Postnatal gonadal steroid effects on human behavior

Intersexuality and alternative gender categories in non-Western cultures

BACKGROUND

In the Western world, it is widely accepted as natural - and seen almost as a law of nature - that mankind is divided into two sexes or genders - males and females. In many cultures and societies, however, more than two sex and/or gender categories are recognized, which in some instances refer to the biological sex and in others to gender roles and social status.

AIMS

To give an intercultural comparison of various ways of dealing with gender variance.

METHODS

In the following paper, we review the anthropological literature during the last 100 years describing individuals who live neither as men nor women in various non-Western cultures.

RESULTS

Only rarely, these individuals suffer from disorders of sex development in the modern medical or biological definition: in many if not all societies there have been individuals who are not covered by the gender category of male and female.

CONCLUSION

There thus appears to be a cultural need for people with a special neither-male-nor-female status, which might be classified as 'gender variance'.

A developmental examination of gender differences in brain engagement during evaluation of threat

BACKGROUND

Females appear to be more sensitive and responsive to social cues, including threat signals, than are males. Recent theoretical models suggest that developmental changes in brain functioning play important roles in the emergence of such gender differences.

METHODS

We used functional magnetic resonance imaging to examine developmental and gender differences in activation of neural structures thought to mediate attention to emotional faces depicting varying degrees of threat. Analyses focused on the orbitofrontal cortex, amygdala, and anterior cingulate cortex during the evaluation of threat conveyed by faces. Healthy adolescents (n = 17; 53% male) and adults (n = 17; 53% male) were scanned while they rated how threatening pictures of neutral and emotional (angry, fearful, or happy) faces appeared.

RESULTS

Results indicate significant interactions among age, gender, and face type for activation during explicit threat monitoring. In particular, adult women activated orbitofrontal cortex and amygdala selectively to unambiguous threat (angry) cues, while adult men showed a less discriminating pattern of activation. No gender differences were evident for adolescents, who as a group resembled adult males.

CONCLUSIONS

These findings suggest that there are gender differences in patterns of neural responses to emotional faces that are not fully apparent until adulthood.

Are there physical risk factors for psychogenic non-epileptic seizures in patients with epilepsy?

Patients with epilepsy may have additional psychogenic non-epileptic seizures (PNES). It has been suggested that PNES are more common if patients with epilepsy are female, develop epilepsy later in life and have right-sided brain lesions. We examine whether these or other physical factors affect the risk of PNES in patients with epilepsy in a controlled study.

METHODS

Ninety consecutive patients with PNES and concurrent epilepsy (PNES+E group) and 90 consecutive patients with epilepsy alone (epilepsy group) were compared with regard to the variables sex, age at onset of epilepsy, epilepsy type (focal/generalised), location and lateralisation of epileptogenic zone, aetiology of epilepsy, interictal epileptiform potentials, magnetic resonance imaging (MRI) abnormalities, neuropsychological (NPS) deficits and intelligence quotient (IQ).

RESULTS

Female sex (P<0.001), abnormal visual memory (P=0.012), global NPS impairment (P=0.029), and low IQ category (P=0.005) were associated with a higher risk of PNES. Other variables did not differ between the groups.

CONCLUSIONS

In patients with epilepsy, female sex, poor visual memory or global neuropsychological underperformance and low IQ are associated with an increased risk of PNES. MRI changes, epileptiform EEG abnormalities and location of epileptogenic zone do not show a predilection for one hemisphere.

The missing politics and unsettled science of the trend toward earlier puberty

The age of puberty in many populations has declined steeply over recent centuries and may be declining still. Consequently, today's children tend to experience the hormonal stresses of rapid development at younger ages than did their ancestors, around whose later, if not more gradual, maturation traditional behavioral expectations formed. Little has been made of this "rush to puberty" outside the life sciences. This article reviews its historical documentation, scholarly appreciation, epidemiological correlations, putative physiological and environmental explanations, sociological implications, and largely latent politics.

