Sex-Typed Toy Play Behavior Correlates with the Degree of Prenatal Androgen Exposure Assessed by CYP21 Genotype in Girls with Congenital Adrenal Hyperplasia
Abstract
Previous studies have shown that girls with congenital adrenal hyperplasia (CAH), a syndrome resulting in overproduction of adrenal androgens from early fetal life, are behaviorally masculinized. We studied play with toys in a structured play situation and correlated the results with disease severity, assessed by CYP21 genotyping, and age at diagnosis. Girls with CAH played more with masculine toys than controls when playing alone. In addition, we could demonstrate a dose-response relationship between disease severity (i.e. degree of fetal androgen exposure) and degree of masculinization of behavior. The presence of a parent did not influence the CAH girls to play in a more masculine fashion. Four CAH girls with late diagnosis are also described. Three of the four girls played exclusively with one of the masculine toys, a constructional toy. Our results support the view that prenatal androgen exposure has a direct organizational effect on the human brain to determine certain aspects of sex-typed behavior.
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The majority of girls and women with CAH experience a female binary gender identity, yet there is evidence that the strength of that identity may be reduced.
“The majority of girls and women with CAH experience a female binary gender identity (578), yet there is evidence that the strength of that identity may be reduced (577,599).”
From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [599]
Female play can also be altered by neuro-endocrine manipulations.
“although it is well known that female play can also be altered by neuro-endocrine manipulations (Hines 2003; Nordenstrom et al. 2002; Servin et al. 2003).”
From Perinatal Exposure to Low Levels of the Environmental Antiandrogen Vinclozolin Alters Sex-Differentiated Social Play and Sexual Behaviors in the Rat (2005) · cites this paper as Nordenstrom et al. 2002
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References 30 · Cited by 256
- Authors
- Nordenström, A., Servin, A., Bohlin, G., Larsson, A., & Wedell, A.
- Affiliations
- Karolinska Institutet (SE)
- Uppsala University (SE)
- Karolinska University Hospital (SE)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2002-11
- Volume
- 87
- Issue
- 11
- Pages
- 5119-5124
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2097138737
- Cited by
- 256
- References
- 30
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 31 · 2023: 5 · 2022: 10 · 2021: 13 · 2020: 16 · 2019: 9 · 2018: 10 · 2017: 8 · 2016: 13 · 2015: 8 · 2014: 9 · 2013: 11 · 2012: 12
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
- Keywords
- congenital adrenal hyperplasia, toy preferences, prenatal androgen exposure, disease severity, sexual differentiation of the brain, age at diagnosis
- MeSH terms
- Adrenal Hyperplasia, Congenital, Androgens, Behavior, Brain, Female, Genotype, Humans, Play and Playthings, Pregnancy, Prenatal Exposure Delayed Effects, Sex Characteristics, Steroid 21-Hydroxylase
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