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Sadr-Bazzaz M, Talaei A, Sadeghi MJ, Moradi M, Ahmadisoleymani Z, Vasey PL. Association of Recalled Childhood Sex-Typed Behavior with Sexual Orientation and Gender Identity in Iranian Adult Males and Females. JOURNAL OF SEX RESEARCH 2024:1-14. [PMID: 38691343 DOI: 10.1080/00224499.2024.2346926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Same-sex sexual attraction in both males and females has been associated with childhood sex-atypical behavior. Gynephilic females recall behaving in a manner that is less female-typical and more male-typical compared to cisgender androphilic females, whereas androphilic males recall behaving in a manner that is less male-typical and more female-typical compared to cisgender gynephilic males. In addition, male and female ambiphilic individuals exhibit intermediate levels of childhood sex-atypicality. In this study, we examined recalled childhood sex-typed behavior among Iranian cisgender gynephilic males (n = 236), cisgender ambiphilic males (n = 51), cisgender androphilic males (n = 191), transgender androphilic males (n = 60), cisgender androphilic females (n = 243), cisgender ambiphilic females (n = 96), cisgender gynephilic females (n = 32), and transgender gynephilic females (n = 122). Both cisgender androphilic males and cisgender gynephilic females recalled elevated childhood sex-atypicality, scoring intermediate between cisgender gynephilic males and cisgender androphilic females. Male and female ambiphilic participants scored intermediate between their other- and same-sex attracted cisgender counterparts. Transgender androphilic males exhibited hyper-feminized childhood behavior, scoring even more female-typical than cisgender androphilic females. Transgender gynephilic females recalled behaving as male-typical as cisgender gynephilic males. Consistent with previous research, our findings from Iran - a non-Western, Middle Eastern culture - provide cross-cultural support for the universality of childhood sex-atypicality as a normative developmental precursor of monosexual or ambisexual same-sex attraction in both males and females who are cisgender and transgender.
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Affiliation(s)
| | - Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences
| | | | - Marjan Moradi
- Department of Psychology, Toos Institute of Higher Education
| | | | - Paul L Vasey
- Department of Neuroscience, University of Lethbridge
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2
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Lupu DC, Monedero I, Rodriguez-Ruiz C, Pita M, Turiegano E. In support of 2D:4D: More data exploring its conflicting results on handedness, sexual orientation and sex differences. PLoS One 2023; 18:e0280514. [PMID: 37607180 PMCID: PMC10443882 DOI: 10.1371/journal.pone.0280514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 12/28/2022] [Indexed: 08/24/2023] Open
Abstract
In the last few years, several studies have questioned the value of the second-to-fourth digit ratio (2D:4D) as a measure of exposure to sex hormones before birth. Controversy has also extended to the 2D:4D association with individual features previously related to this exposure such as handedness and sexual orientation. Given that it has been argued that sex differences in 2D:4D could be a consequence of body-size differences, we have tested in a large sample the allometric relationship between finger lengths and body size. Our results show that the association is either allometric or isometric, depending on the analyses performed. In any case, the deviation from isometry is not large enough to explain the typically observed sex difference in this trait. We have also tested the association between sexual orientation and 2D:4D, finding a relationship between 2D:4D and sexual orientation in men but not in women. We attribute this discordance with previously published meta-analysis to differences in genetic background, a variable that has gained relevance in recent years in studies involving 2D:4D. Finally, we did not find any relationship between 2D:4D and handedness, evaluated through self-reported preference and hand performance. Our main conclusion is that 2D:4D shows differences between sexes beyond their disparity in body size. In our opinion, 2D:4D can be used cautiously as an indicator of intrauterine exposure to sex hormones taking into account some considerations, such as analysing a very large sample and taking careful measurements of the ethnicity of the sample.
