Handedness in women with intrauterine exposure to diethylstilbestrol

An examination of the influence of prenatal sex hormones on handedness: Literature review and amniotic fluid data

Competing theories have posited roles for foetal androgen exposure in the development of human handedness. However, due to practical and ethical considerations, few studies have used hormonal measures to examine this possibility. The current paper reviews this literature and reveals a generally inconsistent pattern of results. We also present data from a longitudinal study of prenatal sex hormone exposure and subsequent handedness. More specifically, we examine correlations between testosterone and estradiol measured from second trimester amniotic fluid and hand preference (Dutch language version of the Edinburgh Handedness Inventory) and hand skill asymmetry (pegboard task) measured at 15 years of age. Prenatal sex hormone exposure was not associated with the direction of hand preference in either males or females. However, in females, high levels of prenatal testosterone were associated with weaker lateralisation of hand skill, and high levels of prenatal estradiol were associated with weaker hand preference. In addition, high levels of prenatal testosterone were associated with increased task duration (i.e., slow hand speed) for the right and left hands of males. The pattern of results observed here is not entirely consistent with any of the main theories linking sex hormones with handedness, suggesting that an association between these variables may be more complex than initially thought.

Second to fourth digit ratio, handedness and testicular germ cell tumors

BACKGROUND

Research on early life exposures and testicular germ cell tumors (TGCT) risk has focused on a possible perinatal etiology with a well-known hypothesis suggesting that hormonal involvement during fetal life is associated with risk. Second-to-fourth digit ratio (2D:4D) and left-hand dominance have been proposed as markers of prenatal hormone exposure.

AIM

To evaluate associations between 2D:4D digit ratio, right minus left 2D:4D (ΔR-L), and left-hand dominance and TGCT in the U.S. Servicemen's Testicular Tumor Environmental and Endocrine Determinants Study.

METHODS

A total of 246 TGCT cases and 236 non-testicular cancer controls participated in the current study, and completed a self-administered questionnaire. Associations between digit ratio, hand dominance and TGCT were estimated using unconditional logistic regression adjusting for identified covariates.

RESULTS

Right 2D:4D was not associated with TGCT [odds ratio (OR) for a one-standard deviation (SD) increase in right-hand 2D:4D: 1.12, 95% confidence interval (CI): 0.93-1.34]. The results were consistent when evaluating the association based on the left hand. The difference between right and left-hand 2D:4D was also not associated with TGCT risk [OR for a one-SD increase in ΔR-L: 1.03, 95% CI: 0.87-1.23]. Compared to men who reported right-hand dominance, ambidexterity [OR (95% CI)=0.65 (0.30-1.41)] and left-hand dominance [OR (95% CI)=0.79 (0.44-1.44)] were not associated with risk.

CONCLUSIONS

These results do not support the hypothesis that prenatal hormonal imbalance is associated with TGCT risk. Given the limited sample size, further evaluation of the relationship between TGCT and prenatal hormonal factors using digit ratio, ΔR-L, or left-hand dominance and larger sample size are warranted.

Steroid 21 hydroxylase deficiency congenital adrenal hyperplasia

Steroid 21 hydroxylase deficiency is the most common form of congenital adrenal hyperplasia (CAH). The severity of this disorder depends on the extent of impaired enzymatic activity, which is caused by various mutations of the 21 hydroxylase gene. This article reviews adrenal steroidogenesis and the pathophysiology of 21 hydroxylase deficiency. The three forms of CAH are then discussed in terms of clinical presentation, diagnosis and treatment, and genetic basis. Prenatal diagnosis and treatment are also reviewed. The goal of therapy is to correct the deficiency in cortisol secretion and suppress androgen overproduction. Glucocorticoid replacement has been the mainstay of treatment for CAH, but new treatment strategies continue to be developed and studied.

Decreased prevalence of left-handedness among females with male co-twins: evidence suggesting prenatal testosterone transfer in humans?

