Spatial ability and prenatal androgens: meta-analyses of congenital adrenal hyperplasia and digit ratio (2D:4D) studies

Memory in female adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

INTRODUCTION

In females with congenital adrenal hyperplasia (CAH), the influence of hyperandrogenism and glucocorticoid supplementation on neurocognition is controversial.

OBJECTIVES

To identify possible differences in visual working memory and verbal memory in adolescent girls with CAH due to 21-hydroxylase deficiency and matched controls. Moreover, to study if any relationship between variables associated with CAH and the scores of the selected memory tests was present.

MATERIAL AND METHODS

In total 39 individuals were studied, female adolescents with CAH and age and pubertal stage matched healthy male and female controls (13 in each group). Sociodemographic, clinical, hormonal, and neurocognitive variables were explored. In female adolescents with CAH, variables related to the disease (age at diagnosis, clinical form, time since diagnosis, and glucocorticoid doses) were correlated with the scores obtained for neurocognitive variables.

RESULTS

The mean age was 13.9 ± 3.3 years. In female adolescents with CAH the results were worse compared to controls in Free Recall (p = 0.039) and in Visual Memory Span score (p = 0.016). Age at diagnosis was negatively correlated to number of hits (p = 0.04), number recalled backward (p = 0.03), Visual Memory Span test score (p = 0.04) and Total Free Recall (p = 0.04), i.e., memory was worse with later diagnosis.

CONCLUSIONS

Female adolescents with CAH had worse visual working memory compared to matched controls, but not in verbal memory. Age at diagnosis was negatively associated with the memory tests.

Giftedness and atypical sexual differentiation: enhanced perceptual functioning through estrogen deficiency instead of androgen excess

Syndromic autism spectrum conditions (ASC), such as Klinefelter syndrome, also manifest hypogonadism. Compared to the popular Extreme Male Brain theory, the Enhanced Perceptual Functioning model explains the connection between ASC, savant traits, and giftedness more seamlessly, and their co-emergence with atypical sexual differentiation. Overexcitability of primary sensory inputs generates a relative enhancement of local to global processing of stimuli, hindering the abstraction of communication signals, in contrast to the extraordinary local information processing skills in some individuals. Weaker inhibitory function through gamma-aminobutyric acid type A (GABAA) receptors and the atypicality of synapse formation lead to this difference, and the formation of unique neural circuits that process external information. Additionally, deficiency in monitoring inner sensory information leads to alexithymia (inability to distinguish one's own emotions), which can be caused by hypoactivity of estrogen and oxytocin in the interoceptive neural circuits, comprising the anterior insular and cingulate gyri. These areas are also part of the Salience Network, which switches between the Central Executive Network for external tasks and the Default Mode Network for self-referential mind wandering. Exploring the possibility that estrogen deficiency since early development interrupts GABA shift, causing sensory processing atypicality, it helps to evaluate the co-occurrence of ASC with attention deficit hyperactivity disorder, dyslexia, and schizophrenia based on phenotypic and physiological bases. It also provides clues for understanding the common underpinnings of these neurodevelopmental disorders and gifted populations.

Altered Emotion Perception Linked to Structural Brain Differences in Youth With Congenital Adrenal Hyperplasia

CONTEXT

Congenital adrenal hyperplasia (CAH) is a genetic disorder that results in hormonal imbalances and decreased brain volumes in regions important for emotional processing.

OBJECTIVE

To examine whether emotion perception differs between youth with CAH and control youth, and if these differences relate to brain volumes.

METHODS

In this cross-sectional study of 27 youths with CAH (mean age = 12.63 years, 16 female) and 35 age- and sex-matched controls (mean age = 13.03 years, 20 female), each participant rated picture stimuli and completed a 3T structural brain scan. Valence and arousal ratings and reaction times of 61 affective images were assessed. Gray matter volumes were measured by MRI.

RESULTS

Youth with CAH had lower valence ratings for negative (P = .007) and neutral (P = .019) images. Controls showed differences in reaction times and arousal ratings across stimuli conditions, but youth with CAH did not. Brain volumes of the right amygdala (P = .025) and left hippocampus (P = .002) were associated with valence ratings. Left rostral middle frontal (P < .001) and right medial orbitofrontal cortex (P = .002) volumes were negatively related to valence scores only in youth with CAH, whereas left medial orbitofrontal cortex (P < .001) volumes were associated with valence scores positively in youth with CAH and negatively in controls.

CONCLUSION

Findings suggest that youth with CAH perceive emotive stimuli as more unpleasant. Decreased brain volumes in the amygdala, hippocampus, and prefrontal cortex are associated with these measures of altered emotion perception in youth with CAH.

Sex/gender differences in cognitive abilities

Sex/gender differences in cognitive sciences are riddled by conflicting perspectives. At the center of debates are clinical, social, and political perspectives. Front and center, evolutionary and biological perspectives have often focused on 'nature' arguments, while feminist and constructivist views have often focused on 'nurture arguments regarding cognitive sex differences. In the current narrative review, we provide a comprehensive overview regarding the origins and historical advancement of these debates while providing a summary of the results in the field of sexually polymorphic cognition. In so doing, we attempt to highlight the importance of using transdisciplinary perspectives which help bridge disciplines together to provide a refined understanding the specific factors that drive sex differences a gender diversity in cognitive abilities. To summarize, biological sex (e.g., birth-assigned sex, sex hormones), socio-cultural gender (gender identity, gender roles), and sexual orientation each uniquely shape the cognitive abilities reviewed. To date, however, few studies integrate these sex and gender factors together to better understand individual differences in cognitive functioning. This has potential benefits if a broader understanding of sex and gender factors are systematically measured when researching and treating numerous conditions where cognition is altered.

Verbal Abilities: Sex Differences in Children at Different Ages

Background

The assertion of sex differences in verbal abilities is a highly controversial subject. Some studies have demonstrated a female advantage; other studies have found higher rates in males. The results depended on the type of verbal ability that was studied, the cultural context, and the ages of the subjects. There are two types of theories that have been developed to explain the existence of sex differences in cognitive abilities. Social theories explain the differences as caused by social determinants. Biological theories consider biological factors such as prenatal development conditions and hormone levels, among others, as the cause of sex differences.

Objective

To investigate sex differences in verbal abilities in children of different ages.

Design

Two different editions of Wechsler tests were used. For children age 2.5 to 5 years, the Wechsler Preschool Primary Scale of Intelligence (WPPSI-IV) was used. For children age 6 and older, we administered the Wechsler Intelligence Scale for Children (WISC-V). The total sample included 313 children.

Results

The study found significant sex differences in performance on the Verbal Comprehension Scale in children of different ages. At the age of 2 to 4 years, the girls performed better than the boys. In the group of boys, there was a significant increase in verbal abilities at the age of 8-9 years. By the age of 10-11 years, boys began outperforming girls on the Verbal Comprehension Index. Scores on the Verbal Comprehension and Visual Spatial subtests for the boy sample showed stronger correlations than in the girl sample in all age groups.

