Disorders of Sexual Differentiation (DSD) are misunderstood in Palestinian society, so its management is a huge challenge from a medical, surgical and psychological standpoint. Although this case is rare, in the last three years Hadassah has treated more than 20 boys and girls with a variety of complex conditions, most of which require surgical intervention. Puberty is a complex time of transition – physically and emotionally. This complexity is compounded if the changes don’t fit a normal gender pattern. They are compounded even further if the gender development is happening in a society that is not geared to accept or address them.