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Affiliation(s)
| | - Ignacio Monedero
- Departamento de Fisiología, Universidad Autónoma de Madrid, Madrid, España
| | | | - Miguel Pita
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, España
| | - Enrique Turiegano
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, España
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3
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Conflitti AC, Spaziani M, Pallotti F, Tarsitano MG, Di Nisio A, Paoli D, Lombardo F. Update on bioethical, medical and fertility issues in gender incongruence during transition age. J Endocrinol Invest 2023:10.1007/s40618-023-02077-5. [PMID: 37071372 PMCID: PMC10371879 DOI: 10.1007/s40618-023-02077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the treatment of these patients to provide a practical approach for clinicians. METHODS A comprehensive literature search within PubMed was performed to provide updates of available evidence regarding the impact on bioethical, medical and fertility issues in gender incongruence during transition age. RESULTS Gender Affirming Hormone Treatment (GAHT) and Gender Affirming Surgery (GAS) can induce unsatisfaction with change, future regrets, and the risk of infertility. This raises ethical issues especially in the management of pubertal patients that remain unresolved. Therapy with GnRH analogues (GnRHa) is intended to delay puberty, so as to give the adolescent a longer period of time to decide whether to continue with the treatments. At the level of physical changes, this therapy may have an effect on bone mineralization and body composition; however, long-term longitudinal data are not yet available. An important feature related to the use of GnRHa is the risk of fertility. Gamete cryopreservation is the most established method of fertility preservation (FP) and should be counselled to transgender adolescents. However, these patients are not always interested in having biological children. CONCLUSION Based on the current evidence, there is a need to conduct further research to clarify certain issues and to standardize clinical practice and improve counselling in transgender adolescent decision making and avoid regrets in the future.
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Affiliation(s)
- A C Conflitti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Science, University Magna Graecia, Catanzaro, Italy
| | - A Di Nisio
- Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Padua, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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4
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Levin RN, Erickson-Schroth L, Mak K, Edmiston EK. Biological studies of transgender identity: A critical review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2127042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rachel N. Levin
- Departments of Biology and Neuroscience, Pomona College, Claremont, CA, USA
| | | | - Kristie Mak
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - E. Kale Edmiston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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5
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Pickering GJ, Anger N, Baird J, Dale G, Tattersall GJ. Use of crowdsourced images for determining 2D:4D and relationship to pro-environmental variables. Acta Ethol 2022; 25:165-178. [PMID: 36097527 PMCID: PMC9452876 DOI: 10.1007/s10211-022-00401-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 01/02/2023]
Abstract
The primary purpose of this study was to examine whether 2D:4D ratios (a putative measure of prenatal androgen exposure) could be determined using participant-submitted hand images. The secondary purpose was to examine whether 2D:4D ratio was associated with pro-environmental behaviors, attitudes, and empathy, given the recent literature linking sex to environmental attitudes and actions. Participants (N = 1065) were asked via an online survey to submit a clear photograph of their right hand, palm side up. Participants also completed a questionnaire to assess (a) demographics, (b) dispositional empathy, and (c) environmental attitudes and behavior. A 2D:4D ratio was calculated for each participant, and the quality of each image was classified as poor, moderate, or good. We then examined the reliability of the 2D:4D image measurements, and the relationship between 2D:4D and our environmental measures. 2D:4D ratios fell somewhat outside of previously reported ranges, but the measurements did show acceptable intra-rater consistency. Although we did not find a sex difference in 2D:4D, we did find a sex by ratio interaction for both empathy and the number of pro-environmental behaviors in which individuals had engaged. Specifically, as 2D:4D ratio increased, males reported lower empathy and less engagement in pro-environmental behaviors, whereas females reported more engagement in pro-environmental behaviors (but no differences in empathy). These findings were contrary to expectations, as we anticipated that greater digit ratios (i.e., feminized) would be associated with greater empathy and pro-environmental behaviors. Overall, the findings of this study present a preliminary examination of the utility of measuring digit ratio with online samples. Furthermore, our results provide information regarding the complex relationship between sex and pro-environmental behaviors.