Conclusion

Sex differences in verbal abilities varied depending on the age of the children. The boys showed a stronger integration of their verbal abilities into the structure of their intelligence than the girls.

Characteristics of Congenital Adrenal Hyperplasia Diagnosed in Adulthood: A Literature Review and Case Series

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders characterized by impaired cortisol synthesis. CAH, depending on its clinical form, is usually diagnosed in the neonatal period, later in childhood, in adolescence, or in young adults. Herein, we report a case series of eight individuals in whom CAH was diagnosed between the ages of 18 and 81 years.

METHODS

We report on clinical presentations, hormonal tests, adrenal/gonadal imaging, and genetic findings. The clinical data of eight people with CAH, including four women (46, XX) and four men (46, XY), were reviewed. A genetic analysis of the cytochrome P450 family 21 subfamily A member 2 (CYP21A2) gene was performed in six patients. A comprehensive literature review was also conducted.

CASE SERIES

Partial cortisol deficiency was found in all patients. The most frequent genotype was the homozygotic I173N mutation in CYP21A2. Adrenal masses were detected in seven patients, except for the youngest. Most of the patients were of short stature. Hypogonadotropic hypogonadism was detected in two males, and three females presented with primary amenorrhea. Hirsutism was noticeable in three females. All of the patients developed insulin resistance, and half of them were obese.

CONCLUSIONS

The clinical presentations of different forms of CAH overlapped. Genotype-phenotype correlations were strong but not absolute. The management of CAH should be individualized and based on clinical and laboratory findings. Furthermore, the assessment of the cortisol response to adrenocorticotrophic hormone stimulation should be mandatory in all adults with CAH. Additionally, the regular long-term screening of cardiometabolic status is required in the CAH population.

To What Extent are Prenatal Androgens Involved in the Development of Male Homosexuality in Humans?

Endocrine variations, including possibly reduced exposure to androgens, may contribute to the development of male homosexuality, with animal models demonstrating same-sex mate preference with altered exposure during prenatal or early postnatal development. As similar studies in humans are impossible, indirect physical and cognitive measures of androgen exposure are used. Some studies suggest that physical measures affected by prenatal androgens, including the index-to-ring finger ratio, growth indices, and facial structure, are more "feminine" in gay men. Gay men also exhibit significant childhood gender non-conformity and a "feminized" anatomical and functional brain pattern in sexual arousal, as well as domains such as language, visuospatial skills and hemispheric relationships. However, many of these results are equivocal and may be confounded by other factors. Research has also been hampered by inconsistencies in the reporting of sexual orientation and the potentially unrepresentative populations of gay men studied, while additional complexities pertaining to gender conformity and sexual role may also influence results.

Congenital Adrenal Hyperplasia and Brain Health: A Systematic Review of Structural, Functional, and Diffusion Magnetic Resonance Imaging (MRI) Investigations

BACKGROUND

Congenital adrenal hyperplasia (CAH) is a group of genetic disorders that affects the adrenal glands and is the most common cause of primary adrenal insufficiency in children. In the past few decades, magnetic resonance imaging (MRI) has been implemented to investigate how the brain may be affected by CAH. A systematic review was conducted to evaluate and synthesize the reported evidence of brain findings related to CAH using structural, functional, and diffusion-weighted MRI.

METHODS

We searched bibliographical databases through July 2021 for brain MRI studies in individuals with CAH.

RESULTS

Twenty-eight studies were identified, including 13 case reports or series, 10 studies that recruited and studied CAH patients vs unaffected controls, and 5 studies without a matched control group. Eleven studies used structural MRI to identify structural abnormalities or quantify brain volumes, whereas 3 studies implemented functional MRI to investigate brain activity, and 3 reported diffusion MRI findings to assess white matter microstructure. Some commonly reported findings across studies included cortical atrophy and differences in gray matter volumes, as well as white matter hyperintensities, altered white matter microstructure, and distinct patterns of emotion and reward-related brain activity.

CONCLUSIONS

These findings suggest differences in brain structure and function in patients with CAH. Limitations of these studies highlight the need for CAH neuroimaging studies to incorporate larger sample sizes and follow best study design and MRI analytic practices, as well as clarify potential neurologic effects seen across the lifespan and in relation to clinical and behavioral CAH phenotypes.

Childhood Experience Reduces Gender Differences in Spatial Abilities: A Cross-Cultural Study

Spatial experience in childhood is a factor in the development of spatial abilities. In this study, we assessed whether American and Faroese participants' (N = 246, M_age = 19.31 years, 151 females) early spatial experience and adult spatial outcomes differed by gender and culture, and if early experience was related to adult performance and behavior. Participants completed retrospective reports on their childhood spatial experience, both large-scale (permitted childhood range size) and small-scale (Lego play). They also completed assessments of their current large-scale spatial behavior (navigational strategy) and small-scale ability (mental rotation task, MRT). We replicated earlier results showing better MRT performance among males and more reliance by males on orientation navigational strategies, although males and females reported similar ranges as children. However, there were cross-cultural differences, with Faroese having larger childhood ranges, less reliance on route strategies, better MRT scores, and a smaller gender difference in MRT. Larger permitted childhood ranges were associated with reduced use of route strategies for navigation in adulthood, and greater Lego play in childhood predicted better MRT performance as adults. There was also some evidence supporting relationships across spatial scales, with more Lego play predicting an orientation style of navigation and larger childhood ranges predicting better performance on the MRT, although the latter was not independent of country. In sum, we observed an association in both cultures between large-scale childhood experience and large-scale behavior in adulthood, small-scale experience in childhood and adult small-scale performance, and some associations between experience and behavior across spatial scales.

One brick at a time: Building a developmental profile of spatial abilities

Spatial abilities are not only fundamental for activities of daily living, but they are also markers of academic and professional success. It has remained a challenge, however, to understand their development across childhood and adolescence, partly because of the lack of spatial tasks that are appropriate across age groups. For example, the well-established paper-based mental rotation test (MRT) has been shown to be too difficult for children. In the current study, we tested girls and boys in three age groups: younger children (5-8-years-old), older children (9-12), and adolescents (13-17) on a hands-on visuospatial task using toy bricks: the brick-building task (BBT). Children completed a low- and a high-mental rotation demand (LMR and HMR) version of the BBT and the paper-based MRT. Correlations were found between all tasks. Children, especially females, found the HMR more challenging than the LMR condition, but all children successfully completed the BBT. In contrast, the MRT was too difficult for the younger children to solve performing at chance. Given this result and that the BBT is a game-like, 3D, interactive task, the BBT could be used to examine the biological and/or environmental factors that affect the early development of visuospatial abilities.