Studies of singletons suggest that right-handed individuals may have higher levels of testosterone than do left-handed individuals. Prenatal testosterone levels are hypothesised to be especially related to handedness formation. In humans, female members from opposite-sex twin pairs may experience elevated level of prenatal exposure to testosterone in their intrauterine environment shared with a male. We tested for differences in rates of left-handedness/right-handedness in female twins from same-sex and opposite-sex twin pairs. Our sample consisted of 4736 subjects, about 70% of all Finnish twins born in 1983-1987, with information on measured pregnancy and birth related factors. Circulating testosterone and estradiol levels at age 14 were available on 771 and 744 of these twins, respectively. We found significantly (p=.006) lower prevalence of left-handedness in females from opposite-sex pairs (5.3%) compared to females from same-sex pairs (8.6%). The circulating levels of neither testosterone nor estradiol related to handedness in either females or males. Nor were there differences in circulating testosterone or estradiol levels between females from opposite-sex and same-sex twin pairs. Birth and pregnancy related factors for which we had information were unrelated to handedness. Our results are difficult to fully explain by postnatal factors, but they offer support to theory that relates testosterone to formation of handedness, and in a population-based sample, are suggestive of effects of prenatal testosterone transfer.

Season of birth and risk for adult onset glioma

Adult onset glioma is a rare cancer which occurs more frequently in Caucasians than African Americans, and in men than women. The etiology of this disease is largely unknown. Exposure to ionizing radiation is the only well established environmental risk factor, and this factor explains only a small percentage of cases. Several recent studies have reported an association between season of birth and glioma risk. This paper reviews the plausibility of evidence focusing on the seasonal interrelation of farming, allergies, viruses, vitamin D, diet, birth weight, and handedness. To date, a convincing explanation for the occurrence of adult gliomas decades after a seasonal exposure at birth remains elusive.

Steroid 21 hydroxylase deficiency congenital adrenal hyperplasia

Steroid 21 hydroxylase deficiency is the most common form of congenital adrenal hyperplasia (CAH). The severity of this disorder depends on the extent of impaired enzymatic activity, which is caused by various mutations of the 21 hydroxylase gene. This article reviews adrenal steroidogenesis and the pathophysiology of 21 hydroxylase deficiency. The three forms of CAH are then discussed in terms of clinical presentation, diagnosis and treatment, and genetic basis. Prenatal diagnosis and treatment are also reviewed. The goal of therapy is to correct the deficiency in cortisol secretion and suppress androgen overproduction. Glucocorticoid replacement has been the mainstay of treatment for CAH, but new treatment strategies continue to be developed and studied.

Serious psychiatric outcome of subjects prenatally exposed to diethylstilboestrol in the E3N cohort study

BACKGROUND

Prenatal exposure to diethylstilboestrol (DES) may induce neurodevelopmental disturbances potentially mediating an increased risk of psychiatric disorders in exposed subjects. Most findings of an increased prevalence of psychiatric disorders in men and women prenatally exposed to DES are not easy to interpret because of selection biases.

METHOD

Information on hormonal treatment during pregnancy and on offspring's medical outcome was collected from women participating in the Etude Epidemiologique de femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective cohort who completed consecutive postal questionnaires on a range of medical events since 1990. Information on hormonal treatment during pregnancy was collected in 1992 and on offspring's medical outcome in 2004. The psychiatric outcome of subjects prenatally exposed to DES was compared to that of their unexposed siblings.

RESULTS

A total of 1352 mothers with DES treatment for at least one pregnancy provided information on 1680 exposed children and 1447 unexposed siblings. After adjustment for duration of follow-up, educational level, history of obstetric complication, prenatal exposure to progestagen drugs or other hormones and parental history of psychiatric hospitalization, no association was found between prenatal exposure to DES and occurrence of strictly defined serious psychiatric outcome (suicide or psychiatric hospitalization) [adjusted odds ratio (OR) 0.8, 95% confidence interval (CI) 0.5-1.2], or of broadly defined serious psychiatric outcome (same events plus psychiatric or psychological consultation) (adjusted OR 1.0, 95% CI 0.8-1.2).

CONCLUSIONS

These findings suggest that the impact of prenatal DES exposure on foetal brain development, if any, is unlikely to increase the risk of serious psychiatric disorders.

Left-handedness and risk of breast cancer

Left-handedness may be an indicator of intrauterine exposure to oestrogens, which may increase the risk of breast cancer. Women (n=1786) from a 1981 health survey in Busselton were followed up using death and cancer registries. Left-handers had higher risk of breast cancer than right-handers and the effect was greater for post-menopausal breast cancer (hazard ratio=2.59, 95% confidence interval 1.11–6.03).

