Some forms of DSD have their bases in genetics (in an individual’s genetic make-up). In some of those cases, the genetic basis for the DSD might run in the family. For example, congenital adrenal hyperplasia and 5-alpha reductase deficiency can run in families. In some cases of genetically-caused DSD, the DSD is caused by a “random mutation,” or a genetic chance. (By the way, we all have random mutations in our genetic codes, although some of those mutations never become apparent to us because they don’t result in any noticeable change.)
Some DSD may be caused by environmental factors. For example, if a woman is pregnant with a male fetus and accidentally ingests a drug that dampens down androgens (like some hair loss medications for men do), that can cause the fetus to develop in an atypical fashion.
Many people with DSD never find out what caused their particular sex atypicality. Human sex development is very complex.
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