Second to fourth (2D:4D) digit ratio and their relationships among a mother and child population in Ghana

The study aimed to determine the relationship between digit ratios among a mother–child population in Ghana. This was a cross-sectional study from December 2020 to April 2021 involving 272 mothers, their daughters (n = 132) and their sons (n = 140). The right (2D:4DR) and the left (2D:4DL) digit ratios were measured using computer-assisted analysis. The data were analysed in SPSS (v23) and GraphPad Prism (v8) at an alpha value of 0.05. The mean ± SD age of the mothers was 23.9 ± 3.67 years while the median (IQR) age of daughters was 116(54–240) days and sons, 134(54–240) days. The mean ± SD 2D:4DR were 0.94 ± 0.04, 0.91 ± 0.04 and 0.90 ± 0.04 respectively for mothers, daughters and sons. The mean ± SD 2D:4DL was 0.93 ± 0.04, for mothers, 0.92 ± 0.05 for daughters and 0.92 ± 0.05 for sons. The daughters and sons showed leftward asymmetry while the mothers showed rightward asymmetry in digit ratios. The 2D:4DR of sons was significantly lower than daughters (P = 0.031). There were negative correlations between the 2D:4DL and age of daughters (r = −0.182, P = 0.043) and sons (r = −0.221, P = 0.012). The 2D:4DR of mothers was positively correlated with that of daughters (r = 0.332, P = 0.000) and that of sons (r = 0.233, P = 0.008). There are significant relationships between digit ratios in a mother–child population.

Evidence and Implications from a Natural Experiment of Prenatal Androgen Effects on Gendered Behavior

Sex and gender are key to people's lives, and are the focus of scientific and popular interest and controversy. Sex-related psychological characteristics reflect more than socialization; they are influenced by sex hormones present during sensitive periods of development, particularly prenatal androgens. Studies of females with congenital adrenal hyperplasia (CAH) show how prenatal androgens affect behavior across the life span, with large effects on gendered activity interests and engagement, moderate effects on spatial abilities, and relatively small (or no) effects on gender identity, gender cognitions, and gendered peer involvement. In addition to showing the complexity of androgen effects on gendered behavior, studies of females with CAH provide an opportunity to test theories of gender development, understand how nature and nurture work together, and examine mechanisms of development. The implications of this work have often been misunderstood, so we consider what it means - and does not mean - for biology to influence gender-related behavior.

Psychoneuroendocrine protocol to comprehensively study sexually dimorphic cognition

Background

A large body of research provides evidence for sex differences in cognitive abilities. These sex differences stem from the interplay between biological sex (e.g., birth-assigned sex, sex hormones) and psychosocial gender (e.g., gender identity, gender-roles, sexual orientation). Literature remains rather mixed with regards to the magnitude of sex and gender effects on cognitive abilities and mental health. Growing evidence shows that sex hormone assessment combined with measures of psychosocial gender may be fundamental to comprehensively understand individual differences in sexually dimorphic cognitive abilities.

Objectives

This study protocol describes a sexually dimorphic cognitive battery to assess the influence of sex hormones on performance. In parallel, we aim to assess the inter-related effects that biological sex and psychosocial gender-based factors exert on cognition and mental health.

Methods

Our projected sample includes 180 adult participants who are at least 18 years old. Sub-groups will be recruited based on birth-assigned sex, gender identity, and sexual orientation. Biological measures will be collected via salivary samples throughout testing to include sex hormones (testosterone, estradiol and progesterone) and stress hormones (cortisol). Demographic and psychosocial variables will be measured through self-report questionnaires. Participants will be required to complete eight classic cognitive tasks that assess a variety of cognitive domains in a 2-h testing session.

Results and future directions

Results from this study provides unique insights into the correlates of cognitive sex differences and gender diversity. This will give us solid ground to further investigate these influences in clinical populations in which sex hormones and cognitive functioning are often altered.

•

Cognition is modulated by multiple sex and gender factors.

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Cognitive abilities will be assessed among 180 adults representing diverse sexual orientations and gender identities.

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This protocol aims to nuance the effects of sex hormones in contrast to those of socio-cultural gender.

Mental Health, Mitochondria, and the Battle of the Sexes

This paper presents a broad perspective on how mental disease relates to the different evolutionary strategies of men and women and to growth, metabolism, and mitochondria—the enslaved bacteria in our cells that enable it all. Several mental disorders strike one sex more than the other; yet what truly matters, regardless of one’s sex, is how much one’s brain is “female” and how much it is “male”. This appears to be the result of an arms race between the parents over how many resources their child ought to extract from the mother, hence whether it should grow a lot or stay small and undemanding. An uneven battle alters the child’s risk of developing not only insulin resistance, diabetes, or cancer, but a mental disease as well. Maternal supremacy increases the odds of a psychosis-spectrum disorder; paternal supremacy, those of an autism-spectrum one. And a particularly lopsided struggle may invite one or the other of a series of syndromes that come in pairs, with diametrically opposite, excessively “male” or “female” characteristics. By providing the means for this tug of war, mitochondria take center stage in steadying or upsetting the precarious balance on which our mental health is built.

Men, women and STEM: Why the differences and what should be done?

It is a well-known and widely lamented fact that men outnumber women in a number of fields in STEM (science, technology, engineering and maths). The most commonly discussed explanations for the gender gaps are discrimination and socialization, and the most common policy prescriptions target those ostensible causes. However, a great deal of evidence in the behavioural sciences suggests that discrimination and socialization are only part of the story. The purpose of this paper is to highlight other aspects of the story: aspects that are commonly overlooked or downplayed. More precisely, the paper has two main aims. The first is to examine the evidence that factors other than workplace discrimination contribute to the gender gaps in STEM. These include relatively large average sex differences in career and lifestyle preferences, and relatively small average differences in cognitive aptitudes – some favouring males, others favouring females – which are associated with progressively larger differences the further above the average one looks. The second aim is to examine the evidence suggesting that these sex differences are not purely a product of social factors but also have a substantial biological (i.e. inherited) component. A more complete picture of the causes of the unequal sex ratios in STEM may productively inform policy discussions.

Relationships between ovarian hormone concentrations and mental rotations performance in naturally-cycling women

Circulating gonadal hormones have been linked to variation in the structure and function of the adult human brain, raising the question of how cognition is affected by sex hormones in adulthood. The impacts of progestogens and estrogens are of special interest due to the widespread use of hormone supplementation. Multiple studies have analyzed relationships between ovarian hormones and mental rotation performance, one of the largest known cognitive sex differences; however, results are conflicting. These discrepancies are likely due in part to modest sample sizes and reliance on self-report measures to assess menstrual cycle phase. The present study aimed to clarify the impact of progestogens and estrogens on visuospatial cognition by relating mental rotation task performance to salivary hormone concentrations. Across two studies totaling 528 naturally-cycling premenopausal women, an internal meta-analysis suggested a small, positive effect of within-subjects changes in progesterone on MRT performance (estimate = 0.44, p = 0.014), though this result should be interpreted with caution given multiple statistical analyses. Between-subjects differences and within-subject changes in estradiol did not significantly predict MRT. These results shed light on the potential cognitive effects of endogenous and exogenous hormone action, and the proximate mechanisms modulating spatial cognition.