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Affiliation(s)
- Gary J. Pickering
- Department of Biological Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
- Psychology Department, Brock University, St. Catharines, Canada
- Environmental Sustainability Research Centre, Brock University, St. Catharines, Canada
- Sustainability Research Centre, University of the Sunshine Coast, Sippy Downs, Australia
| | - Nicholas Anger
- Centre for Digital Humanities, Brock University, St. Catharines, Canada
| | - Julia Baird
- Environmental Sustainability Research Centre, Brock University, St. Catharines, Canada
- Sustainability Research Centre, University of the Sunshine Coast, Sippy Downs, Australia
- Department of Geography and Tourism Studies, Brock University, St. Catharines, Canada
| | - Gillian Dale
- Environmental Sustainability Research Centre, Brock University, St. Catharines, Canada
| | - Glenn J. Tattersall
- Department of Biological Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
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6
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Skorska MN, Coome LA, Peragine DE, Aitken M, VanderLaan DP. An anthropometric study of sexual orientation and gender identity in Thailand. Sci Rep 2021; 11:18432. [PMID: 34531440 PMCID: PMC8445993 DOI: 10.1038/s41598-021-97845-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
The biodevelopment of psychological sex differentiation is putatively reflected in several anthropometrics. We examined eight anthropometrics in 1404 Thai participants varying in sex, sexual orientation, and gender identity/expression: heterosexual men and women, gay men, lesbian women, bisexual women, sao praphet song (transgender birth-assigned males), toms (transgender birth-assigned females), and dees (birth-assigned females attracted to toms). Exploratory factor analyses indicated the biomarkers should be analyzed independently. Using regressions, in birth-assigned males, less male-typical second-to-fourth digit ratios in the left hand were associated with sexual orientation towards men regardless of gender identity/expression, whereas shorter height and long-bone growth in the arms and legs were more evident among sao praphet song-who are both sexually oriented towards men and markedly feminine. In birth-assigned females, there were no clear sexual orientation effects, but there were possible gender-related effects. Groups of individuals who tend to be more masculine (i.e., toms, lesbians) showed more male-typical patterns on weight and leg length than some groups of individuals who tend to be less masculine (i.e., heterosexual women, dees). Thus, it appears the various anthropometrics inform separate biodevelopmental processes that differentially relate to sexual orientation and gender identity/expression depending on the measure in question as well as birth-assigned sex.
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Affiliation(s)
- Malvina N Skorska
- Child & Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada
| | - Lindsay A Coome
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Rd. N., Mississauga, ON, L5L 1C6, Canada
| | - Diana E Peragine
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Rd. N., Mississauga, ON, L5L 1C6, Canada
| | - Madison Aitken
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
| | - Doug P VanderLaan
- Child & Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H4, Canada.
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Rd. N., Mississauga, ON, L5L 1C6, Canada.
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7
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Vorsatz M, Sanchez-Pages S, Turiegano E. Masculinity and Lying. Front Psychol 2021; 12:684226. [PMID: 34393911 PMCID: PMC8360853 DOI: 10.3389/fpsyg.2021.684226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Dishonesty in communication has important economic implications. The standing literature has shown that lying is less pervasive than predicted by standard economic theory. We explore whether biology can help to explain this behavior. In a sample of men, we study whether masculine traits are related to (dis)honesty in a sender-receiver game. We study three masculine physical traits: the second-to-fourth digit ratio, facial morphometric masculinity and the facial width-to-height ratio. These biomarkers display significant associations with lying and deception in the game. We also explore the extent to which these effects operate through social preferences or through beliefs about the behavior of receivers.
