Cognitive and behavioral characteristics of turner syndrome: exploring a role for ovarian hormones in female sexual differentiation

Uncovering sex/gender differences of arithmetic in the human brain: Insights from fMRI studies

Over the long run, STEM fields had been perceived as dominant by males, despite that numerous studies have shown that female students do not underperform their male classmates in mathematics and science. In this review, we discuss whether and how sex/gender shows specificity in arithmetic processing using a cognitive neuroscience approach not only to capture contemporary differences in brain and behavior but also to provide exclusive brain bases knowledge that is unseen in behavioral outcomes alone. We begin by summarizing studies that had examined sex differences/similarities in behavioral performance of mathematical learning, with a specific focus on large-scale meta-analytical data. We then discuss how the magnetic resonance imaging (MRI) approach can contribute to understanding neural mechanisms underlying sex-specific effects of mathematical learning by reviewing structural and functional data. Finally, we close this review by proposing potential research issues for further exploration of the sex effect using neuroimaging technology. Through the lens of advancement in the neuroimaging technique, we seek to provide insights into uncovering sex-specific neural mechanisms of learning to inform and achieve genuine gender equality in education.

The speech and language profile of a child with Turner Syndrome- a case study

BACKGROUND

Turner syndrome is a genetic disorder that affects only females. It has specific cognitive characteristics, but speech and language data are scarce.

METHODS AND PROCEDURES

Prospective case report; we report a girl aged seven's cognitive and speech and language profile.

RESULTS

Cognitive assessment shows higher performance IQ (PIQ), and atypical cognitive profile for Turner syndrome. Speech and language assessment show a significant difference between receptive and expressive language levels. Although the girl did comprehend most of the language structure, there was a lack of it in spontaneous speech. She demonstrated inconsistency in the use of language morphology and complex linguistic structures, primarily because of significant inconsistency in her sound production. Although she produced the majority of phonemes correctly in isolation, her spontaneous speech production was incomprehensible.

CONCLUSION

Case studies of speech and language development may reveal a specific characteristic in the cases with Turner syndrome to delineate genetic factors from individual developmental variabilities.

Low Perinatal Androgens Predict Recalled Childhood Gender Nonconformity in Men

The contributions of gonadal hormones to the development of human behavioral sex differences are subjects of intense scientific and social interest. Isolated gonadotropin-releasing-hormone deficiency (IGD) is a rare endocrine disorder that can reveal a possible role of early gonadal hormones. IGD is characterized by low or absent gonadal hormone production after the first trimester of gestation, but external genitalia and hence gender of rearing are concordant with chromosomal and gonadal sex. We investigated recalled childhood gender nonconformity in men (n = 65) and women (n = 32) with IGD and typically developing men (n = 463) and women (n = 1,207). Men with IGD showed elevated childhood gender nonconformity, particularly if they also reported undescended testes at birth, a marker of low perinatal androgens. Women with IGD did not differ from typically developing women. These results indicate that early androgen exposure after the first trimester contributes to male-typical gender-role behaviors in childhood.

Altered Brain Structure in Infants with Turner Syndrome

Turner syndrome (TS) is a genetic disorder affecting approximately 1:2000 live-born females. It results from partial or complete X monosomy and is associated with a range of clinical issues including a unique cognitive profile and increased risk for certain behavioral problems. Structural neuroimaging studies in adolescents, adults, and older children with TS have revealed altered neuroanatomy but are unable to identify when in development differences arise. In addition, older children and adults have often been exposed to years of growth hormone and/or exogenous estrogen therapy with potential implications for neurodevelopment. The study presented here is the first to test whether brain structure is altered in infants with TS. Twenty-six infants with TS received high-resolution structural MRI scans of the brain at 1 year of age and were compared to 47 typically developing female and 39 typically developing male infants. Results indicate that the typical neuroanatomical profile seen in older individuals with TS, characterized by decreased gray matter volumes in premotor, somatosensory, and parietal-occipital cortex, is already present at 1 year of age, suggesting a stable phenotype with origins in the prenatal or early postnatal period.

Lack of consensus in the choice of termination of pregnancy for Turner syndrome in France

BACKGROUND

The observed rate of termination of pregnancy (TOP) for Turner syndrome varies worldwide and even within countries. In this vignette study we quantified agreement among ten multidisciplinary prenatal diagnosis centers in Paris.