Seasonal trends in the birth of sinistrals

This study examined the proposition that hand preference may change with season of birth in a group of 523 students born in southern Australia. Hand preference and performance measures revealed a higher incidence of sinistrality or weak dextrality for individuals born in winter and autumn compared to summer and spring. These seasonal effects tended to be more pronounced for females compared to males. Similar seasonal patterns have been observed in the northern hemisphere. Previous research has accounted for seasonal changes in hand preference in terms of changes in the frequency of viral infections. It is proposed that seasonal variations in hand preference can also be accounted for by seasonal variations in hormone levels. Higher levels of testosterone in spring compared to autumn have been reported in females. Exposure to higher levels of testosterone during the first trimester of foetal development is thought to promote the development of the right hemisphere. Individuals born in winter would have been exposed to the high testosterone levels associated with spring during the first critical trimester of foetal brain development. The lack of seasonal effect observed for males may be related to endocrinological differences between the male and female foetus.

Foetal testosterone, social relationships, and restricted interests in children

BACKGROUND

Sex-differences exist in some areas of human social behaviour. In animals, foetal testosterone (fT) plays a central role in organising the brain and in later social behaviour. fT has also been implicated in language development, eye-contact, and spatial ability in humans.

METHODS

Fifty-eight children (35 male and 23 female), whose fT was analysed in amniotic fluid, were followed up at age 4. Their mothers completed the Children's Communication Checklist, a questionnaire assessing language, quality of social relationships and restricted interests.

RESULTS

fT was negatively correlated to quality of social relationships, taking sex-differences into account. fT was also positively correlated with restricted interests in boys.

CONCLUSIONS

These findings implicate fT in both social development and attentional focus. They may also have implications for understanding the sex ratio in autism.

Androgenic influences on neural asymmetry: Handedness and language lateralization in individuals with congenital adrenal hyperplasia

This study tested the hypothesis that prenatal androgen levels influence hand preferences and language lateralization, two manifestations of neural asymmetry. Participants were individuals with congenital adrenal hyperplasia (CAH, a genetic disorder that results in excess adrenal androgen production beginning prenatally) (40 females; 29 males) and their unaffected relatives (29 females; 30 males) who ranged in age from 12-45 years. The Edinburgh-Crovitz Inventory and the performance of five simple tasks (the Handedness Activities Test) were the measures of hand preferences, and a dichotic listening task composed of consonant-vowel nonsense syllables was the measure of language lateralization. No sex differences were observed among relative controls in hand preferences or language lateralization. Male participants with CAH were less consistently right-handed for writing than unaffected male relatives, when those who had been forced to switch writing hands from left to right were considered with left-handers as being not consistently right-handed. There were no other significant differences between individuals with CAH and unaffected relatives. These results do not support the hypothesis that prenatal androgens influence language lateralization, nor do they support the Geschwind-Behan-Galaburda model that posits a key role for testosterone in the development of cognitive problems in males, secondary to changes in hemispheric development and cognitive lateralization. Hormonal influences on handedness, although not always consistent, may be more likely. However, given that sex differences in both language lateralization and handedness are small, it is possible that limited sample size precludes the detection of consistent group differences.

Salivary testosterone is related to both handedness and degree of linguistic lateralization in normal women

The aim of this study was to test the hypothesis that individual differences in testosterone (T) are associated with different patterns of linguistic lateralization and hand preference. Twenty left-handed (LH) and 19 right-handed (RH) women filled in a handedness questionnaire and performed a consonant-vowel dichotic listening test (DL-CV). Salivary T was measured by radioimmunoassay (RIA). LH women showed significantly lower mean salivary T than RH women. T levels were negatively correlated with the absolute value of the DL laterality index. Subjects with right ear advantage (REA) were classified into strongly and weakly lateralized following Wexler et al. method (Brain Lang. 13 (1981) 13). When taking into account hand preference, a pattern emerged in that RH-strongly lateralized and LH-weakly lateralized women showed similar T levels. The lowest level appeared for LH-strongly lateralized women and the highest for RH-weakly lateralized women, being significantly different from each other. The results are discussed in terms of several theories that have proposed a link between testosterone and cerebral lateralization.

Hormonally active agents in the environment and children's behavior: assessing effects on children's gender-dimorphic outcomes

BACKGROUND

Early sex hormone exposure contributes to gender-dimorphic behavioral development in mammals, including humans. Environmental toxicants concentrated in contaminated sport fish can interfere with the actions of sex steroids.

METHODS

This study developed an outcome variable by combining gender-dimorphic behaviors that differentiates boys and girls. Offspring of participants in the New York State Angler Cohort Study (NYSACS) were targeted in a parent-report postal survey. Instruments were selected based on findings of gender differences in the general population.