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Affiliation(s)
- Marc Vorsatz
- Department of Economic Analysis, National University of Distance Education (UNED), Madrid, Spain
| | | | - Enrique Turiegano
- Department of Biology, Autonomous University of Madrid, Madrid, Spain
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8
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Differences in digit ratios between gay men who prefer receptive versus insertive sex roles indicate a role for prenatal androgen. Sci Rep 2021; 11:8102. [PMID: 33854100 PMCID: PMC8046970 DOI: 10.1038/s41598-021-87338-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Among non-human mammals, exposure to androgens during critical periods of development leads to gynephilia (attraction to females), whereas the absence or low levels of prenatal androgens leads to androphilia (attraction to males). However, in humans, retrospective markers of prenatal androgens have only been associated with gynephilia among women, but not with androphilia among men. Here, we asked whether an indirect indication of prenatal androgen exposure, 2D:4D, differs between subsets of gay men delineated by anal sex role (ASR). ASR was used as a proxy for subgroups because ASR groups tend to differ in other measures affected by brain sexual differentiation, such as gender conformity. First, we replicated the finding that gay men with a receptive ASR preference (bottoms) report greater gender nonconformity (GNC) compared to gay men with an insertive ASR preference (tops). We then found that Tops have a lower (male-typical) average right-hand digit ratio than Bottoms, and that among all gay men the right-hand 2D:4D correlated with GNC, indicating that a higher (female-typical) 2D:4D is associated with increased GNC. Differences were found between non-exclusive and exclusive same-sex attraction and GNC, and ASR group differences on digit ratios do not reach significance when all non-heterosexual men are included in the analyses, suggesting greater heterogeneity in the development of non-exclusive same-sex sexual orientations. Overall, results support a role for prenatal androgens, as approximated by digit ratios, in influencing the sexual orientation and GNC of a subset of gay men.
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9
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Butovskaya M, Burkova V, Apalkova Y, Dronova D, Rostovtseva V, Karelin D, Mkrtchyan R, Negasheva M, Batsevich V. Sex, population origin, age and average digit length as predictors of digit ratio in three large world populations. Sci Rep 2021; 11:8157. [PMID: 33854119 PMCID: PMC8046776 DOI: 10.1038/s41598-021-87394-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Recently, a number of authors have claimed that sexual dimorphism in the second-to-fourth digit ratio (2D:4D) is simply dependent on digit length and is an artifact of allometry. The goal of our study is to verify the validity of these assumptions. The study sample comprised 7,582 individuals (3,802 men and 3,780 women) from three large world populations: Europeans (n = 3043), East Africans (n = 2844), and Central Asians (n = 1695). The lengths of the second and fourth digits on both hands were measured. Digit ratios were computed according to standard procedures. Analyses were conducted separately for each hand for the whole sample and in succession for the three large populations. Additionally, we separately tested four age cohorts (≤ 13, 14-18, 19-30, and 31 ≥ years) to test the effect of developmental allometry. The second and fourth digits showed strong positive linear relationships on both hands, and demonstrated an increase with age; digit length in women from the youngest age cohort was longer or equal to that of men, and shorter than men in older age cohorts. However, the 2D:4D magnitude and its sexual dimorphism remained stable throughout the ontogeny. To test for an allometric effect on 2D:4D, the average digit lengths were calculated. Both sex and population origin were permanent reliable predictors of 2D:4D, whereas average digit length was not. Height was applied as another measure of allometric effect on the limited sample (≤ 30 years) from the European population, along with sex and age. No allometric effect was observed in this case. We conclude that sex differences in 2D:4D are not an artifact of allometry.
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Affiliation(s)
- Marina Butovskaya
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991.
- National Research University Higher School of Economics, Moscow, Russia.