Gender differences in cerebral blood flow and oxygenation response during focal physiologic neural activity

Using functional magnetic resonance imaging techniques CBF and oxygenation changes were measured during sustained checkerboard stimulation in 38 right-handed healthy volunteers (18 men and 20 women). The average blood oxygenation level dependent (BOLD) contrast technique signal intensity change was 1.67 +/- 0.6% in the group of male volunteers and 2.15 +/- 0.6% in the group of female volunteers (P < .05). Baseline regional CBF (rCBF) values in activated gray matter areas within the visual cortex were 57 +/- 10 mL x 100 g(-1) x min(-1) in women and 50 +/- 12 mL x 100 g(-1) x min(-1) in men, respectively (P = .09). Despite a broad overlap between both groups the rCBF increase was significantly higher in women compared to men (33 +/- 5 mL x 100 g(-1) x min(-1) versus 28 +/- 4 mL x 100 g(-1) x min(-1), P < .01). The increase of rCBF was not correlated with the baseline rCBF (mL x 100 g(-1) x min(-1)) (r(s) = 0.01, P = .9). Moreover, changes of rCBF were not correlated with changes in BOLD signal intensities (r(s) = 0.1, P = .7). Enhanced rCBF response in women during visual stimulation could be related to gender differences in visual physiology or may reflect gender differences in the vascular response to focal neuronal activation. Gender differences must be considered when interpreting the results of functional magnetic resonance imaging studies.

Influence of S-adenosyl-L-methionine on chronic mild stress-induced anhedonia in castrated rats

1. S-adenosyl-L-methionine (SAMe) is the most important methyl donor in the brain and is essential for polyamine synthesis. Methyl group deficiency in the brain has been implicated in depression; on the other hand, polyamines enhance phosphorylation processes, and phosphorylation of functional proteins in neurons in involved in the therapeutic mechanisms of antidepressants. 2. The effect of SAMe in an animal model of 'depression', the chronic mild stress-induced anhedonia, was studied using long-term castrated male and female Lister hooded rats. 3. Chronic daily exposure to an unpredictable sequence of mild stressors produced, within 3 weeks, a significant reduction of the consumption of a sucrose solution. SAMe (100, 200 or 300 mg kg-1 daily i.m.) while having no influence on sucrose intake in non-stressed animals, dose-dependently reinstated sucrose consumption within the first week of treatment, both in male and in female stressed rats. Imipramine (10 mg kg-1 daily i.p.) produced a similar effect after a 3 week treatment. 4. Similarly, a palatable food reward-induced place preference conditioning was developed in SAMe (200 or 300 mg kg-1 daily i.m.)--and in imipramine (10 mg kg-1 daily i.p.)--treated chronically stressed animals (males and females), whilst it could not be obtained in vehicle-treated rats. 5. Moreover, the same doses of SAMe (but not of imipramine) restored the exploratory activity and curiosity for the environment (rearing), in the open-field test. 6. While imipramine caused a blockade of the growth throughout the treatment, SAMe produced only a transient growth arrest during the first week of treatment. 7. These results show that SAMe reverses an experimental condition of 'depression-like' behaviour in rats, the effect being more rapid and complete than that of imipramine, and without apparent side effects.

Serum testosterone levels, mental disorders and criminal behaviour

OBJECTIVE

Although previous studies have revealed an association between androgens and aggression, there is a lack of knowledge of this issue in different mental disorders.

METHOD

The associations between serum testosterone levels and criminal behaviour in different mental disorders were examined using data collected from forensic psychiatric male patients (20 schizophrenics and 42 subjects with personality disorders).

RESULTS

Male criminals with personality disorders had significantly higher serum levels of total and free testosterone than criminal schizophrenics. Among schizophrenics, total (P=0.01) and free testosterone (P=0.01) declined significantly more with age compared to healthy controls and patients with personality disorders, and also correlated with duration of neuroleptic drug use (r=-0.60, P=0.000 for total and r=-0.46, P=0.0001 for free testosterone). The recidivists with personality disorder had higher total (P=0.04) and free testosterone (P=0.05) levels than non-recidivists with personality disorder.

CONCLUSION

Personality disordered criminals with multiple offences had high serum testosterone levels. The low testosterone concentrations among schizophrenics may be due either to long-term use of neuroleptic agents or to the mental illness itself and its possible inhibition of the pituitary-gonadal axis.

Ambiguous genitalia, gender-identity problems, and sex reassignment

This article discusses general issues with regard to gender-identity problems, sex reassignment, and clinical management in patients with ambiguous genitalia, based on a detailed case history of a patient with penile agenesis who has been followed more than 20 years. After initial uncertainty, the patient began to grow up as a boy, lived from the fourth year of life as a girl and young woman, and lived from late puberty on as a man. Over his lifetime he experienced extensive corrective surgery plus hormonal substitution therapy. Pre- and perinatal hormonal conditions, phenomenology of the genitalia, sex of rearing, timing of sex reassignment and corrective surgery, for example, appear to be important components for the development of gender-role behavior, gender identity, and sexual orientation of intersex patients. Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.

