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Among the sequential hermaphrodites are protogynous species in which an individual begins reproductive life as a female and later may switch to male, protandrous species in which a fish starts as a male and later may switch to female, and serial bi-directional sex changers.

Among the synchronous hermaphrodites (in which an individual can simultaneously produce eggs and sperm) are several outcrossing and one predominantly selfing species.

And in 2011, he established a major longitudinal study to track the psychological and medical well-being of hundreds of children with DSDs.

Vilain says that he doesn't seek out controversy, but his research seems to attract it.

“The thing I don't want to compromise is scientific integrity, even when it clashes with the community narrative.” The idea that there are only two sexes is so entrenched in society that the first question many people ask on finding out that a friend is pregnant is: boy or girl?

“People don't answer 'I'm having a baby',” says Vilain.

A few species also consist of mixtures of hermaphroditic and single-sex individuals.

All of these reproductive categories have been the subject of numerous theoretical and empirical treatments from an evolutionary perspective.

This is particularly important when the recommended agent is a new and/or infrequently employed drug.

Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s).

But what has brought Vilain the most grief of late has been his stance on sex-assignment surgery for infants with DSDs.

Although he generally opposes it, he won't categorically condemn it or the doctors who perform it.

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