METHODS

We submitted online three cases of Turner syndrome (increased nuchal translucency, normal ultrasound, aortic coarctation) to fetal medicine experts: one obstetrician, one pediatrician and one geneticist in each of the ten Parisian centers. Each case was presented in the form of a progressive clinical history with conditional links dependent upon responses. The background to each case was provided, along with the medical history of the parents and the counseling they got from medical staff. The experts indicated online whether or not they would accept the parents' request for TOP. We assessed the percentage of agreement for acceptance or refusal of TOP. We also used a multilevel logistic regression model to evaluate differences among obstetrician-gynecologists, pediatricians and cytogeneticists.

RESULTS

Overall agreement among the experts to accept or refuse TOP was, respectively, 25 and 28%. The percentage of disagreement was 47%. The percentage of agreement to accept TOP was 33, 8 and 33% for obstetrician-gynecologists, pediatricians and cytogeneticists, respectively. The respective percentages of agreement to refuse TOP were 19, 47 and 26%.

CONCLUSION

Our results show the lack of consensus with regard to decisions related to termination of pregnancy for Turner Syndrome. This lack of consensus in turn underscores the importance of multidisciplinary management of these pregnancies in specialized fetal medicine centers.

Changes in the cohort composition of turner syndrome and severe non-diagnosis of Klinefelter, 47,XXX and 47,XYY syndrome: a nationwide cohort study

Background

Knowledge on the prevalence of sex chromosome abnormalities (SCAs) is limited, and delayed diagnosis or non-diagnosis of SCAs are a continuous concern. We aimed to investigate change over time in incidence, prevalence and age at diagnosis among Turner syndrome (TS), Klinefelter syndrome (KS), Triple X syndrome (Triple X) and Double Y syndrome (Double Y).

Methods

This study is a nationwide cohort study in a public health care system. The Danish Cytogenetic Central Registry (DCCR) holds information on all karyotypes performed in Denmark since 1961. We identified all individuals in the DCCR with a relevant SCA during 1961–2014; TS: n = 1156; KS: n = 1235; Triple X: n = 197; and Double Y: n = 287. From Statistics Denmark, which holds an extensive collection of data on the Danish population, complete data concerning dates of death and migrations in and out of Denmark were retrieved for all individuals.

Results

The prevalence among newborns was as follows: TS: 59 per 100,000 females; KS: 57 per 100,000 males; Triple X: 11 per 100,000 females; and Double Y: 18 per 100,000 males. Compared with the expected number among newborns, all TS, 38% of KS, 13% of Triple X, and 18% of Double Y did eventually receive a diagnosis. The incidence of TS with other karyotypes than 45,X (P < 0.0001), KS (P = 0.02), and Double Y (P = 0.03) increased during the study period whereas the incidence of 45,X TS decreased (P = 0.0006). The incidence of Triple X was stable (P = 0.22).

Conclusions

The prevalence of TS is higher than previously identified, and the karyotypic composition of the TS population is changing. Non-diagnosis is extensive among KS, Triple X and Double Y, whereas all TS seem to become diagnosed. The diagnostic activity has increased among TS with other karyotypes than 45,X as well as among KS and Double Y.

Klinefelter Syndrome: Integrating Genetics, Neuropsychology, and Endocrinology

Although first identified over 70 years ago, Klinefelter syndrome (KS) continues to pose substantial diagnostic challenges, as many patients are still misdiagnosed, or remain undiagnosed. In fact, as few as 25% of patients with KS are accurately diagnosed and most of these diagnoses are not made until adulthood. Classic characteristics of KS include small testes, infertility, hypergonadothropic hypogonadism, and cognitive impairment. However, the pathophysiology behind KS is not well understood, although genetic effects are also thought to play a role. For example, recent developments in genetics and genomics point to a fundamental change in our understanding of KS, with global epigenetic and RNA expression changes playing a central role for the phenotype. KS is also associated with more general health markers, including higher morbidity and mortality rates and lower socioeconomic status (which likely affect both morbidity and mortality). In addition, hypogonadism is associated with greater risk of metabolic syndrome, type 2 diabetes, cardiovascular disease, breast cancer, and extragonadal germ cell tumors. Medical treatment typically focuses on testosterone replacement therapy (TRT), although the effects of this therapy have not been studied rigorously, and future studies need to evaluate the effects of TRT on metabolic risk and neurocognitive outcomes. This review presents a comprehensive interdisciplinary examination of recent developments in genetic, endocrine, and neurocognitive science, including the study of animal models. It provides a number of recommendations for improving the effectiveness of research and clinical practice, including neonatal KS screening programs, and a multidisciplinary approach to KS treatment from childhood until senescence.

Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

Turner syndrome affects 25-50 per 100,000 females and can involve multiple organs through all stages of life, necessitating multidisciplinary approach to care. Previous guidelines have highlighted this, but numerous important advances have been noted recently. These advances cover all specialty fields involved in the care of girls and women with TS. This paper is based on an international effort that started with exploratory meetings in 2014 in both Europe and the USA, and culminated with a Consensus Meeting held in Cincinnati, Ohio, USA in July 2016. Prior to this meeting, five groups each addressed important areas in TS care: 1) diagnostic and genetic issues, 2) growth and development during childhood and adolescence, 3) congenital and acquired cardiovascular disease, 4) transition and adult care, and 5) other comorbidities and neurocognitive issues. These groups produced proposals for the present guidelines. Additionally, four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with a separate systematic review of the literature. These four questions related to the efficacy and most optimal treatment of short stature, infertility, hypertension, and hormonal replacement therapy. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with The European Society for Pediatric Endocrinology, The Endocrine Society, European Society of Human Reproduction and Embryology, The American Heart Association, The Society for Endocrinology, and the European Society of Cardiology. The guideline has been formally endorsed by the European Society for Endocrinology, the Pediatric Endocrine Society, the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology and the Endocrine Society. Advocacy groups appointed representatives who participated in pre-meeting discussions and in the consensus meeting.

Estrogen Replacement Improves Verbal Memory and Executive Control in Oligomenorrheic/Amenorrheic Athletes in a Randomized Controlled Trial

OBJECTIVE

Both estrogen and exercise may have cognition enhancing benefits; however, young oligomenorrheic/amenorrheic athletes (OA) with estrogen deficiency have not been evaluated for cognitive deficits. Our objective was to determine whether 6 months of estrogen replacement will impact cognitive domains in OA. We hypothesized that estrogen replacement would improve verbal memory and executive control in OA.

METHODS

We performed cognitive assessments at baseline and after 6 months in 48 OA (14-25 years) randomized to estrogen (EST+) (oral 30 µg ethinyl estradiol [n = 16] or transdermal 100 µg 17-β-estradiol patch [n = 13]) or no estrogen (EST-) (n = 19) in an ongoing clinical trial. Neurocognitive testing included California Verbal Learning Test-Second Edition (CVLT-II) (for verbal memory) and Delis-Kaplan Executive Function System Color-Word Interference Test (D-KEFS-CWIT) (executive control).

RESULTS

On average, subjects (mean ± SEM age: 19.9 ± 3.1 years, body mass index: 20.6 ± 2.3 kg/m²) participated in 10.3 ± 5.9 hours per week of weight-bearing activities of their lower limbs. The EST+ group performed better for CVLT-II verbal memory scores for immediate recall over 6 months of therapy compared to EST- (P < .05) even after controlling for baseline scores and age. Changes in D-KEFS-CWIT scores over 6 months did not differ between the groups. However, the EST+ group had greater improvements in inhibition-switching completion time over 6 months compared with the EST- group after controlling for baseline scores and age (P = .01).

CONCLUSIONS

OA show improvements in verbal memory and executive control following 6 months of estrogen replacement. These findings in athletes, who are in their prime of neurocognitive development, underscore the need for future studies exploring cognition in OA.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00946192.