Imprinting of female offspring with testosterone results in insulin resistance and changes in body fat distribution at adult age in rats

In women, a relative hyperandrogenicity is statistically associated with insulin resistance and centralization of body fat, which are predictors for the development of non-insulin-dependent diabetes mellitus. The aim of this study was to evaluate the effect of androgenization of newborn female rats on insulin sensitivity at adult age. To mimic the neonatal androgen peak normally observed in male rats, female pups were administered one high dose of testosterone (T) subcutaneously within 3 h after birth. They were then given back to their mothers and followed to adult age. At the end of the week 9, tail samples were taken, showing no differences in fasting plasma concentrations of glucose, lactate, insulin, or free fatty acids between T-treated rats and controls. Plasma concentrations of T and progesterone were significantly lower in the T-treated rats, whereas no differences were found in the levels of corticosterone, estradiol, insulin-like growth factor I, or ACTH. After 10 wk, insulin sensitivity was studied with hyperglycemic and euglycemic hyperinsulinemic (5 mU insulin/kg/min) clamp techniques. The T-treated rats showed insulin resistance with both techniques, which was overcome with time and increasing insulin concentrations during the clamp measurements. The T-treated rats were also heavier and had increased relative weights of skeletal muscles and the spleen. Parametrial, retroperitoneal, and inguinal adipose tissues decreased in weight while mesenteric adipose tissue tended to increase, resulting in an approximately 30-50% larger mesenteric than other adipose tissues. It is concluded that neonatal T imprinting of female rats is followed by insulin resistance, changes in adipose tissue distribution, and an enlarged lean mass, without elevation of circulating T. Similar changes are seen in adult female rats or women receiving T.

Salivary testosterone in children with and without learning disabilities

Previous studies have indicated that the sex steroids have organizational effects upon neural tissue and that abnormal secretion during development may lead to functional anomalies. In this study, we explore the possibility of prepubertal steroid hormone involvement in the etiology of learning disabilities. Salivary testosterone levels in 264 children without learning disabilities (133 males, 131 females) were measured and compared to that in 32 children with learning disabilities (25 males, 7 females). The presence of learning disabilities was significantly associated with higher salivary testosterone. Data from equivalent samples of learning-disabled and control subjects also were compared separately because of disparities in sample size and variable distribution in the total group analysis. A 32-member sample of nonlearning-disabled children was created by randomly selecting individuals who exactly matched the age, race, and sex characteristics of the learning-disabled group. The matched analysis further substantiated the association between testosterone secretion and learning disabilities. Thus, it is possible that some learning disabilities may be associated in part with abnormal testosterone levels.

Neural sexual mosaicism: sexual differentiation of the human temporo-parietal region for functional asymmetry

Sex differences in human brain organization and behavior are documented by several converging lines of evidence based on patterns of functional asymmetry and cognitive abilities in normal adults and children, in patients with unilateral brain damage, and in clinical groups having atypical levels of sex hormones. Sex differences also exist in the structure of the human brain, and these are reviewed in detail herein. In addition, dichotomous differences, rather than just differences along a continuum, are noted in anatomical-functional correlations between men and women. Many of the anatomical differences cluster in the temporo-parietal regions of the brain, which subserve the asymmetric representation of some linguistic, motoric and spatial functions. The hypothesis is presented that development of the temporo-parietal region of the human brain is an anatomic network dependent on the organizing effects of sex hormones during embryonic or perinatal sexual differentiation, and that in each sex the pattern of functional asymmetries and cognitive attributes is differentially influenced by early sex hormone exposure. It is further suggested that the naturally occurring regressive events of cell death and axon elimination in early brain development contribute to the variation in the structure of the temporo-parietal region, and that this mechanism is differentially influenced by sex hormones in each sex. The specific, directional hypothesis put forward is that in early development of the male brain, lower levels of androgenic hormones or receptors lead to less regressive events in some brain regions, such as the temporo-parietal region, resulting in a larger isthmus of the corpus callosum, less cerebral functional asymmetry, and some cognitive correlates. Some supporting evidence for this hypothesis from neuropsychological studies of clinical groups and homosexual individuals is presented. The neuroanatomical correlate of functional asymmetry in posterior brain regions in women is not evident. The neural regressive events which occur in each sex may be related differently to lateralization. The concept of sexual mosaicism in the human brain is discussed.