- Russian State University for the Humanities, Moscow, Russia.
| | - Valentina Burkova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
- National Research University Higher School of Economics, Moscow, Russia
| | - Yulia Apalkova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
| | - Daria Dronova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
| | - Victoria Rostovtseva
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
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10
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Turan Ş, Boysan M, Tarakçıoğlu MC, Sağlam T, Yassa A, Bakay H, Demirel ÖF, Tosun M. 2D:4D Digit Ratios in Adults with Gender Dysphoria: A Comparison to Their Unaffected Same-Sex Heterosexual Siblings, Cisgender Heterosexual Men, and Cisgender Heterosexual Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:885-895. [PMID: 33694048 DOI: 10.1007/s10508-021-01938-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
We compared gender dysphoria (GD) patients and their same-sex siblings in terms of their 2D:4D ratios, which may reflect prenatal exposure to androgen, one of the possible etiological mechanisms underlying GD. Sixty-eight GD patients (46 Female-to-Male [FtM]; 22 Male-to-Female [MtF]), 68 siblings (46 sisters of FtMs; 22 brothers of MtFs), and 118 heterosexual controls (62 female; 56 male) were included in the study. FtMs were gynephilic and MtFs were androphilic. We found that 2D:4D ratios in the both right hand (p < .001) and the left hand (p = .003) were lower in male controls than in female controls. Regarding right hands, FtM GD patients had lower 2D:4D ratios than female controls (p < .001) but their ratios did not differ from those of their sisters or male controls. FtM GD patients had no significant difference in their left-hand 2D:4D ratios compared to their sisters or female and male controls. While there was no significant difference in right hands between FtM's sisters and male controls, left-hand 2D:4D ratios were significantly higher in FtM's sisters (p = .017). MtF GD patients had lower right-hand 2D:4D ratios than female controls (p <.001), but their right-hand ratios did not differ from those of their brothers and male controls. There was no significant difference in left-hand 2D:4D ratios between MtF GD patients, and their brothers, or female and male controls. FtM GD patients showed significantly masculinized right-hand 2D:4D ratios, while there was no evidence of feminization in MtF GD patients.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey.
| | - Murat Boysan
- Department of Psychology, Faculty of Social Sciences and Humanities, Ankara Social Sciences University, Ankara, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Department of Child and Adolescent Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tarık Sağlam
- Department of Psychiatry, Halil Şıvgın Çubuk State Hospital, Ankara, Turkey
| | - Ahmet Yassa
- Department of Psychiatry, Yozgat State Hospital, Yozgat, Turkey
| | - Hasan Bakay
- Department of Psychiatry, Nizip State Hospital, Gaziantep, Turkey
| | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
| | - Musa Tosun
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
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11
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Amir H, Perl L, Barda S, Lantsberg D, Becker AS, Israeli G, Azem F, Oren A. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod Sci 2021; 29:260-269. [PMID: 33788173 DOI: 10.1007/s43032-021-00561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Parental income inequality and children's digit ratio (2D:4D): a 'Trivers-Willard' effect on prenatal androgenization? J Biosoc Sci 2021; 54:154-162. [PMID: 33557976 DOI: 10.1017/s0021932021000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Income inequality is associated positively with disease prevalence and mortality. Digit ratio (2D:4D) - a negative proxy for prenatal testosterone and a positive correlate of prenatal oestrogen - is related to several diseases. This study examined the association of income inequality (operationalized as relative parental income) and children's 2D:4D. Participants self-measured finger lengths (2D=index finger, and 4D=ring finger) in a large online survey conducted in July 2005 (the BBC Internet Study) and reported their parents' income. Children of parents of above-average income had low 2D:4D (high prenatal testosterone, low prenatal oestrogen) while the children of parents of below-average income had high 2D:4D (low prenatal testosterone, high prenatal oestrogen). The effects were significant in the total sample, present among Whites (the largest group in the sample), in the two largest national samples (UK and USA) and were greater for males than females. The findings suggest a Trivers-Willard effect, such that high-income women may prenatally masculinize their sons at the expense of the fitness of their daughters. Women with low income may prenatally feminize their daughters at the fitness expense of their sons. The effect could, in part, explain associations between low income, high 2D:4D (low prenatal testosterone) and some major causes of mortality such as cardiovascular disease.