Large Sex Difference in Adolescents on a Timed Line Judgment Task: Attentional Contributors and Task Relationship to Mathematics

Visuospatial performance, assessed with the new, group-administered Judgment of Line Angle and Position test (JLAP-13), varied with sex and mathematical competence in a group of adolescents. The JLAP-13, a low-level perceptual task, was modeled after a neuropsychological task dependent upon functioning of the posterior region of the right hemisphere [Benton et al, 1994 Contributions to Neuropsychological Assessment: A Clinical Manual (New York: Oxford University Press)]. High-school boys ( N = 52) performed better than girls ( N = 62), with a large effect for sex ( d= 1.11). Performance increased with mathematical competence, but the sex difference did not vary significantly across different levels of mathematics coursework. On the basis of earlier work, it was predicted that male, but not female, performance in line judgment would decline with disruptions to task geometry (page frame), and that the sex difference would disappear with disruptions to geometry. These predictions were supported by a number of univariate and sex-specific analyses, although an omnibus repeated-measures analysis did not detect the predicted interaction, most likely owing to limitations in power. Thus, there is partial support for the notion that attentional predispositions or strategies may contribute to visuospatial sex differences, with males more likely than females to attend to, and rely upon, internal or external representations of task geometry. Additional support for this hypothesis may require development of new measures or experimental manipulations with more powerful geometrical disruptions.

A meta-analysis of math performance in Turner syndrome

AIM

Studies investigating the relationship between Turner syndrome and math learning disability have used a wide variation of tasks designed to test various aspects of mathematical competencies. Although these studies have revealed much about the math deficits common to Turner syndrome, their diversity makes comparisons between individual studies difficult. As a result, the consistency of outcomes among these diverse measures remains unknown. The overarching aim of this review is to provide a systematic meta-analysis of the differences in math and number performance between females with Turner syndrome and age-matched neurotypical peers.

METHOD

We provide a meta-analysis of behavioral performance in Turner syndrome relative to age-matched neurotypical populations on assessments of math and number aptitude. In total, 112 comparisons collected across 17 studies were included.

RESULTS

Although 54% of all statistical comparisons in our analyses failed to reject the null hypothesis, our results indicate that meaningful group differences exist on all comparisons except those that do not require explicit calculation.

INTERPRETATION

Taken together, these results help elucidate our current understanding of math and number weaknesses in Turner syndrome, while highlighting specific topics that require further investigation.

Neuroendocrine mechanisms in athletes

Athletic activity may be associated with alterations in various neuroendocrine axes depending on the state of energy availability. In addition, genetic factors and an underlying predilection for polycystic ovarian syndrome (PCOS) may predispose some athletes to develop functional hypothalamic amenorrhea earlier than other athletes. In conditions of low energy availability associated with athletic activity, changes that occur in various neuroendocrine axes are primarily adaptive, and aim to either conserve energy for the most essential functions, or allow the body to draw on its reserves to meet energy needs. These hormonal changes, however, then lead to changes in body composition and bone metabolism. Impaired bone accrual in younger athletes and low bone density in older athletes constitutes the major pathologic consequence of neuroendocrine changes associated with low energy availability. The female athlete triad of low energy availability, menstrual dysfunction, and low bone density is prevalent in certain kinds of sports and activities, particularly endurance sports, gymnastics, and ballet. It is essential to screen for this condition in athletes at every preparticipation physical and during office visits, and to put in place an effective treatment team to manage the triad early, in order to optimize outcomes.

Testosterone measured in infancy predicts subsequent sex-typed behavior in boys and in girls

The testes are active during gestation, as well as during early infancy. Testosterone elevation during fetal development has been shown to play a role in human neurobehavioral sexual differentiation. The role of early postnatal gonadal activation in human psychosexual development is largely unknown, however. We measured testosterone in 48 full term infants (22 boys, 26 girls) by monthly urinary sampling from day 7 postnatal to age 6 months, and related the area under the curve (AUC) for testosterone during the first 6 months postnatal to subsequent sex-typed behavior, at the age of 14 months, using the Pre-School Activities Inventory (PSAI), and playroom observation of toy choices. In boys, testosterone AUC correlated significantly with PSAI scores (Spearman's rho = 0.54, p = 0.04). In addition, play with a train and with a baby doll showed the anticipated sex differences, and play with the train correlated significantly and positively with testosterone AUC in girls (Spearman's rho = 0.43, p = 0.05), while play with the doll correlated significantly and negatively with testosterone AUC in boys (Spearman's rho = -0.48, p < 0.03). These results may support a role for testosterone during early infancy in human neurobehavioral sexual differentiation.