No credible evidence for links between 2D:4D and COVID-19 outcomes: A probabilistic perspective on digit ratio, ACE variants, and national case fatalities

Research into COVID-19 susceptibility and outcomes are critical, but claims must be carefully evaluated to inform policy decisions. In a recent series of articles, Manning and Fink [1-3] use national-level data to describe associations between case-fatality ratios and male and female finger ratios (2D:4D), a suggested measure of prenatal androgen exposure, as well as angiotensin-converting enzyme (ACE) allele and genotype frequencies. The authors suggest that 2D:4D is linked with ACE variant prevalence, and that higher male 2D:4D is associated with higher case fatality ratios, and point to 2D:4D as a useful prognostic measure for COVID-19 susceptibility. A critical review and robust Bayesian analysis of the hypothesis is described here, finding no conclusive evidence of COVID-19 mortality and 2D:4D, nor associations between 2D:4D and ACE1 allele or ACE2 genotype frequency. This absence of evidence is present for data taken from the second wave of COVID-19 in October 2020. Problematic theoretical grounding, individual-level conclusions drawn from national-level data, and issues with statistical inference in the original articles are discussed. Taken together, the current data offer no clear utility of 2D:4D in determining COVID-19 outcomes.

Effects of hand preference on digit lengths and digit ratios among children and adults

BACKGROUND

Prenatal sex hormones may not exclusively determine effects of hand preference on digit ratios. Genetic determination is an alternative possibility.

AIM

To study the likelihood of similar effects of hand preference on digit lengths and digit ratios.

METHODS

We selected similar numbers of left-handers and right-handers in samples of kindergarten children (N = 101, age range: 3.5-7 years) and adults (N = 189, age range: 17-28 years) and measured digit lengths (excluding the thumb) directly on the palmar hand.

RESULTS

Compared to right-handers, left-handers had longer digits and lower third-to-fourth (3D:4D) digit ratios among children, whereas an opposite pattern of handedness differences occurred among adults.

CONCLUSIONS

Effects of hand preference on digit lengths and ratios might be genetically/ontogenetically determined. Also discussed are implications of this set of findings for digit ratio research.

Digit ratio (2D:4D) and congenital adrenal hyperplasia (CAH): Systematic literature review and meta-analysis

The ratio of length between the second and fourth fingers (2D:4D) is commonly used as an indicator of prenatal sex hormone exposure. Several approaches have been used to try to validate the measure, including examining 2D:4D in people with congenital adrenal hyperplasia (CAH), a suite of conditions characterised by elevated adrenal androgen production secondary to defective steroidogenesis. We present a systematic review and meta-analysis that examines the relationship between these two variables. Twelve articles relating to nine CAH cohorts were identified, and 2D:4D comparisons have been made between cases and controls in eight of these cohorts. Altogether, at least one 2D:4D variable has been compared between n = 251 females with CAH and n = 358 unaffected females, and between n = 108 males with CAH and n = 204 unaffected males. A previous meta-analysis (Hönekopp and Watson, 2010) reported lower right hand (R2D:4D) and left hand (L2D:4D) digit ratios in patients with CAH relative to sex-matched controls. Our meta-analysis showed the same pattern, with medium effect sizes for R2D:4D and small effect sizes for L2D:4D. Differences of small magnitude were also observed for M2D:4D, and no significant effects were observed for D_[R-L]. Notably, the only effects that remained statistically significant when stratified by sex were R2D:4D in males and L2D:4D in females, and the average effect size had reduced by 46.70% since the meta-analysis of Hönekopp and Watson (2010). We also found that individual comparisons in this literature were considerably underpowered, and that patterns of sexual dimorphism in 2D:4D were similar in CAH samples as in typically developing populations. Findings are discussed in relation to the prenatal androgen hypothesis as well as alternative explanations.

An evaluation of visuospatial skills using hands-on tasks

Several tests of mental rotation ability have been used to investigate its development and the origins of sex differences. One of the most used tests is the mental rotation test (MRT) by Vandenberg and Kuse. A limitation of the MRT is that it is a pen-and-paper test with 2D images of 3D objects. This is a challenge to the ecological validity of the MRT because mental rotation typically involves physical 3D objects that are also physically manipulated. The purpose of the present study was to compare mental rotation ability as evaluated by the MRT to three new tasks with physical objects (toy bricks) that were physically manipulated. The different tasks allowed us to vary the processing demands on mental rotation while standardizing other aspects of the tasks. Fifty-nine females and twenty-eight males completed the LMR and HMR conditions (low- and high-mental rotation demands, respectively) of the brick building task (BBT), a visual search task, and the MRT. As demands on mental rotation for the BBT increased, performance decreased and a sex difference, with males outperforming females, increased. There were correlations between all tasks, but they were larger between the versions of the BBT with the MRT. The results suggest that spatial skill is an assembly of interrelated subskills and that the sex difference is sensitive to the demands on mental rotation and dimensionality crossing. The benefits of the BBT are that it is ecologically valid, avoids dimensionality crossing, and the demands on mental rotation can be manipulated.

Gender-affirming hormone treatment and cognitive function in transgender young adults: a systematic review and meta-analysis

BACKGROUND

Previous studies have examined whether steroid hormone treatment in transgender individuals may affect cognitive function; yet, their limited power does not allow firm conclusions to be drawn. We leveraged data from to-date literature aiming to explore the effect of gender-affirming hormone administration on cognitive function in transgender individuals.

METHODS

A search strategy of MEDLINE was developed (through June 1, 2019) using the key terms transgender, hormone therapy and cognitive function. Eligible were (i) cohort studies examining the longitudinal effect of hormone therapy on cognition, and (ii) cross-sectional studies comparing the cognitive function between treated and non-treated individuals. Standardized mean differences (Hedges' g) were pooled using random-effects models. Study quality was evaluated using the Newcastle-Ottawa Scale.

OUTCOMES

Ten studies (seven cohort and three cross-sectional) were eligible representing 234 birth-assigned males (aM) and 150 birth-assigned females (aF). The synthesis of cohort studies (n = 5) for visuospatial ability following hormone treatment showed a statistically significant enhancement among aF (g = 0.55, 95% confidence intervals [CI]: 0.29, 0.82) and an improvement with a trend towards statistical significance among aM (g = 0.28, 95%CI: -0.01, 0.58). By contrast, no adverse effects of hormone administration were shown. No heterogeneity was evident in most meta-analyses.

