Limitations of linear load-velocity modeling for bench press performance in youth elite athletes.

Establishing standardized, India-specific guidelines for the management of differences of sexual development (DSD) is an urgent necessity, given the unique sociocultural, legal, and healthcare realities of the country. Although international consensus frameworks provide a strong scientific and ethical foundation, their direct application in India is often limited by profound contextual differences.[] In the Indian setting, the birth of a child with atypical genitalia is frequently perceived as a social crisis rather than a medical condition, leading to intense parental anxiety, maternal distress, marital discord, and at times, abandonment, driven by deep-rooted cultural beliefs, rigid gender binaries, and societal stigma. This “gender panic” exerts significant pressure on families and clinicians to pursue early genital normalization, contrasting with evolving Western paradigms that increasingly support deferred surgical intervention. In addition, unlike Western countries where most DSD cases are identified in the neonatal period, many Indian patients present late – during childhood, adolescence, or even adulthood – due to lack of awareness, social concealment, rural healthcare limitations, and economic constraints, thereby complicating sex assignment, medical and surgical management, fertility considerations, and psychosocial adaptation.[] A pilot survey of Indian stakeholders demonstrated a strong preference for early sex assignment among parents, physicians, and grown-up DSD patients. Most parents favored parent-led decision-making for surgical interventions to ensure social integration and upbringing.[] Reported gender dysphoria was extremely low, with overall satisfaction toward early management strategies. The absence of a clear national legal framework further compounds these challenges, leaving families and physicians to navigate inconsistencies in birth registration, correction of sex in official documents, and informed consent for irreversible interventions. These issues are exacerbated by significant disparities in healthcare infrastructure, with limited availability of well-established multidisciplinary DSD teams and fragmented pediatric urological and endocrine services across the country. Consequently, India-specific guidelines are essential to provide a culturally sensitive, legally sound, and pragmatically feasible framework, including the standardization of a Local Multidisciplinary Committee (LMDC) model, to ensure ethical decision-making, uniformity of care, and improved long-term outcomes for individuals with DSD and their families. This prompted us to perform a Delphi consensus and produce guidelines on the management of DSD, further vetted by the Government of India.