Sex difference in the bed nucleus of the stria terminalis of the human brain

A quantitative analysis of the volume of the darkly staining region of the posteromedial bed nucleus of the stria terminalis was performed on the brains of 26 age-matched male and female human subjects. We suggest the term "darkly staining posteromedial" component of the bed nucleus of the stria terminalis (BNST-dspm) to describe this sexually dimorphic region of the human brain. The volume of the BNST-dspm was 2.47 times greater in males than in females. This region in humans appears to correspond to an area of the bed nucleus of the stria terminalis in laboratory animals that exhibits volumetric and neurochemical sexual dimorphisms, concentrates gonadal steroids, and is anatomically connected to several other sexually dimorphic nuclei. Furthermore, the bed nucleus of the stria terminalis is involved in sexually dimorphic functions, including aggressive behavior, sexual behavior, and gonadotropin secretion, which are also influenced by gonadal steroids. Therefore, it is possible that in human beings as well, gonadal hormones influence the sexual dimorphism in the BNST-dspm and that this morphological difference, in part, underlies sexually dimorphic function.

Disorders of sexual differentiation and development. Psychological aspects

Children with abnormalities in sexual differentiation and development can have a smooth course of psychosocial development in spite of the significant risks and challenges they face. Chances for a positive emotional outcome are made more likely by the careful handling of these patients at the time of first presentation. Parents' unambiguous acceptance of the child's sex of rearing and early surgical intervention to normalize the child's external genital appearance are critical elements in a positive outcome. Further, the patterns of behavior documented in the materials reviewed in this article suggest difficulties of immaturity and social development rather than significant psychopathology. Parent-child interactions were repeatedly found to be central to the child's emotional well-being, underscoring the need to provide parents with adequate counsel and support. These patterns, however, represent findings across groups of patients and cannot predict the emotional, social, or academic functioning of any individual. Within all these clinical syndromes there is great individual variation in social, emotional, and physical presentation. Finally, rather than minimizing problems, physicians need to educate parents so they can be active advocates for their children in the educational and social arenas.

Gender identity disorder and psychosexual problems in children and adolescents

This article provides a selected overview of the literature on gender identity disorder and psychosexual problems in children and adolescents, with a focus on diagnosis, clinical course, etiology, and treatment.

17-beta Oestradiol Pretreatment of Mouse Striatal Neurons in Culture Enhances the Responses of Adenylate Cyclase Sensitive to Biogenic Amines

Embryonic striatal neurons from the mouse grown in primary culture (6 day old culture) were used in order to investigate the effects of 17-beta oestradiol (17-beta E2) on biogenic amine-sensitive adenylate cyclases. Pretreatment (28 h) of intact cells with 17-beta E2 (10-9 M) enhanced cyclic AMP production induced by either dopamine, isoproterenol, serotonin, or 2-chloro-adenosine (maximal effective concentrations). These effects of 17-beta E2 on biogenic amine-sensitive adenylate cyclases occurred after several hours (8 h at least) and were seen in most cases with a concentration as low as 10-11 M (EC50: 10-10 M). They were additive with those induced by phenol red (5.6 microg/l) and chemically specific since 17alpha-oestradiol, 2(OH)17-beta E2, progesterone, and dexamethasone were without effect. In addition, they were not seen in cells which had been pretreated (30 h) with cycloheximide or alpha-amanitin, suggesting an involvement of de novo protein synthesis. Since 17-beta E2 did not influence cyclic AMP production induced by either forskolin or manganese ions, the stimulatory effects of 17-beta E2 pretreatment on biogenic amine-sensitive adenylate cyclases were not linked to an increase in the amount of enzyme catalytic units. 17-beta E2 pretreatment enhanced twofold the number of beta-adrenergic receptors (as estimated by the specific binding of (125I)iodocyanopindolol) but did not, in contrast, affect either the number or the affinity of dopaminergic receptors (as estimated by (125I)SCH 23982 binding). Therefore, the enhancing effects of 17-beta E2 pretreatment on biogenic amine-sensitive adenylate cyclases could be related either to an increased number of coupled receptors or to modifications of the adenylate cyclase transducing system (occurring probably at the G-protein level) or to a combination of the two.

Is greater female longevity a general finding among animals?

(A) There are data showing beyond question a gender gap, with women living longer than men, especially in economically developed societies. There is greater male vulnerability to the major causes of human death. (B) In lower animals there are data suggesting a female survival advantage to adult life in many species, but the observations do not consider longevity or survival to an advanced age. (C) In laboratory rodents kept under controlled conditions the relationship of sex to longevity is variable, with males sometimes showing greater longevity than females and with life span being dependent on factors like breeding and diet. (D) Similar genetic and hormonal processes operate in humans and in non-human mammals including the genetic mechanism of sex determination, the hormonal consequences of sex determination, and the effects of hormones on processes which affect longevity such as cholesterol levels and immune functions. (E) Causes of death in humans and animals are different, and it seems unlikely, therefore, that the same mechanisms could be determinants of longevity in all mammalian species. (F) Human male and female longevity continue to change, and it is likely that the gender gap will narrow, with societal and medical changes in post-industrial societies reducing the male disadvantages in behaviour and in the handling of cholesterol. (G) It remains an important question whether part of the gender gap seen in humans is based on other differences in the basic biology of males and females.