INTERPRETATION

Current evidence does not support an adverse impact of hormone therapy on cognitive function, whereas a statistically significant enhancing effect on visuospatial ability was shown in aF. New longitudinal studies with longer follow-up should explore the long-term effects of hormone therapy, especially the effects on younger individuals, where there is greater scarcity of data.

No relationship between the digit ratios (2D:4D) and salivary testosterone change: Study on men under an acute exercise

The digit ratio (2D:4D) is said to be a potential marker of exposure to prenatal sex steroids. Some studies suggest that the 2D:4D is also linked with the testosterone response to challenging situations due to organizational effect of prenatal hormonal milieu on adult endocrine functioning. However, up to date, there were only four studies (conducted on small samples) that examined the 2D:4D and the testosterone response to a challenging situation (i.e. physical exertion or aggressive context). Here, we examined the relationship between the 2D:4D and the testosterone change under an acute exercise among 97 men. We found that the digit ratios (the right 2D:4D, the left 2D:4D, and the right minus left 2D:4D) were neither predictors of pre-exercise testosterone, nor the change in testosterone level after a cycling task. Our results add a contradictory to previous studies evidence in a discussion on the links of the 2D:4D and the testosterone change.

Timing of peripubertal steroid exposure predicts visuospatial cognition in men: Evidence from three samples

Experiments in male rodents demonstrate that sensitivity to the organizational effects of steroid hormones decreases across the pubertal window, with earlier androgen exposure leading to greater masculinization of the brain and behavior. Similarly, some research suggests the timing of peripubertal exposure to sex steroids influences aspects of human psychology, including visuospatial cognition. However, prior studies have been limited by small samples and/or imprecise measures of pubertal timing. We conducted 4 studies to clarify whether the timing of peripubertal hormone exposure predicts performance on male-typed tests of spatial cognition in adulthood. In Studies 1 (n = 1095) and 2 (n = 173), we investigated associations between recalled pubertal age and spatial cognition in typically developing men, controlling for current testosterone levels in Study 2. In Study 3 (n = 51), we examined the relationship between spatial performance and the age at which peripubertal hormone replacement therapy was initiated in a sample of men with Isolated GnRH Deficiency. Across Studies 1-3, effect size estimates for the relationship between spatial performance and pubertal timing ranged from. -0.04 and -0.27, and spatial performance was unrelated to salivary testosterone in Study 2. In Study 4, we conducted two meta-analyses of Studies 1-3 and four previously published studies. The first meta-analysis was conducted on correlations between spatial performance and measures of the absolute age of pubertal timing, and the second replaced those correlations with correlations between spatial performance and measures of relative pubertal timing where available. Point estimates for correlations between pubertal timing and spatial cognition were -0.15 and -0.12 (both p < 0.001) in the first and second meta-analyses, respectively. These associations were robust to the exclusion of any individual study. Our results suggest that, for some aspects of neural development, sensitivity to gonadal hormones declines across puberty, with earlier pubertal hormone exposure predicting greater sex-typicality in psychological phenotypes in adulthood. These results shed light on the processes of behavioral and brain organization and have implications for the treatment of IGD and other conditions wherein pubertal timing is pharmacologically manipulated.

No evidence that hormonal contraceptive use or circulating sex steroids predict complex emotion recognition

Relatively little is known about the effects of endogenous and exogenous steroid hormones on ecologically relevant behavioral and cognitive phenotypes in women, such as emotion recognition, despite the widespread use of steroid hormone-altering hormonal contraceptives (HCs). Though some previous studies have examined the effect of HC use, estradiol, progesterone, and testosterone on emotion recognition in women, they have been limited by cross-sectional designs, small sample sizes (total n < 100), and compromised statistical power to detect significant effects. Using data from two test sessions in a large sample of naturally cycling women (NC; n = 192) and women on HCs (n = 203), we found no group differences in emotion recognition; further, the lack of group differences in emotion recognition was not modulated by item difficulty or emotional valence. Among NC women who provided saliva samples across two sessions that were assayed for estradiol and progesterone concentrations, we found no compelling evidence across models that between-subject differences and within-subject fluctuations in these ovarian hormones predicted emotion recognition accuracy, with the exception that between-subjects estradiol negatively predicted emotion recognition for emotions of neutral valence (p = .042). Among HC women who provided saliva samples across two sessions that were assayed for testosterone, we found no compelling evidence that between-subjects differences and within-subject fluctuations in testosterone predicted emotion recognition accuracy. Overall, our analyses provide little support for the idea that circulating endogenous or exogenous ovarian hormones influence emotion recognition in women.

Sexual Orientation and Cognitive Ability: A Multivariate Meta-Analytic Follow-Up

A cross-sex shift model of human sexual orientation differences predicts that homosexual men should perform or score in the direction of heterosexual women, and homosexual women in the direction of heterosexual men, in behavioral domains such as cognition and personality. In order to test whether homosexual men and women's cognitive performance was closer to that of heterosexual men or that of heterosexual women (i.e., sex-atypical for their sex and closer to that of the opposite-sex), we conducted a multivariate meta-analysis based on data from our previous meta-analysis (Xu, Norton, & Rahman, 2017). A subset of this data was used and comprised 30 articles (and 2 unpublished datasets) and 244,434 participants. The multivariate meta-analysis revealed that homosexual men were sex-atypical in mental rotation (Hedges' g = -0.36) and the water level test (Hedges' g = -0.55). In mental rotation, homosexual men were in-between heterosexual men and women. There was no significant group difference on spatial location memory. Homosexual men were also sex-atypical on male-favoring spatial-related tasks (Hedges' g = -0.54), and female-favoring spatial-related tasks (Hedges' g = 0.38). Homosexual women tended to be sex-typical (similar to heterosexual women). There were no significant group differences on male-favoring "other" tasks or female-favoring verbal-related tasks. Heterosexual men and women differed significantly on female-favoring "other" tasks. These results support the cross-sex shift hypothesis which predicts that homosexual men perform in the direction of heterosexual women in sex differentiated cognitive domains. However, the type of task and cognitive domain tested is critical.