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Kristensen TT, Christensen LL, Frystyk J, Glintborg D, T'Sjoen G, Roessler KK, Andersen MS. Effects of testosterone therapy on constructs related to aggression in transgender men: A systematic review. Horm Behav 2021; 128:104912. [PMID: 33309817 DOI: 10.1016/j.yhbeh.2020.104912] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transgender men are assigned female sex at birth, but identify as men. The anabolic and androgenic sex hormone testosterone has been positively associated with aggression. Therefore, transgender men are warned of increasing aggression when initiating testosterone therapy. AIM To explore the literature regarding the effects of testosterone therapy on aggression-related constructs in transgender men. METHODS Following PRISMA-guidelines, PsycINFO, MEDLINE®, EMBASE, and PubMed® were searched in November 2019. Risk of bias was analyzed using the Newcastle-Ottawa-Scale, and result-synthesis was grouped by aggression-outcome. RESULTS Seven prospective cohort studies investigating aggression-dimensions pre- and post-testosterone therapy, reporting on data from 664 transgender men, were eligible. The studies had moderate to high risk of bias due to non-randomization, lack of appropriate control groups, and reliance on self-report. The behavioral tendency to react aggressively increased in three studies out of four (at three months follow-up), whereas only one study out of five found angry emotions to increase (at seven months follow-up). In contrast, one out of three studies reported a decrease in hostility after initiation of testosterone therapy. The remaining studies found no change in aggressive behavior, anger or hostility during hormone therapy. DISCUSSION AND CONCLUSION Four out of seven studies reported an increase in aggression-related constructs, while one study reported a decrease. In all studies reporting changes, the follow-up period was less than 12 months, indicating that gender-affirming testosterone therapy could have a short-term impact on aggression-related constructs. However, the available studies carried a risk of bias, which indicates a need for further research.
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Affiliation(s)
- Tine Taulbjerg Kristensen
- Body Identity Clinic, Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000 Odense C, Denmark; Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
| | - Louise Lehmann Christensen
- Body Identity Clinic, Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000 Odense C, Denmark
| | - Jan Frystyk
- Body Identity Clinic, Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000 Odense C, Denmark
| | - Dorte Glintborg
- Body Identity Clinic, Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000 Odense C, Denmark
| | - Guy T'Sjoen
- Ghent University Hospital, Department of Endocrinology and Center for Sexology and Gender, De Pintelaan 185, 9000 Ghent, Belgium
| | - Kirsten K Roessler
- Ghent University Hospital, Department of Endocrinology and Center for Sexology and Gender, De Pintelaan 185, 9000 Ghent, Belgium
| | - Marianne Skovsager Andersen
- Body Identity Clinic, Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000 Odense C, Denmark
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Jones AL, Jaeger B, Schild C. No credible evidence for links between 2D:4D and COVID-19 outcomes: A probabilistic perspective on digit ratio, ACE variants, and national case fatalities. Early Hum Dev 2021; 152:105272. [PMID: 33227636 PMCID: PMC7670914 DOI: 10.1016/j.earlhumdev.2020.105272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Alex L. Jones
- Swansea University, United Kingdom,Corresponding author