RESULTS

A linear discriminant function model incorporating three gender behavior scales correctly classified the sex of 97.7% of children (252 boys and 234 girls) from a random NYSACS sample. The discriminant function was cross-validated by correctly classifying the sex of 98.4% of children (457 boys and 425 girls) from the remaining NYSACS cases and 97.6% of children (154 boys and 142 girls) from an independent school sample. Within-sex stepwise multiple regression analyses revealed that masculine behavior increased among boys with age and with the number of years of maternal sport fish consumption. In girls, older age and previous live-born siblings were associated with more masculine behavior, whereas feminine behavior increased with the duration of breast feeding. These associations were replicated in an independent sample.

CONCLUSIONS

A linear discriminant function effectively transformed the binary classification of sex (male-female) to a bipolar continuum of gender (masculinity-femininity). Findings from this study are consistent with the hypothesis that environmental contaminants contribute to shifts in gender-role behavior. Future investigations will need to account for competing explanations of this effect.

Psychosexual characteristics of men and women exposed prenatally to diethylstilbestrol

BACKGROUND

Between 1939 and the 1960s, the synthetic estrogen diethylstilbestrol (DES) was given to millions of pregnant women to prevent pregnancy complications and losses. The adverse effects of prenatal exposure on the genitourinary tract in men and the reproductive tract in women are well established, but the possible effects on psychosexual characteristics remain largely unknown.

METHODS

We evaluated DES exposure in relation to psychosexual outcomes in a cohort of 2,684 men and 5,686 women with documented exposure status.

RESULTS

In men, DES was unrelated to the likelihood of ever having been married, age at first intercourse, number of sexual partners, and having had a same-sex sexual partner in adulthood. DES-exposed women, compared with the unexposed, were slightly more likely to have ever married (odds ratio [OR] = 1.1; confidence interval [CI] = 1.0-1.4) and less likely to report having had a same-sex sexual partner (OR = 0.7; CI = 0.5-1.0). The DES-exposed women were less likely to have had first sexual intercourse before age 17 (OR = 0.7; CI = 0.6-0.9) or to have had more than one sexual partner (OR = 0.8; CI = 0.7-0.9). There was an excess of left-handedness in DES-exposed men (OR = 1.4; CI = 1.1-1.7) but not in DES-exposed women. DES exposure was unrelated to self-reported history of mental illness in women.

CONCLUSIONS

Overall, our findings provide little support for the hypothesis that prenatal exposure to DES influences the psychosexual characteristics of adult men and women.

Language lateralization and handedness in women prenatally exposed to diethylstilbestrol (DES)

Hand preferences and language lateralization were assessed in women exposed prenatally to the synthetic estrogen, diethylstilbestrol (DES), and in their unexposed sisters. The DES-exposed women showed an increased degree of hand preference (regardless of direction) and were more likely to be left handed for writing. However, the groups did not differ significantly on a dichotic listening measure of language lateralization. Perhaps as a result of the alterations in hand preferences, the typical relationship between hand preferences and language lateralization was disrupted in the DES-exposed group. Also, within the DES-exposed group, exposure early in gestation correlated with left handedness whereas exposure late in gestation correlated with reduced left ear (right hemisphere) scores on the verbal dichotic task. Results are discussed in terms of theoretical perspectives predicting hormonal influences on sexual differentiation of hemispheric asymmetry and in terms of separate critical periods for hormonal effects on individual sexually differentiated characteristics.

Sexual orientation and handedness in men and women: a meta-analysis

Recent findings suggest that sexual orientation has an early neurodevelopmental basis. Handedness, a behavioral marker of early neurodevelopment, has been associated with sexual orientation in some studies but not in others. The authors conducted a meta-analysis of 20 studies that compared the rates of non-right-handedness in 6,987 homosexual (6,182 men and 805 women) and 16,423 heterosexual (14,808 men and 1,615 women) participants. Homosexual participants had 39% greater odds of being non-right-handed. The corresponding values for homosexual men (20 contrasts) and women (9 contrasts) were 34% and 91%, respectively. The results support the notion that sexual orientation in some men and women has an early neurodevelopmental basis, but the factors responsible for the handedness-sexual orientation association require elucidation. The authors discuss 3 possibilities: cerebral laterality and prenatal exposure to sex hormones, maternal immunological reactions to the fetus, and developmental instability.