No Evidence for Enhancement of Spatial Ability with Elevated Prenatal Androgen Exposure in Congenital Adrenal Hyperplasia: A Meta-Analysis

Spatial abilities contribute to life and occupational competencies, and certain spatial skills differ, on average, between males and females, typically favoring males when differences occur. Factors contributing to spatial skills could include prenatal as well as experiential/cultural influences, with biological and social influences likely interacting and difficult to disentangle. This meta-analysis examined the potential influence of prenatal androgen exposure on spatial skill by examining studies of patients with congenital adrenal hyperplasia (CAH). CAH involves elevated adrenal androgens prenatally, with overall androgen concentrations higher for females with CAH versus same-sex controls but with little overall difference between males with CAH versus controls. We hypothesized that, if androgens contribute prenatally to neurobehavioral development in humans as in many other species, females with CAH would show spatial enhancement versus control females, but with no definitive hypothesis for males. Meta-analysis of 12 studies examining overall spatial skill and three spatial subcategories failed to support enhanced spatial performance for females with CAH; males with CAH showed lower spatial ability compared to control males, at least for the category of overall spatial skill. Although statistical logic precludes accepting the null hypothesis for females, the meta-analysis failed to support the idea that prenatal exposure to androgens explains spatial gender/sex differences in humans. Alternative explanations for average gender/sex differences in some spatial tasks could include androgen exposure at other times, such as mini-puberty, or different social factors experienced by males and females. We also discuss possible explanations for the different outcomes seen in females versus males with CAH.

Sex differences in cognition and aging and the influence of sex hormones

Sex differences in cognitive functioning have been consistently reported in some cognitive tasks, with varying effect sizes. The most consistent findings in healthy adults are sex differences in the areas of mental rotation and aspects of attention and verbal memory. Sex differences in the vulnerability and manifestation of several psychiatric and neurologic diseases that involve cognitive disruption provide strong justification to continue investigating the social and biologic influences that underpin sex differences in cognitive functioning across health and disease. The biologic influences are thought to include genetic and epigenetic factors, sex chromosomes, and sex hormones. Sex steroid hormones that regulate reproductive function have multiple effects on the development, maintenance, and function of the brain, including significant effects on cognitive functioning. The aim of the current chapter is to provide a theoretical review of sex differences across different cognitive domains in adulthood and aging, as well as provide an overview on the role of sex hormones in cognitive function and cognitive decline.

Sex Hormones as Cognitive Enhancers?

Understanding the differences in the way women and men think has made headway thanks to experiments showing how sex hormones influence cognitive capacities. Masculine and feminine sex hormones (androgens and estrogens, respectively) affect cognition in different ways and may account for some of the gender differences in cognitive abilities, allowing men and women to perform better in certain cognitive tests. In this opinion article, we discuss studies addressing differences in cognitive functions between males and females and the underlying neural substrates, as well as the effects of sex hormone supplementation. Even though some studies on patients receiving exogenous sex hormones showed gender differences that emerge at group levels on a few cognitive tasks, it is not yet clear whether these differences can be partially attributed to hormonal causes. Supplementation of female estrogen can enhance verbal skills, whereas masculine androgen can increase performance in mathematical and visuospatial tasks. Studies of the administration of exogenous sex hormones have allowed further insight into the use of sex hormones as possible cognitive enhancers.

The digit ratio (2D:4D) and economic preferences: no robust associations in a sample of 330 women

Many studies report on the association between 2D:4D, a putative marker for prenatal testosterone exposure, and economic preferences. However, most of these studies have limited sample sizes and test multiple hypotheses (without preregistration). In this study we mainly replicate the common specifications found in the literature for the association between the 2D:4D ratio and risk taking, the willingness to compete, and dictator game giving separately. In a sample of 330 women we find no robust associations between any of these economic preferences and 2D:4D. We find no evidence of a statistically significant relation for 16 of the 18 total regressions we run. The two regression specifications which are statistically significant have not previously been reported and the associations are not in the expected direction, and therefore they are unlikely to represent a real effect.

Cognitive functions in children with congenital adrenal hyperplasia

OBJECTIVE

There is controversy regarding cognitive function in patients with congenital adrenal hyperplasia (CAH). This study is aimed at the assessment of cognitive functions in children with CAH, and their relation to hydrocortisone (HC) therapy and testosterone levels.

SUBJECTS AND METHODS

Thirty children with CAH due to 21 hydroxylase deficiency were compared with twenty age- and sex-matched healthy controls. HC daily and cumulative doses were calculated, the socioeconomic standard was assessed, and free testosterone was measured. Cognitive function assessment was performed using the Wechsler Intelligence Scale - Revised for Children and Adults (WISC), the Benton Visual Retention Test, and the Wisconsin Card Sorting Test (WCST).

RESULTS

The mean age (SD) of patients was 10.22 (3.17) years [11 males (36.7%), 19 females (63.3%)]. Mean (SD) HC dose was 15.78 (4.36) mg/m 2 /day. Mean (SD) cumulative HC dose 44,689. 9 (26,892.02) mg. Patients had significantly lower scores in all domains of the WISC test, performed significantly worse in some components of the Benton Visual Retention Test, as well as in the Wisconsin Card Sorting Test. There was no significant difference in cognitive performance when patients were subdivided according to daily HC dose (< 10, 10 - 15, > 15 mg/m 2 /day). A positive correlation existed between cumulative HC dose and worse results of the Benton test. No correlation existed between free testosterone and any of the three tests.

CONCLUSION

Patients with CAH are at risk of some cognitive impairment. Hydrocortisone therapy may be implicated. This study highlights the need to assess cognitive functions in CAH.

Sibling sex, but not androgens, shapes phenotypes in perinatal common marmosets (Callithrix jacchus)

When offspring share a womb, interactions among fetuses can impart lasting impressions on phenotypic outcomes. Such intrauterine interactions often are mediated by sex steroids (estrogens and androgens) produced by the developing fetuses. In many mammals, intrauterine interactions between brothers and sisters lead to masculinization of females, which can induce fitness consequences. Many litter-bearing primates, though, seem to escape androgen-mediated litter effects, begging why? Here, we investigated how the sex composition (i.e., same- or mixed-sex) of litters influences perinatal outcomes in the common marmoset monkey (Callithrix jacchus), using a combination of physiological, morphological, and behavioural assays. We hypothesized that androgens from male fetuses would mediate developmental differences across litter types. We found that newborns (24-36 hours old) from same- and mixed-sex litters were indistinguishable by urinary androgen profiles, birth weights, morphometrics, and behaviour. However, monkeys born into same- and mixed-sex litters exhibited subtle morphological and neurobehavioral differences later in the perinatal period, independent of their androgen profiles. Our findings suggest that while androgens from male fetuses likely do not organize their siblings' phenotypes, perinatal stimuli may initiate divergent developmental trajectories among siblings, which, in turn, promotes inter-individual variability within families.

Cognitive abilities in women with complete androgen insensitivity syndrome and women with gonadal dysgenesis

BACKGROUND

Many questions regarding the mechanisms behind sex differences in cognitive abilities are still unanswered. On a group level, men typically outperform women on certain spatial tasks, whereas women perform better on certain tests of memory and verbal ability. The prevailing theories concerning the biological predispositions for these and other differences in behaviour and brain function focus on early and prolonged exposure to sex hormones. There is, however, evidence of direct effects of sex chromosomes on sex-typical behaviour in other species.

OBJECTIVES

To study the influence of sex hormones and sex chromosomes on cognition in women with Complete androgen insensitivity (CAIS) and Gonadal dysgenesis (GD).