Is early effeminate behavior in boys early homosexuality?

This report continues the study of early effeminate behavior in boys. A previous article reported on the long term follow-up of 55 boys and the resulting outcome in homosexuality. In this paper an effort is made to explore further the nature of the connection between childhood effeminate behavior and adult homosexuality. Individual signs are discussed with regard to relevant aspects of their development. It is concluded that early effeminate behavior is not merely a forerunner of homosexuality in that it forecasts homosexuality, but that is is in fact the earliest stage of homosexuality itself.

Structure-activity relationships of steroid hormones on muscarinic receptor binding

A total of fifty steroidal compounds were tested for their inhibition on the binding of muscarinic receptor antagonist, [3H]quinuclidinyl benzilate ([3H](-)QNB), to the hypothalamic membranes prepared from male rats. Among the compounds tested, the active structures (with IC50 values less than or equal to 100 microM in parentheses) are: progesterone (40), 5 beta-pregnane-3,20-dione (40), deoxy-corticosterone (50), 5 beta-pregnane-17 alpha,21-diol-3,20-dione (30), 11-desoxy-17-hydroxycorticosterone (22), 17 alpha-hydroxyprogesterone (20), 5 beta-pregnan-17 alpha-ol-3,20-dione (24), 5 beta-androstane-3,17-dione (100), and 5 beta-dihydrotestosterone (100). By examining all the compounds tested, the following structure-activity relationship became apparent: (a) The ring A-reduced steroidal structures with a 5 beta-conformation were more potent than those with a 5 alpha-conformation; (b) 17 alpha-hydroxylation of the steroidal ring increased the steroid's inhibitory activity; (c) The C3 carbonyl group was essential for activity; (d) Reduction of the C3 carbonyl group or aromatization of the ring A abolished the steroid's inhibitory activity; (e) Oxidation of the C11 position of ring C resulted in a decrease or loss of inhibitory activity; and (f) Different modifications of the side chain of ring D by acetylation resulted in either an increase or a decrease in the inhibitory activity. The structure-activity relationship as revealed in this study might provide an insight for the synthesis of a steroidal molecule with a high affinity for the muscarinic receptor as well as for the search of a more potent and physiologically relevant steroidal metabolite possessing the ability to interact with the muscarinic receptor.

Gender dysphoria in a child with true hermaphroditism

This case report describes the psychosexual development of a child with true hermaphroditism who was assigned to the male sex at birth, but reassigned to the female sex at age two months. Given this child's excessive exposure to male sex hormone in utero, relative to physically normal females, one would predict a biological predisposition to behave in a masculine manner. This has occurred since two years of age. In addition, this child has had periodic episodes of gender disturbance, dysphoria, and ambivalence. In contrast, a physically normal fraternal twin sister has been conventionally feminine. A number of psychosocial factors appeared to have exacerbated the biologic predisposition to behave in a masculine manner, and thus may have been responsible for "pushing" this child into varying degrees of gender identity conflict. These included a closer father-daughter than mother-daughter relationship, parental tolerance of cross-gender behavior, and a mother who has been psychologically disturbed since the birth of her children. The heuristic value of this case will be discussed in relation to contemporary models of psychosexual development which emphasize the interaction of biological and psychosocial factors.

Testosterone levels change with subsistence hunting effort in !Kung San men

Although little is known empirically of the physiology of human hunting, arguments for innate biological bases of gender-dimorphic behaviors such as aggression frequently point to the role of hunting in human evolution. Study of !Kung San hunter-gatherer men demonstrated that the diurnal pattern in serum testosterone was altered during a six-day hunt, compared to pre- and post-hunt levels, due mainly to elevation of evening values. Hunting success did not correlate with any testosterone measures. The pattern of changes observed is most consistent with the known concomitants of moderate prolonged exercise.