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Richards G, Baron-Cohen S, van Steen T, Galvin J. Assortative mating and digit ratio (2D:4D): A pre-registered empirical study and meta-analysis. Early Hum Dev 2020; 151:105159. [PMID: 32942249 DOI: 10.1016/j.earlhumdev.2020.105159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND It has been hypothesised that the ratio of length between the second and fourth fingers (2D:4D), commonly employed as an indicator of foetal sex hormone exposure, may be positively correlated between heterosexual partners. AIMS As previous evidence has been conflicting, our study aimed to determine whether intra-couple correlations exist for digit ratio variables, and if so, to estimate the size and direction of these effects. STUDY DESIGN We present a preregistered (osf.io/6jg8p) correlational study and quantitative meta-analysis of the available literature, and attempted to locate further published and unpublished data (i.e. 'grey literature') by contacting n = 248 researchers in the 2D:4D and related fields. SUBJECTS n = 58 heterosexual dating couples from the UK took part in our empirical study, and the meta-analysis included data from k = 11 samples. OUTCOME MEASURES We measured digit ratio for the right hand (R2D:4D), left hand (L2D:4D), and average of both hands (M2D:4D), as well as the right-left-difference (D[R-L]). RESULTS We found no evidence of significant positive intra-couple correlations in our own data, but a significant (positive) meta-analytic effect size estimate emerged for R2D:4D (r = 0.072, p = 0.014). The meta-analytic effects for L2D:4D (r = 0.043, p = 0.303), M2D:4D (r = 0.070, p = 0.225), and D[R-L] (r = 0.028, p = 0.649) were all in the same direction but not statistically significant. However, if the sample from Klimek et al. (2014, 2016) were omitted, meta-analysis would also yield a significant positive correlation for M2D:4D (r = 0.128, p = 0.001). CONCLUSIONS Although our findings are based on a fairly small range of studies, which themselves provide a relatively small sample of participants, they do imply the intriguing possibility of small effects of positive assortment in relation to characteristics associated with the prenatal hormonal environment.
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Affiliation(s)
- Gareth Richards
- School of Psychology, Faculty of Medical Sciences, Newcastle University, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, UK.
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
| | - Tommy van Steen
- Institute of Security and Global Affairs, Universiteit Leiden, Netherlands
| | - John Galvin
- Department of Psychology, Birmingham City University, UK
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Siegmann EM, Müller T, Dziadeck I, Mühle C, Lenz B, Kornhuber J. Digit ratio (2D:4D) and transgender identity: new original data and a meta-analysis. Sci Rep 2020; 10:19326. [PMID: 33168880 PMCID: PMC7653965 DOI: 10.1038/s41598-020-72486-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 09/02/2020] [Indexed: 01/20/2023] Open
Abstract
Previously reported associations between second-to-fourth digit length ratio (2D:4D), a proxy for prenatal androgen load, and transgender identity have been inconsistent. The objectives of the present study were to provide additional original data and an updated meta-analysis concerning this association. In a study of 464 participants, we compared the 2D:4D of transgender individuals with age- and sex-matched controls. Patients were recruited at a specialized psychiatrist's medical office, whereas controls were hired via flyers, advertisements, and as convenience sample. A random-effects meta-analysis of the literature (17 samples, n = 3674) also quantifies the overall magnitude of the difference in 2D:4D between transgender individuals and controls. In our study providing new original data, we found a significantly higher (i.e. feminized) left-hand 2D:4D in the male-to-female transgender (MtF) identity [mean age: 32.3 (18; 61)] than in the male control group [mean age: 34.5 (18; 65)] with a Cohen's d = 0.271. Concordantly, the meta-analytic results suggest a significant difference in 2D:4D among MtF individuals compared to male controls [g = 0.153; 95% CI (0.063; 0.243)], which was even more pronounced when individuals had been diagnosed by a clinician instead of self-identified as transgender [g = 0.193; 95% CI (0.086; 0.300)]. In both studies, no significant results were revealed for female-to-male transgender individuals [mean age: 26.1 (18; 53)] versus female controls [mean age: 27.2 (18; 55)]. This original investigation and the updated meta-analysis clarify the association between transgender identity and 2D:4D indicating the influence of prenatal androgen on the development of gender identity in subjects born as males.
