patient come in with that situation as many doctors are willing to restudy the state of the art when they have a special case. In terms of spot check I still consider this verified.