Neuropsychological functioning in girls with premature adrenarche

Contemporary research indicates that brain development occurs during childhood and into early adulthood, particularly in certain regions. A critical question is whether premature or atypical hormone exposures impact brain development (e.g., structure) or function (e.g., neuropsychological functioning). The current study enrolled 40 girls (aged 6-8 years) diagnosed with premature adrenarche (PA) and a comparison group of 36 girls with on-time maturation. It was hypothesized that girls with PA would demonstrate lower IQ and performance on several neuropsychological tasks. The potential for a sexually dimorphic neuropsychological profile in PA was also explored. No significant univariate or multivariate group differences emerged for any neuropsychological instrument. However, effect size confidence intervals contained medium-sized group differences at the subscale level. On-time girls performed better on verbal, working memory, and visuospatial tasks. Girls with PA showed improved attention, but not a sexually dimorphic profile. These results, though preliminary, suggest that premature maturation may influence neuropsychological functioning.

Gender development and the human brain

Convincing evidence indicates that prenatal exposure to the gonadal hormone, testosterone, influences the development of children's sex-typical toy and activity interests. In addition, growing evidence shows that testosterone exposure contributes similarly to the development of other human behaviors that show sex differences, including sexual orientation, core gender identity, and some, though not all, sex-related cognitive and personality characteristics. In addition to these prenatal hormonal influences, early infancy and puberty may provide additional critical periods when hormones influence human neurobehavioral organization. Sex-linked genes could also contribute to human gender development, and most sex-related characteristics are influenced by socialization and other aspects of postnatal experience, as well. Neural mechanisms underlying the influences of gonadal hormones on human behavior are beginning to be identified. Although the neural mechanisms underlying experiential influences remain largely uninvestigated, they could involve the same neural circuitry as that affected by hormones.

Developmental malformation of the corpus callosum: a review of typical callosal development and examples of developmental disorders with callosal involvement

This review provides an overview of the involvement of the corpus callosum (CC) in a variety of developmental disorders that are currently defined exclusively by genetics, developmental insult, and/or behavior. I begin with a general review of CC development, connectivity, and function, followed by discussion of the research methods typically utilized to study the callosum. The bulk of the review concentrates on specific developmental disorders, beginning with agenesis of the corpus callosum (AgCC)-the only condition diagnosed exclusively by callosal anatomy. This is followed by a review of several genetic disorders that commonly result in social impairments and/or psychopathology similar to AgCC (neurofibromatosis-1, Turner syndrome, 22q11.2 deletion syndrome, Williams yndrome, and fragile X) and two forms of prenatal injury (premature birth, fetal alcohol syndrome) known to impact callosal development. Finally, I examine callosal involvement in several common developmental disorders defined exclusively by behavioral patterns (developmental language delay, dyslexia, attention-deficit hyperactive disorder, autism spectrum disorders, and Tourette syndrome).

Cognitive profile of Turner syndrome

Turner syndrome (TS) is a relatively common neurogenetic disorder characterized by complete or partial monosomy-X in a phenotypic female. TS is associated with a cognitive profile that typically includes intact intellectual function and verbal abilities with relative weaknesses in visual-spatial, executive, and social cognitive domains. In this report, we review previous and current research related to the cognitive profile of TS. We also discuss how cognitive impairments in this syndrome may reflect integrative rather than modular deficits. For example, the less commonly reported areas of verbal difficulty in TS and certain visual-spatial deficits seem significantly influenced by impairments in executive function and spatially loaded stimuli. We provide a summary of cognitive testing measures used in the assessment of visual-spatial and executive skills, which includes test domain descriptions as well as a comprehensive examination of social cognitive function in TS. This review concludes with a discussion of ecological interpretations regarding the meaning of cognitive deficits in TS at the individual level.

