Adolescents with abnormal sexual differentiation or intersex conditions present a unique challenge to their healthcare providers. While sex refers to the biologic considerations that specify a person as male or female, gender refers to the sex of rearing. For the child with an intersex condition, sex may differ from gender, and as that child grows into adolescence, this may lead to many concerns, questions, and decisions. Although gender is usually fixed by adolescence, there will be those adolescents with intersex conditions wishing a gender reassignment during this period. Often a physician is the best resource for information and counsel to these young adults. Although most infants with ambiguous genitalia will have a karyotype done to determine gender identity, there are occasions when a gender discrepancy is not noticed until an adolescent presents with delayed pubarche. Regardless of the age at diagnosis, at adolescence, the physician must the address the medical consequences of infertility, bone health, and hormone replacement in addition to handling the heightened psychological concerns of gender identity during puberty. It is hoped that adolescents with intersex conditions will have the support and information necessary to allow them to live as normal a life as possible.