METHODS

Eighteen women with CAIS, 6 women with 46,XYGD, and 7 women with 46,XXGD were compared with age-matched male and female controls on tests of spatial and verbal abilities, memory functions, and emotion recognition.

RESULTS

Women with CAIS, XYGD, and XXGD performed similar to female controls on cognitive tasks. However, on a test of emotion recognition, women with XXGD outperformed the other groups, whereas women with CAIS and XYGD performed similar to male controls.

CONCLUSION

Our results support theories of androgen effects on cognitive abilities and suggest that factors related to sex chromosomes may influence emotion recognition. Implications of an atypical sex hormone situation and sex chromosome variation are discussed.

Prenatal testosterone does not explain sex differences in spatial ability

The most consistent sex differences in cognition are found for spatial ability, in which males, on average, outperform females. Utilizing a twin design, two studies have shown that females with male co-twins perform better than females with female co-twins on a mental rotation task. According to the Twin Testosterone Transfer hypothesis (TTT) this advantage is due to in-uterine transmission of testosterone from males to females. The present study tested the TTT across 14 different spatial ability measures, including mental rotation tasks, in a large sample of 19–21-year-old twins. Males performed significantly better than females on all spatial tasks, with effect sizes ranging from η² = 0.02 to η² = 0.16. Females with a male co-twin outperformed females with a female co-twin in two of the tasks. The effect sizes for both differences were negligible (η² < 0.02). Contrary to the previous studies, our results gave no indication that prenatally transferred testosterone, from a male to a female twin, influences sex differences in spatial ability.

Sex Differences and the Influence of Sex Hormones on Cognition through Adulthood and the Aging Process

Hormones of the hypothalamic-pituitary-gonadal (HPG) axis that regulate reproductive function have multiple effects on the development, maintenance and function of the brain. Sex differences in cognitive functioning have been reported in both health and disease, which may be partly attributed to sex hormones. The aim of the current paper was to provide a theoretical review of how sex hormones influence cognitive functioning across the lifespan as well as provide an overview of the literature on sex differences and the role of sex hormones in cognitive decline, specifically in relation to Alzheimer’s disease (AD). A summary of current hormone and sex-based interventions for enhancing cognitive functioning and/or reducing the risk of Alzheimer’s disease is also provided.

Gene expression and DNA methylation changes in the hypothalamus and hippocampus of adult rats developmentally exposed to bisphenol A or ethinyl estradiol: a CLARITY-BPA consortium study

Bisphenol A (BPA), an endocrine disrupting chemical (EDC), is a ubiquitous pollutant. As part of the Consortium Linking Academic and Regulatory Insights on BPA Toxicity (CLARITY-BPA), we sought to determine whether exposure of Sprague-Dawley rats to 2,500 μg/kg/day BPA (BPA) or 0.5 μg/kg/day ethinyl estradiol (EE) from gestational day 6 through postnatal day 21 induces behavior-relevant gene expression and DNA methylation changes in hippocampus and hypothalamus at adulthood. RNA and DNA were isolated from both regions. Expression of ten genes (Dnmt1, Dnmt3a, Dnmt3b, Esr1, Esr2, Avp, Ar, Oxt, Otr, and Bdnf) presumably altered by early-life BPA/EE exposure was examined. Three genes (Bdnf, Dnmt3b, and Esr1) were studied for DNA methylation changes in their putative 5' promoter regions. Molecular changes in hippocampus were correlated to prior Barnes maze performance, including sniffing correct holes, distance traveled, and velocity. Exposure to BPA and/or EE disrupted patterns of sexually dimorphic gene expression/promoter DNA methylation observed in hippocampus and hypothalamus of controls. In the hippocampus of female offspring, BPA exposure resulted in hypermethylation of the putative 5' promoter region of Bdnf, while EE exposure induced hypomethylation. Bdnf methylation was weakly associated with Bdnf expression in hippocampi of female rats. Hippocampal Bdnf expression in females showed a weak negative association with sniffing correct hole in Barnes maze. Hippocampal expression of Avp, Esr2, Oxt, and Otr was strongly associated with velocity of control rats in Barnes maze. Findings suggest BPA exposure induced non-EE-like gene expression and epigenetic changes in adult rat hippocampi, a region involved in spatial navigation.

Do Gender-Related Stereotypes Affect Spatial Performance? Exploring When, How and to Whom Using a Chronometric Two-Choice Mental Rotation Task

It is a common belief that males have superior visuospatial abilities and that differences in this and other cognitive domains (e.g., math) contribute to the reduced interest and low representation of girls and women in STEM education and professions. However, previous studies show that gender-related implicit associations and explicit beliefs, as well as situational variables, might affect cognitive performance in those gender-stereotyped domains and produce between-gender spurious differences. Therefore, the present study aimed to provide information on when, how and who might be affected by the situational reactivation of stereotypic gender-science beliefs/associations while performing a 3D mental rotation chronometric task (3DMRT). More specifically, we assessed the explicit beliefs and implicit associations (by the Implicit Association Test) held by female and male students of humanities and STEM majors and compared their performance in a 3DMRT after receiving stereotype- congruent, incongruent and nullifying experimental instructions. Our results show that implicit stereotypic gender-science associations correlate with 3DMRT performance in both females and males, but that inter-gender differences emerge only under stereotype-reactivating conditions. We also found that changes in self-confidence mediate these instructions’ effects and that academic specialization moderates them, hence promoting 3DMRT performance differences between male and female humanities, but not STEM, students. Taken together, these observations suggest that the common statement “males have superior mental rotation abilities” simplifies a much more complex reality and might promote stereotypes which, in turn, might induce artefactual performance differences between females and males in such tasks.

Hypothalamic transcriptomic alterations in male and female California mice (Peromyscus californicus) developmentally exposed to bisphenol A or ethinyl estradiol

Bisphenol A (BPA) is an endocrine‐disrupting chemical (EDC) prevalent in many household items. Rodent models and human epidemiological studies have linked this chemical to neurobehavior impairments. In California mice, developmental exposure to BPA results in sociosexual disorders at adulthood, including communication and biparental care deficits, behaviors that are primarily regulated by the hypothalamus. Thus, we sought to examine the transcriptomic profile in this brain region of juvenile male and female California mice offspring exposed from periconception through lactation to BPA or ethinyl estradiol (EE, estrogen present in birth control pills and considered a positive estrogen control for BPA studies). Two weeks prior to breeding, P₀ females were fed a control diet, or this diet supplemented with 50 mg BPA/kg feed weight or 0.1 ppb EE, and continued on the diets through lactation. At weaning, brains from male and female offspring were collected, hypothalamic RNA isolated, and RNA‐seq analysis performed. Results indicate that BPA and EE groups clustered separately from controls with BPA and EE exposure leading to unique set of signature gene profiles. Kcnd3 was downregulated in the hypothalamus of BPA‐ and EE‐exposed females, whereas Tbl2, Topors, Kif3a, and Phactr2 were upregulated in these groups. Comparison of transcripts differentially expressed in BPA and EE groups revealed significant enrichment of gene ontology terms associated with microtubule‐based processes. Current results show that perinatal exposure to BPA or EE can result in several transcriptomic alterations, including those associated with microtubule functions, in the hypothalamus of California mice. It remains to be determined whether these genes mediate BPA‐induced behavioral disruptions.