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Affiliation(s)
- Eva-Maria Siegmann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Tobias Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Psychiatric Practice, Treibberg 5, 90403, Nuremberg, Germany
| | - Isabelle Dziadeck
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Richards G, Browne WV, Aydin E, Constantinescu M, Nave G, Kim MS, Watson SJ. Digit ratio (2D:4D) and congenital adrenal hyperplasia (CAH): Systematic literature review and meta-analysis. Horm Behav 2020; 126:104867. [PMID: 32998030 DOI: 10.1016/j.yhbeh.2020.104867] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/15/2023]
Abstract
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.
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Affiliation(s)
- Gareth Richards
- School of Psychology, Faculty of Medical Sciences, Newcastle University, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, UK.
| | | | - Ezra Aydin
- Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
| | - Mihaela Constantinescu
- Gender Development Research Centre, University of Cambridge, UK; School of Psychology, University of East London, UK
| | - Gideon Nave
- Marketing Department, The Wharton School, University of Pennsylvania, USA
| | - Mimi S Kim
- Keck School of Medicine, University of Southern California, USA
| | - Steven J Watson
- School of Psychology, Faculty of Medical Sciences, Newcastle University, UK; Department of Psychology of Conflict, Risk and Safety, University of Twente, Netherlands
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Manning JT, Fink B. Evidence for (mis-)understanding or obfuscation in the COVID-19 and digit ratio relationship? A reply to Jones et al. Early Hum Dev 2020; 148:105100. [PMID: 32527517 DOI: 10.1016/j.earlhumdev.2020.105100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- John T Manning
- Applied Sports, Technology, Exercise, and Medicine (A-STEM), Swansea University, Swansea, United Kingdom
| | - Bernhard Fink
- Biosocial Science Information, Biedermannsdorf, Austria..
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Manning JT, Trivers R, Fink B. Digit Ratio (2D:4D), Transgendered Belief, and Transsexual Drug Therapy in the BBC Internet Study. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2020. [DOI: 10.1007/s40806-020-00247-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Amir H, Oren A, Klochendler Frishman E, Sapir O, Shufaro Y, Segev Becker A, Azem F, Ben-Haroush A. Oocyte retrieval outcomes among adolescent transgender males. J Assist Reprod Genet 2020; 37:1737-1744. [PMID: 32430731 DOI: 10.1007/s10815-020-01815-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare fertility preservation (FP) outcomes among adolescent transgender males with those of cisgender females. METHODS This retrospective cohort study included nine adolescent transgender males and 39 adolescent cisgender females who underwent FP between January 2017-April 2019 and September 2013-April 2019, respectively. The transgender males were referred before initiating testosterone, and the cisgender females were referred due to cancer diagnosis before starting anticancer treatment. Statistical analyses compared assisted reproductive technology (ART) data and FP outcomes between two groups. RESULTS Basal FSH levels (5.4 ± 1.7 mIU/mL) and AFC (19.8 ± 5.6) of all transgender males were normal compared with standard references. The mean age of transgender males and cisgender females was similar (16.4 ± 1.1 vs 15.5 ± 1.3 years, respectively, P = 0.064). The amount of FSH used for stimulation was significantly lower among the former compared with the latter (2416 ± 1041 IU vs 4372 ± 1877 IU, P < 0.001), but the duration of stimulation was similar (12.6 ± 4.0 and 10.1 ± 2.8 days, P = 0.086). Peak estradiol level was significantly higher among transgender males compared with cisgender females (3073 ± 2637 pg/mL vs 1269 ± 975 pg/mL, respectively, P = 0.018), but there were no significant differences in number of retrieved oocytes between the two groups (30.6 ± 12.8 vs 22 ± 13.2, P = 0.091), number of MII oocytes (25.6 ± 12.9 vs 18.8 ± 11.2, P = 0.134), or maturity rates (81.5 ± 10.0% vs 85.4 ± 14.6%, P = 0.261). CONCLUSIONS Adolescent transgender males have an excellent response to ovulation stimulation before initiating testosterone treatment. Oocyte cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilie Klochendler Frishman
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Affiliation(s)
- Kenneth J Zucker
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
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