Functional anatomy of visuo-spatial working memory during mental rotation is influenced by sex, menstrual cycle, and sex steroid hormones

Recent observations indicate that sex and level of steroid hormones may influence cortical networks associated with specific cognitive functions, in particular visuo-spatial abilities. The present study probed the influence of sex, menstrual cycle, and sex steroid hormones on 3D mental rotation and brain function using 3-T fMRI. Twelve healthy women and 12 men were investigated. Menstrual cycle and hormone levels were assessed. The early follicular and midluteal phase of the menstrual cycle were chosen to examine short-term cyclical changes. Parietal and frontal areas were activated during mental rotation in both sexes. Significant differences between men and women were revealed in both phases of menstrual cycle. In men we observed a significant correlation of activation levels with testosterone levels in the left parietal lobe (BA 40). In women, a cycle-dependent correlation pattern was observed for testosterone: brain activation correlated with this male hormone only during the early follicular phase. In both cycle phases females' brain activation was significantly correlated with estradiol in frontal and parietal areas. Our study provides evidence that fMRI-related activity during performance of cognitive tasks varies across sex and phases of the menstrual cycle. The variation might be partly explained by better task performance in men, but our results indicate that further explanations like basic neuronal or neurovascular effects modulated by steroid hormones must be considered. Both estradiol and testosterone levels may influence fMRI signals of cognitive tasks, which should affect selection of subjects for future fMRI studies.

Fetal testosterone and sex differences in typical social development and in autism

Experiments in animals leave no doubt that androgens, including testosterone, produced by the testes in fetal and/or neonatal life act on the brain to induce sex differences in neural structure and function. In human beings, there is evidence supporting a female superiority in the ability to read nonverbal signals, specific language-related skills, and theory of mind. Even more striking than the sex differences seen in the typical population is the elevated occurrence of social and communicative difficulties in human males. One such condition, autism, occurs four times more frequently in boys than in girls. Recently, a novel theory known as the "extreme male brain" has been proposed. It suggests that the behaviors seen in autism are an exaggeration of typical sex differences and that exposure to high levels of prenatal testosterone might be a risk factor. In this article, we argue that prenatal and neonatal testosterone exposures are strong candidates for having a causal role in sexual dimorphism in human behavior, including social development, and as risk factors for conditions characterized by social impairments, particularly autism spectrum conditions.

Influence of X chromosome and hormones on human brain development: a magnetic resonance imaging and proton magnetic resonance spectroscopy study of Turner syndrome

BACKGROUND

Women with Turner syndrome (TS; 45,X) lack a normal second X chromosome, and many are prescribed exogenous sex and growth hormones (GH). Hence, they allow us an opportunity to investigate genetic and endocrine influences on brain development.

METHODS

We examined brain anatomy and metabolism in 27 adult monosomic TS women and 21 control subjects with volumetric magnetic resonance imaging and magnetic resonance spectroscopy.

RESULTS

In TS women, regional gray matter volume was significantly smaller in parieto-occipital cortex and caudate nucleus and larger in cerebellar hemispheres. White matter was reduced in the cerebellar hemispheres, parieto-occipital regions, and splenium of the corpus callosum but was increased in the temporal and orbitofrontal lobes and genui of corpus callosum. Women with TS had a significantly lower parietal lobe concentration of N-acetyl aspartate, and higher hippocampal choline. Also, among women with TS, there were significant differences in regional gray matter volumes and/or neuronal integrity, depending upon parental origin of X chromosome and oxandrolone and GH use.

CONCLUSIONS

X chromosome monosomy, imprinting and neuroendocrine milieu modulate human brain development-perhaps in a regionally specific manner.

Effects of Growth Hormone on Cognitive Function

Whether growth hormone deficiency (GHD) and/or treatment in childhood and adolescence influences cognitive outcome in children with GHD or girls with Turner syndrome (TS) is controversial. Previous studies also suggest that quality of life (QoL) is reduced in adults with GHD, particularly in the areas of social isolation and fatigue. Baseline QoL scores were significantly lower in patients with GHD than in the general population of the same age, gender, and nationality. Unfortunately, few data are available describing QoL in children with GHD. TS is a genetic disorder characterized by short stature, gonadal dysgenesis, and a particular neurocognitive profile of normally developed language abilities (particularly verbal intelligence quotients) and impaired visual-spatial and/or visual-perceptual abilities. This study evaluated the effects of GH treatment on neurocognitive function in girls with TS who were enrolled in a long-term, double-blind, placebo-controlled trial of the effects of GH treatment on final adult height. Treatment duration ranged from 1 to 7 years. The major result of this study was the absence of GH treatment effects on cognitive function in girls with TS. GHD and/or treatment in childhood and adulthood influences cognitive and/or QoL outcomes in some but not all studies. This study did not support a role for GH in influencing the characteristic nonverbal neurocognitive deficits associated with TS. However, evaluation of QoL should be a part of the routine clinical management of patients with GHD or TS.