Left-handedness in relation to breast cancer risk in postmenopausal women

Breast cancer risk may be influenced by intrauterine exposure to steroid hormones. We evaluated left-handedness, a marker of intrauterine hormone exposure, in relation to breast cancer risk in our population-based, case-control study. Case women 50-79 years of age with a first diagnosis of invasive breast cancer were ascertained through statewide cancer registries in Wisconsin, Massachusetts, and New Hampshire. Control women were identified in each state through lists of licensed drivers (for ages 50-64) and Medicare beneficiaries (for ages 65-79), and selected at random to correspond with the age distribution of case women. Exposure information, including handedness, was obtained through a telephone interview. Our results indicated a modest association between left-handedness and breast cancer risk (OR = 1.42; 95% CI = 1.10-1.83). The effect of left-handedness was modified by age; we observed the greatest risk ratio in the oldest age group. Left-handedness was not associated with breast tumor laterality. Our results are consistent with the hypothesis that intrauterine hormone exposures play a role in the development of breast cancer.

Cognitive ability and cerebral lateralisation in transsexuals

It is still unclear to what extent cross-gender identity is due to pre- and perinatal organising effects of sex hormones on the brain. Empirical evidence for a relationship between prenatal hormonal influences and certain aspects of gender typical (cognitive) functioning comes from pre- and postpubertal clinical samples, such as women suffering from congenital adrenal hyperplasia and studies in normal children. In order to further investigate the hypothesis that cross-gender identity is influenced by prenatal exposure to (atypical) sex steroid levels we conducted a study with early onset, adult male-to-female and female-to-male transsexuals, who were not yet hormonally treated, and nontranssexual adult female and male controls. The aim of the study was to find out whether early onset transsexuals performed in congruence with their biological sex or their gender identity. The results on different tests show that gender differences were pronounced, and that the two transsexual groups occupied a position in between these two groups, thus showing a pattern of performance away from their biological sex. The findings provide evidence that organisational hormonal influences may have an effect on the development of cross-gender identity.

Prenatal diethylstilbestrol exposure and self-reported immune-related diseases

OBJECTIVE

To compare self-reports of immune-related diseases in diethylstilbestrol (DES) daughters and controls. Prenatal exposure to DES has been associated with several malformations in the lower genital tract, a higher prevalence of adenosis, and increased risk of clear cell adenocarcinoma, and estrogen-dependent tumors. Lately, reports have been published indicating a link between DES exposure and alterations in the immune system. The present study focuses on the possible clinical consequences of an affected immune system.

STUDY DESIGN

DES daughters (n=170) and control women (n=123) completed questionnaires containing lists of immune-related diseases, specified into three categories (i) allergies, (ii) auto-immune disorders, and (iii) infectious diseases.

RESULTS

DES daughters reported significantly more disease conditions than the controls. Analyses for separate disease categories (allergies, auto-immune disorders, infectious disease), yielded a statistically significant difference only for infectious disease. Within this last category, two infectious diseases yielded highly significant differences: bladder infection and measles.

CONCLUSION

The present findings suggest that DES daughters are at higher risk of developing immune-related disease states.

Menstrual cycle phase and mood effects on perceptual asymmetry

Several studies have reported shifts in perceptual asymmetry during the menstrual cycle, but the potential confounding effect of mood changes has been largely ignored. In this study, 24 female subjects completed four visual laterality tasks and a mood questionnaire at three phases of the cycle. Results indicate no overall effect of cycle phase on any of the asymmetry or mood scores. However, results revealed significant associations between affect and perceptual asymmetry on a face perception task. Implications for mood effects on perceptual asymmetry and future research on cycle-related shifts in asymmetry are discussed.

Salivary testosterone levels in left- and right-handed adults

It has been proposed that prenatal testosterone (T) may contribute to the development of hand preference and cerebral functional asymmetry in humans. To investigate any persisting association between T and asymmetry in adulthood, left-handed (LH) and right-handed (RH) men and women were administered a hand preference questionnaire and the Fused Dichotic Words Test. Testosterone was measured in samples of saliva. Results showed that LH subjects of both sexes had lower salivary T concentrations than their RH counterparts. Among LH males, subjects with a right-ear advantage in dichotic listening tended to have lower T concentrations than subjects with a left-ear advantage. These results are consistent with the notion that T may be involved in the development of hand preference and cerebral functional asymmetry.

Handedness and other laterality indices in women prenatally exposed to DES

A group of 175 women who had been exposed to diethylstilbestrol (DES) prenatally were compared with 219 unexposed control subjects on four laterality indices: handedness, footedness, eyedness, and earedness. It was found that there was a higher incidence of left-handedness among the DES-exposed subjects than among the controls. It was concluded that intrauterine exposure to the synthetic estrogen DES disturbs the normal process of cerebral lateralization. The mechanism by which this takes place is still unknown.