This chapter explores ethical issues in the treatment of children who have disorders of sex development (DSD). For the past half-century, much of the medical literature on the treatment of children with DSD has focused on gender, including patient gender identity, gender role, and sexual orientation. Historically, in the pediatric care of children diagnosed with DSD, modern medical approaches have focused on attempting to produce an individual who is gender-typical in terms of physical appearance, self identity, and behavior, including sexual orientation. The multidisciplinary team as envisioned in the DSD consensus statement includes specialists in pediatric endocrinology, pediatric surgery or urology, psychology and/or psychiatry, gynecology, genetics, social work, and medical ethics. Hormone treatments necessary for the induction of puberty typically occur at a time when the child's maturity level allows her or him to participate in decision making, as facilitated by a behavioral health professional.