Mate choice decisions: the role of facial beauty

For most people, facial beauty appears to play a prominent role in choosing a mate. Evidence from research on facial attractiveness indicates that physical beauty is a sexually selected trait mediated, in part, by pubertal facial hormone markers that signal important biological information about the displayer. Such signals would be ineffective if they did not elicit appropriate cognitive and/or emotional responses in members of the opposite sex. In this article, I argue that the effectiveness of these hormonal displays varies with perceivers' brains, which have been organized by the degree of steroid hormone exposure in the uterus, and activated by varying levels of circulating steroids following puberty. I further propose that the methodology used for examining mate choice decisions has general applicability for determining how cognitive and emotional evaluations enter into decision processes.

Fear recognition across the menstrual cycle

This study assesses the mediating role of stage of menstrual cycle in the recognition of emotional expressions. It was hypothesised that fear recognition ability would be stronger at high-oestrogen stages of the menstrual cycle. The accuracy of recognising emotional expressions was compared across 50 women who were at different stages of their menstrual cycle. It was found that accuracy to recognise emotions was significantly affected by the interaction between stages of the menstrual cycle and the emotion being displayed. Further analysis revealed that for the emotion expression of fear alone, participants were significantly more accurate at the preovulatory surge (highest oestrogen levels) than at menstruation (oestrogen levels at lowest point). The results have implications for the processes that underlie fear processing and a possible insight into the sexual dimorphism of this ability and conditions that show variations in fear recognition (e.g., autism, Turner syndrome).

Endocrine disruption and cognitive function in adolescent female rhesus monkeys

Female rhesus monkeys (n=8/group) received daily oral doses of exogenous estrogen [diethylstilbestrol (DES), 0.5 mg/kg, methoxychlor (MXC), 25 or 50 mg/kg] for 6 months before and after the anticipated age of menarche. Behavior was assessed during and for 9 months after dosing. Visual discrimination performance (simultaneous nonmatch-to-sample with trial-unique stimuli) conducted during dosing demonstrated delayed improvement and poorer performance in the MXC50 group, with some similar effects in the DES group. Visual recognition memory, assessed with delays of < or = 3 s, was not apparently affected. Spatial working memory, assessed after dosing, also showed acquisition deficits and possible working memory difficulties in the MXC50 group. Spontaneous motor activity, monitored at 6-month intervals, was not affected by treatment. Late peak latencies of the auditory brainstem response (ABR) were shorter in the DES group 6 months after treatment, suggesting long-term effects on brain. The study suggests that some aspects of brain function can be modified by exposure to exogenous estrogen during pubertal development. Although DES is a more potent estrogen, the high-dose MXC group was more affected behaviorally. Differential effects of the two agents at the estrogen receptor subtypes (ER alpha and ER beta) may be relevant to the differential behavioral outcomes.

Psychosexual development in individuals who have female pseudohermaphroditism

This article describes psychosexual outcomes and issues in syndromes of female pseudohermaphroditism, broadly defined. Congenital adrenal hyperplasia, the most common cause of intersex genitalia at birth, is covered as are Turner Syndrome and syndromes in which XY infants who are born with undervirilized genitalia are assigned and reared as girls (androgen insensitivity syndrome; cloacal exstrophy). The same hormonal abnormalities that cause most physical intersex conditions also influence brain development and behavior; individuals who have intersex conditions can show behavior that is in between that of the typical boy/man and the typical girl/woman. Changes in sex-typical play behavior in childhood are larger than in sexual orientation or core gender identity in adulthood. Most female pseudohermaphrodites, whether XX or XY, who are assigned and reared as girls evolve a feminine core gender identity and primarily are heterosexual. Implications for current debate about the treatment of infants who have ambiguous genitalia are discussed, as is the need for additional research and for consideration of psychologic counseling as part of the treatment program.

Second to fourth finger ratio and possible precursors of developmental psychopathology in preschool children

BACKGROUND

The influence of sex steroids upon brain development has been suggested to mediate sex differences in developmental psychopathology. The ratio of the length of index finger or second finger to the ring finger or fourth finger (the 2D:4D ratio) appears to be a marker of early sex hormone exposure, with low 2D:4D associated with high prenatal testosterone and high 2D:4D associated with high prenatal oestrogen. This relationship allows a non-invasive measure of the long-term influence of prenatal sex steroids. Behaviours such as hyperactivity and poor social cognition are common in preschoolers. An association between 2D:4D and these possible precursors of psychopathology would be most readily identified in this group.

