Why are autism spectrum conditions more prevalent in males?
Open accessAbstract
Autism Spectrum Conditions (ASC) are much more common in males, a bias that may offer clues to the etiology of this condition. Although the cause of this bias remains a mystery, we argue that it occurs because ASC is an extreme manifestation of the male brain. The extreme male brain (EMB) theory, first proposed in 1997, is an extension of the Empathizing-Systemizing (E-S) theory of typical sex differences that proposes that females on average have a stronger drive to empathize while males on average have a stronger drive to systemize. In this first major update since 2005, we describe some of the evidence relating to the EMB theory of ASC and consider how typical sex differences in brain structure may be relevant to ASC. One possible biological mechanism to account for the male bias is the effect of fetal testosterone (fT). We also consider alternative biological theories, the X and Y chromosome theories, and the reduced autosomal penetrance theory. None of these theories has yet been fully confirmed or refuted, though the weight of evidence in favor of the fT theory is growing from converging sources (longitudinal amniocentesis studies from pregnancy to age 10 years old, current hormone studies, and genetic association studies of SNPs in the sex steroid pathways). Ultimately, as these theories are not mutually exclusive and ASC is multi-factorial, they may help explain the male prevalence of ASC.
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ASD is more frequent in males.
“On the contrary, ASD is more frequent in males (Baron-Cohen et al., 2011)”
From Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes: A systematic review and prevalence meta-analyses (2025) · cites this paper as Baron-Cohen et al., 2011
Variations in testosterone levels have been suggested to partially explain some of these differences.
“variations in testosterone levels have been suggested to partially explain some of these differences [4]”
From Effects of sex and gonadectomy on social investigation and social recognition in mice (2015) · cites this paper as [4]
Converging evidence suggests that fetal testosterone may contribute to the higher prevalence of ASD in males than females (about 4:1).
“Knowledge of environmental factors is growing, as exemplified by converging evidence that fetal testosterone may contribute to the preponderance of ASD in males vs. females (∼4:1) (Baron-Cohen et al., 2011).”
From Unifying Views of Autism Spectrum Disorders: A Consideration of Autoregulatory Feedback Loops (2016) · cites this paper as Baron-Cohen et al., 2011
There is a strong male bias in autism diagnoses, and females may be strongly underrepresented, which may have increased the male-biased understanding of autism.
“although there is a strong male bias in autism diagnoses,17 there is reason to believe that females are strongly underrepresented that may have increased the male-biased understanding of autism.18”
From Intranasal oxytocin enhances intrinsic corticostriatal functional connectivity in women (2017) · cites this paper as [17]
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- Authors
- Baron-Cohen, S., Lombardo, M. V., Auyeung, B., Ashwin, E., Chakrabarti, B., & Knickmeyer, R.
- Affiliations
- University of Cambridge (GB)
- University of North Carolina at Chapel Hill (US)
- Venue
- PLoS Biology
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-06-14
- Volume
- 9
- Issue
- 6
- Pages
- e1001081
- ISSN
- 1544-9173 (ISSN-L)
- 1545-7885
- PMC
- PMC3114757
- OpenAlex
- W2089020381
- Cited by
- 754
- References
- 276
- Citations by year
- 2026: 20 · 2025: 28 · 2024: 51 · 2023: 45 · 2022: 69 · 2021: 48 · 2020: 104 · 2019: 37 · 2018: 49 · 2017: 37 · 2016: 63 · 2015: 57 · 2014: 47 · 2013: 55 · 2012: 43
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Biology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- Wellcome Trust
- National Institute for Health and Care Research
- Medical Research Council
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Keywords
- autism spectrum disorder, sex differences, male bias, extreme male brain theory, empathizing-systemizing theory, sex differences in brain structure, fetal testosterone, autism etiology
- MeSH terms
- Brain, Child, Child Development Disorders, Pervasive, Female, Humans, Male, Pregnancy, Testosterone, Prevalence, Polymorphism, Single Nucleotide
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