Evolutionary perspective on sex differences in the expression of neurological diseases

Sex-specific brain and cognitive deficits emerge with malnutrition, some infectious and neurodegenerative diseases, and often with prenatal or postnatal toxin exposure. These deficits are described in disparate literatures and are generally not linked to one another. Sexual selection may provide a unifying framework that integrates our understanding of these deficits and provides direction for future studies of sex-specific vulnerabilities. Sexually selected traits are those that have evolved to facilitate competition for reproductive resources or that influence mate choices, and are often larger and more complex than other traits. Critically, malnutrition, disease, chronic social stress, and exposure to man-made toxins compromise the development and expression of sexually selected traits more strongly than that of other traits. The fundamental mechanism underlying vulnerability might be the efficiency of mitochondrial energy capture and control of oxidative stress that in turn links these traits to current advances in neuroenergetics, stress endocrinology, and toxicology. The key idea is that the elaboration of these cognitive abilities, with more underlying gray matter or more extensive inter-modular white matter connections, makes them particularly sensitive to disruptions in mitochondrial functioning and oxidative stress. A framework of human sexually selected cognitive abilities and underlying brain systems is proposed and used to organize what is currently known about sex-specific vulnerabilities.

Looking behind the score: Skill structure explains sex differences in skilled video game performance

Some have explained large sex differences in visuospatial abilities by genetic adaptations to different roles in primitive hunter-gatherer societies and the interaction of innate biological differences and environmental factors. We explored the extent to which variations in behavior and acquired skills can provide alternative accounts for sex differences in the performance of a complex spatially-demanding video game (Space Fortress). Men and women with limited video game experience were given 30 hours of training, and latent curve analyses examined the development of their ship control performance and behavior. Men had significantly better control performance than women before and after training, but differences diminished substantially over the training period. An analysis of participants’ joystick behaviors revealed that initially men and women relied on different patterns of control behaviors, but changes in these behaviors over time accounted for the reduced sex differences in performance. When we controlled for these differences in behavior, sex effects after training were no longer significant. Finally, examining the development of control performance and control behaviors of men and women categorized as initially high and low performers revealed the lower-performing women may have been controlling their ship using an approach that was very different from the men and higher-performing women. The potential problems of analyzing men and women’s spatial performance as homogenous groups are discussed, as well as how these issues may account for sex differences in skilled video game performance and perhaps other domains involving spatial abilities.

The molecular mechanisms of sexual orientation and gender identity

Differences between males and females are widely represented in nature. There are gender differences in phenotypes, personality traits, behaviors and interests, cognitive performance, and proneness to specific diseases. The most marked difference in humans is represented by sexual orientation and core gender identity, the origins of which are still controversial and far from being understood. Debates continue on whether sexual behavior and gender identity are a result of biological (nature) or cultural (nurture) factors, with biology possibly playing a major role. The main goal of this review is to summarize the studies available to date on the biological factors involved in the development of both sexual orientation and gender identity. A systematic search of published evidence was performed using Medline (from January 1948 to June 2017). Review of the relevant literature was based on authors' expertise. Indeed, different studies have documented the possible role and interaction of neuroanatomic, hormonal and genetic factors. The sexual dimorphic brain is considered the anatomical substrate of psychosexual development, on which genes and gonadal hormones may have a shaping effect. In particular, growing evidence shows that prenatal and pubertal sex hormones permanently affect human behavior. In addition, heritability studies have demonstrated a role of genetic components. However, a convincing candidate gene has not been identified. Future studies (e.i. genome wide studies) are needed to better clarify the complex interaction between genes, anatomy and hormonal influences on psychosexual development.

Effects of sex and prenatal androgen manipulations on Onuf's nucleus of rhesus macaques

The role of gonadal steroids in sexual differentiation of the central nervous system (CNS) is well established in rodents, but no study to date has manipulated androgens prenatally and examined their effects on any CNS structure in a primate. Onuf's nucleus is a column of motoneurons in the sacral spinal cord that innervates the striated perineal muscles. This cell group is larger in males than in females of many species, due to androgens acting during a sensitive perinatal period. Here, we examined Onuf's nucleus in 21 adult rhesus monkeys, including control males and females, as well as males whose mothers had been treated with an anti-androgen or testosterone during gestation. We found a robust sex difference, with more motoneurons in control males than in females. The soma size of Onuf's nucleus motoneurons was also marginally larger in males. Treatment with the anti-androgen flutamide for 35-40 days during early gestation partially blocked masculinization of Onuf's nucleus: motoneuron number in flutamide-treated males was decreased relative to control and testosterone-treated males, but remained greater than in females, with no effect on cell size. A control motor nucleus that innervates foot muscles (Pes9) showed no difference in motoneuron number or size between control males and females. Prenatal testosterone treatment of males did not alter Onuf's nucleus motoneuron number, but did increase the size of both Onuf's and Pes9 motoneurons. Thus, prenatal androgen manipulations cause cellular-level changes in the primate CNS, which may underlie previously observed effects of these manipulations on behavior.

The Sexual Differentiation of the Human Brain: Role of Sex Hormones Versus Sex Chromosomes

Men and women differ, not only in their anatomy but also in their behavior. Research using animal models has convincingly shown that sex differences in the brain and behavior are induced by sex hormones during a specific, hormone-sensitive period during early development. Thus, male-typical psychosexual characteristics seem to develop under the influence of testosterone, mostly acting during early development. By contrast, female-typical psychosexual characteristics may actually be organized under the influence of estradiol during a specific prepubertal period. The sexual differentiation of the human brain also seems to proceed predominantly under the influence of sex hormones. Recent studies using magnetic resonance imaging have shown that several sexually differentiated aspects of brain structure and function are female-typical in women with complete androgen insensitivity syndrome (CAIS), who have a 46 XY karyotype but a female phenotype due to complete androgen resistance, suggesting that these sex differences most likely reflect androgen action, although feminizing effects of estrogens or female-typical socialization cannot be ruled out. By contrast, some male-typical neural characteristics were also observed in women with CAIS suggesting direct effects of sex chromosome genes in the sexual differentiation of the human brain. In conclusion, the sexual differentiation of the human brain is most likely a multifactorial process including both sex hormone and sex chromosome effects, acting in parallel or in combination.