Observations in a preliminary open trial of estradiol therapy for senile dementia-Alzheimer's type

Previous studies have suggested that estrogen may have an effect on cognitive and emotional function in women. Studies in rodents and non-human primates have demonstrated the presence of estrogen receptors in brain, and that estrogen can affect behavior in animals. Estrogen administration to ovariectomized rats increases choline acetyltransferase activity in certain regions of brain. Choline acetyltransferase activity is known to be significantly decreased in senile dementia-Alzheimer's type (SDAT). Based on these observations, we treated seven women with SDAT with low dosages of estradiol over a six week period. A battery of assessments was performed throughout the study period. Significant improvements in three women were noted on measures of attention, orientation, mood and social interaction. These estrogen-responsive women were characterized by dementia associated with an affective disorder, older age at onset, and evidence of osteoporosis. Side effects of estradiol therapy included withdrawal bleeding in one woman and transient breast tenderness in another. Estradiol therapy thus may benefit some postmenopausal women with SDAT. The occurrence of osteoporosis in the estrogen-responsive group suggests that SDAT in some women may be associated with or related to a systemic estrogen deficiency state. However, considering the potential for serious side effects as a result of estrogen therapy, the current risk to benefit ratio precludes the routine clinical use of estrogen for dementia until careful clinical research trials have been performed.

Effect of ovariectomy and estrogen on [3H]imipramine binding to different regions of rat brain

In rats, 35 days after ovariectomy, the number of [3H]imipramine binding sites increased more than 200% in striatum, hippocampus and hypothalamus but it did not change in cerebral cortex and brain-stem. Estradiol-17 beta acting in vitro inhibited [3H]imipramine binding in control membranes of striatum, hippocampus and hypothalamus, but not in the same regions from ovariectomized rats.

Individual differences in mood in early childhood: their relation to gender and neonatal sex steroids

Predominant mood states were assessed for 104 children via 24-hr mother diaries during the first 2 years of life. Consistent sex differences were found across ages and across cohorts: boys were more often reported to be in a happy/excited mood, girls in a quiet/calm mood. The sexes did not differ in the frequency of negative moods (including crying), however. Scores for happy/excited and quiet/calm mood states were quite stable across the ages sampled: 6, 9, 12, 18, and 26 months. These stabilities were generally greater for boys. Negative moods showed only borderline stability. Relationships between the mood scores and five sex-steroid hormones (progesterone, androstenedione, testosterone, estrone, and estradiol), assayed from umbilical cord blood at the time of the children's birth, were assessed. For boys small, but significant, positive relationships were found between happy/excited moods and androstenedione, estrone, and progesterone. Correlations of opposite sign were found between these hormones and boys' scores for quiet/calm mood. For girls, the correlations were low and insignificant, but generally of opposite sign from those found for boys, and a number of hormones showed significant sex-by-hormone interactions in their relation to children's mood scores. The implication of these findings for the understanding of sex differences is discussed. Also discussed are the problems of interpretation posed by the intercorrelations among hormones when hormone scores are used for prediction of aspects of later development.

Changes in saliva testosterone after psychological stimulation in men

Saliva testosterone (ST) concentration was measured in 20 young adult and healthy men before, during and after the presentation of five different films. The films were selected to provoke erotic, sexual, aggressive, stressful and neutral stimulation, respectively. An increase in ST was found 15 min after the onset of both the erotic and the sexual stimulation, while a decline of ST levels was observed during the stressful movie showing dental surgery. No changes were found for either the neutral or the aggressive stimulant. Furthermore, no differences were found between ST levels before and after the showing of any of the films. Thus, saliva testosterone responds quickly to psychological stimulation, and may provide a practical alternative to testosterone measurements in serum under psychological test situations.

Behavior problems and social competence in girls with true precocious puberty

We report a controlled standardized behavioral assessment of 33 girls with true precocious puberty using the Child Behavior Checklist. Although a majority of the girls were reported not to have behavior problems, many were reported to have a dysphoric adjustment to their condition. Twenty-seven percent of the girls with true precocious puberty scored greater than 2 SD above the mean on the Total Behavior Problem scale 10 times the expected prevalence rate. They also scored significantly higher (P less than 0.01) than matched controls on both the internalizing or "overcontrolled symptom" and externalizing or "undercontrolled symptom" scales. Forty-eight percent scored greater than 2 SD above the mean on the Social Withdrawal scale. The high prevalence of reported problem behaviors in this sample may be related directly or indirectly to the precocious maturation mediated by biologic, psychologic, social, and environmental variables. Although elevated levels of sex steroids may directly contribute to increased aggressive and hyperactive behaviors, they may also be modified by social and environmental factors.

Penile malformation, gender identity and sexual orientation

Gender identity and sexual orientation were investigated in 34 men operated for hypospadias in childhood and in 36 matched control subjects. Independent psychiatric assessments from semi-structured interviews, and double-blind formalized psychological ratings from the Rorschach, yielded similar findings. The probands were less secure in their maleness but were similar in sexual orientation as compared to the controls. A third blind, independent measure of unconscious gender identity, the Franck Drawing Completion Test, gave further evidence of uncertain gender identity in the patients. A self-administered inventory, the Gough Femininity Scale, showed a tendency for the patients to take more feminine sex roles. The findings are discussed from psychoendocrinological as well as psycho-analytical view points. The need for early psychological preventive measures for hypospadic boys and their parents is stressed.