AIM

To identify relationships between 2D:4D ratio and behaviours in preschool children which constitute possible precursors of developmental psychopathology.

STUDY DESIGN

Population survey.

METHOD

The 2D:4D ratio was measured in a group of preschool children and behavioural questionnaires were given to parents and teachers.

RESULTS

Sex differences in behaviours were small, whilst correlations with 2D:4D were strong. Low 2D:4D was related to hyperactivity and poor social cognitive function in girls, and high 2D:4D with emotional symptoms in boys.

CONCLUSIONS

We suggest that during early brain development androgens increase the probability of hyperactivity and poor social cognition in girls. Early oestrogens increase the probability of emotional problems in boys.

Effects of estradiol and aging on fine manual performance in female rhesus monkeys

Aging is characterized by a progressive deterioration of motor function related to dysfunctions of the nigrostriatal system. Because estrogen has been reported to protect dopaminergic neurons and to improve the motor deficits associated with Parkinson's disease, we hypothesized that it would partially reverse the age-related decline of motor function in normal aging. We tested the effects of estrogen treatment and withdrawal on fine motor performance in five aged (21-24 years old) and five young (6-9 years old) ovariectomized female rhesus monkeys. The tests required the monkeys to use each hand to retrieve a Life Saver candy from metal rods bent in shapes of different complexity. Monkeys were tested twice a week for 8 consecutive weeks, during treatment with placebo or ethinyl estradiol (EE(2)) in alternating 14-day blocks. Each behavioral test was videotaped and subsequently scored for the duration and the success of the first trial on each shape. Both groups of monkeys improved rapidly with practice in speed and success of retrieval. The older monkeys were slower but as successful as the young monkeys in retrieving the candy. The left hand was faster than the right hand for both the aged and young females. We failed to detect any effect of EE(2) treatment on speed or success of retrieval in either group. These results confirm the slowing of fine motor performance with aging in female rhesus monkeys. They also indicate that estradiol, at least as administered in this study, does not benefit fine manual performance.

Are you looking at me? Accuracy in processing line-of-sight in Turner syndrome

The behavioural phenotype of women with Turner syndrome (X-monosomy, 45,X) is poorly understood, but includes reports of some social development anomalies. With this in mind, accuracy of direction of gaze detection was investigated in women with Turner syndrome. Two simple experimental tasks were used to test the prediction that the ability to ascertain gaze direction from face photographs showing small lateral angular gaze deviations would be impaired in this syndrome, compared with a control population of men and women. The prediction was confirmed and was found to affect both the detection of egocentric gaze from the eyes ('is the face looking at me?') and the detection of allocentric gaze, where the eyes in a photographed face inspected one of a number of locations of attention ('where is she looking?'). We suggest that dosage-sensitive X-linked genes contribute to the development of gaze-monitoring abilities.

Ovarian hormones after postnatal day 20 reduce neuron number in the rat primary visual cortex

Previous work from our lab has documented a sex difference in neuron number in the binocular region of the adult rat primary visual cortex (Oc1B), with males having 19% more neurons than females. In the present study, the role of developmental steroid hormones in the formation of this difference was explored. Male and female rats underwent neonatal hormone manipulation (female + testosterone or dihydrotestosterone; male + flutamide) followed by gonadectomy on postnatal day 20. Animals that did not undergo hormone manipulation were either gonadectomized or sham operated at day 20. Neuron number was quantified in the monocular (Oc1M) and binocular (Oc1B) subfields of the adult rat primary visual cortex using the optical disector technique. As adults, day 20 gonadectomized females, as well as females + testosterone and females + dihydrotestosterone, had significantly more neurons than intact females. There was no difference in neuron number between postnatal day 20 gonadectomized males, males + flutamide, and intact males. Also, intact males had significantly more neurons than intact females in both in Oc1M and Oc1B. It appears that ovarian steroids after day 20 are the primary cause of the lower number of neurons in the primary visual cortex of the female rat.