Introduction: 5 alpha-reductase deficiency is a condition that affects male sexual development before birth and during puberty. Although testosterone is considered a predominant male sex hormone, not all tissues are responsive to testosterone. The 5 alpha-RD2 enzyme converts testosterone into a more potent form of the male sex hormone called dihydrotestosterone (DHT). Aims and Objective: To propound various factors and their relative importance in guiding the determination of sex of rearing in late presenters of 5 alpha-reductase deficiency in developing society. Methods: Seven patients of proven 5 alpha-reductase deficiency were prospectively involved in this study between 2011 and 2020. All patients had been raised as females and presented with the ambiguity of genitalia at a later age which is not so uncommon in a developing society due to various factors. Diagnosis of 5 alpha-reductase deficiency was confirmed after various standard tests. Based on male genotype, size of the phallus, response to dihydrotestosterone cream application, socioeconomic factors and wishes of parents and children, sex of further rearing was advised. Repeated elaborate sessions of counselling were an integral and vital part of these decisions. Results: In view of clinical and laboratory facts, results of medical and surgical interventions, social milieu of the society and personal choice of patients and their family, comprehensive counselling was done and six out of seven patients were advised, and accepted, change of sex of rearing to male and accordingly necessary interventions were done. One patient opted and continued to be reared as female. Quality of life, acceptability in society and most importantly, ability to make a living on its own, were followed, studied and analysed. Conclusion: Clinical facts, social realities, employment avenues, social stigma, infertility and many other factors suggest that, in a developing society, it is strongly advisable to consider the change of sex of rearing to male in all late presenters of 5 alpha-reductase deficiency.