Androgens and personality in normal men and men operated for hypospadias in childhood

Serum levels of LH, FSH, prolactin and androgens were assayed in 33 adult men operated for a penile malformation (hypospadias) in childhood and in 34 matched controls. Two cases of severe hypospadias had signs of hypergonadotrophic hypogonadism. Three moderately severe cases possibly had a central relative androgen receptor insensitivity. Patients had lower levels of 5 alpha-dihydrotestosterone in serum, unrelated to the severity of the hypospadias. The hypospadias patients have previously been shown to be more neurotic and inhibited both socially and sexually than the controls, which might be related to defective androgenic functioning. Relations between androgen levels and psychological variables were studied. Low testosterone levels were related to higher hostility scores in Rorschach. Relations between androgens and other personality characteristics could not be shown.

Data on virilization and erotosexual behavior in male hypogonadotropic hypopituitarism during gonadotropin and androgen treatment

The goal of this investigation was to assess whether or not gonadotropin therapy enhanced the degree of virilization and psychosexual behavior of men with hypogonadotropic hypopituitarism. Pre- and post-gonadotropin assessments of virilization in four men indicated that gonadotropin therapy was associated with dramatic improvements in the degree of virilization that each man previously obtained on androgen only. Retrospective interview data on erotosexual behavior indicated improved erotosexual function on gonadotropin as compared to the prior androgen treatment. These data suggest that complete virilization in these men was partially gonadotropin dependent. Whether or not the behavioral benefits reported by these men represented a direct or synergistic effect of gonadotropin in the expression of erotosexual behavior or an indirect effect of improved virilization can not be answered by these data.

Male pseudohermaphroditism due to 17 beta-hydroxysteroid dehydrogenase deficiency: studies on the natural history of the defect and effect of androgens on gender role

Studies within the Arab population in Israel revealed 25 pseudohermaphrodites due to 17 beta-hydroxysteroid dehydrogenase (17 beta-HSD) deficiency. Twenty-three individuals, presently living in the Gaza strip, belong to a very large inbred kinship which extends over 8 generations. All affected subjects (46, XY) were born with mild to moderate degrees of ambiguity of an apparently normal-looking female genitalia and therefore were reared as girls. In childhood, genital abnormalities consisted of a clitoral-like phallus surrounded by a chordee, non-fused labial-scrotal folds and a urogenital sinus. The testes were in the inguinal canals, or rarely, in the labial-scrotal folds. Wolffian structures were normally differentiated while Mullerian structures were absent. At puberty, subjects developed a male body habitus with abundant body hair and beard. Gynecomastia was absent. The phallus and testes enlarged to adult proportions while the prostate remained small. Together with the physical change from girls to boys they developed a male identity having erections and ejaculations, which in 7 cases led to the spontaneous adoption of a male gender role. In adults the hormonal abnormalities consisted of greatly elevated delta 4-androstenedione (delta 4) (350-1267 ng/dl) associated with subnormal testosterone (T) levels (0.9-3.1 ng/ml). Dihydrotestosterone (DHT) levels, with the exception of 1 patient, were relatively low in all cases (27-35 ng/dl). Children had low levels of delta 4, T and DHT, which were normal for age. Although from puberty on there was a significant rise of the 3 androgens, delta 4 always remained extremely elevated and T and DHT relatively low when compared to normal controls. Dexamethasone failed to suppress the androgen pattern while HCG augmented the defect, making the diagnosis possible in 2 prepubertal children. Dehydroepiandrosterone (DHEA) and 17-hydroxyprogesterone (17-OHP) levels were normal or moderately elevated. Estradiol (E2) levels were normal in children and all but 2 adults, who had high levels. LH and FSH levels were very high after puberty, but normal before. However, there was an overresponse to LHRH in all age groups. The contrast between the lack of intrauterine virilization of the external genitalia in fetuses with 17 beta-HSD deficiency versus the marked masculinization that occurs after puberty still remains a puzzling phenomenon. It is conceivable that the postpubertal development of a male phenotype with change of gender identity and role occurs due to the joint effect of delta 4, T and DHT, even though secreted in inadequate proportions. Thus masculinization in these individuals is a slow process requiring a longer period of time than that of normal puberty to be completed.

Cytomegalovirus infection of murine testicular interstitial Leydig cells

We studied the susceptibility of mouse testicular interstitial Leydig cells to cytomegalovirus both in vivo and in vitro. The in vivo studies included intratesticular and intraperitoneal infection of 6-week-old mice with murine cytomegalovirus (MCMV); the in vitro studies involved an MCMV-Leydig cell interaction using a Leydig tumor cell line (I-10). MCMV-specific antigens were detected in interstitial Leydig cells in sections of MCMV-inoculated testes by an indirect immunofluorescence test. MCMV DNA was also localized in the same testes cells derived from mice, which received intratesticular and intraperitoneal MCMV inoculations, respectively, by in situ DNA-RNA hybridization. Cytopathic effects were seen in MCMV-infected I-10 cell cultures 2 or more days after exposure to MCMV. The infected cells showed intranuclear inclusions characteristic of cytomegalovirus when stained with May-Grunwald-Giemsa stain. The indirect immunofluorescence test was also positive with MCMV-infected I-10 cells. MCMV DNA was detected in these cells by in situ DNA-RNA cytohybridization, and the presence of viral particles in MCMV-infected I-10 cells was confirmed by electron microscopy. Thus, we conclude that the interstitial Leydig cell is susceptible to MCMV infection both in vivo and in vitro.

Actions of estrogens and progestins on nerve cells

Estrogens and progestins alter electrical and chemical features of nerve cells, particularly in hypothalamus. Temporally, these events follow nuclear receptor occupation by these steroids, although not all effects have been proved to depend on translocation of receptors to the nucleus. Narrowing studies to focus on particular medial hypothalamic cells has been useful for understanding some of the actions of these steroids in brain. The variety of morphological, chemical, and electrical effects allow for a multiplicity in the cellular functions controlled by these hormones.

Hormones and psychosexual differentiation: implications for the management of intersexuality, homosexuality and transsexuality

During fetal development of subprimate mammals, sexual differentiation of the genitals and of specific sex-dimorphic brain systems depends on androgens; corresponding sex differences are displayed in prepubertal behaviours as well as in behaviours that depend on activation by pubertal hormones. In human beings, fetal hormones play the same role in genital differentiation. Hormone-dependent structural brain changes are also very likely but have not yet been demonstrated. The corresponding effects of fetal hormones on childhood behaviour have been found both in subhuman primates and in man, while the evidence concerning later behaviour, including sexual orientation, is not yet clear. The development of gender identity in humans is a cognitive process that has no counterpart in animal behaviour and is unlikely to be based on a specific hormone-sensitive brain system. It appears that the hormone-dependent variations of sex-dimorphic behaviour in childhood can be accommodated within either gender identity, provided that the child's physical appearance is gender adequate and the parental (or other caregivers') rearing style does not interfere with typical gender role development. In intersex individuals, changes in gender identity seem to occur primarily when genital and/or general physical appearance are in conflict with the assigned gender and/or when rearing has been ambiguous. The available descriptions of such changes do not seem compatible with a primarily neuroendocrine explanation. Thus, decisions on sex assignment and reassignment of intersex patients need to be based on expected social and sexual functioning, and the clinical management of such patients must minimize the risk of ambiguous rearing and of the development of a gender-incongruent physical appearance. The development of a sexual orientation in humans as hetero- or homosexual does not seem to depend on pubertal hormones. The evidence for a role of fetal hormones is suggestive, but the issue is not yet settled. Attempts to implicate the H-Y antigen in the aetiology of transsexuality seem to have failed; psychoendocrine research here parallels that on sexual orientation. Some recent developments in the management of transsexual patients are discussed.

Sexuality and pregnancy: a review

Marital success and failure may be related to sexual satisfaction, including orgasmic capability. Pregnancy represents a life crisis to the pregnant woman and her husband. Complex psychosocial and physiological demands may produce insecurities, anxieties, and somatic complaints. The expectant mother may seek to fulfill increasing nurturant needs through increased physical contact such as cuddling or being held. A pregnant woman's interest in sexual activity may be affected by her changing physical appearance and the hormonal milieu of pregnancy. Although there are marked individual variations and methodological biases and differences among empirical studies, pregnancy appears to be usually accompanied by a decrease in sexual desire, coital frequency, and orgasm. Sexual behavior in pregnancy has been traditionally restricted and is currently poorly defined. Sexual proscriptions may precipitate sexual frustration and marital estrangement. Abortion is only rarely caused by coitus. The relationship of coitus and orgasm to prematurity and distress of the fetus and newborn has not been clearly established. Coitus can indirectly result in maternal, fetal, and neonatal morbidity and mortality through the spread of sexually transmitted diseases. Deaths from air embolism in pregnancy associated with cunnilingus and vaginal insufflation have been reported.