Effects of fetal androgen on childhood behavior.

The effects of fetal androgen excess or deficiency on postnatal behavior were examined in 7 males and 14 females with congenital adrenal hyperplasia or hypoplasia aged 3 to 21 years. The subjects were divided into 3 groups: those with androgen excess (A+) comprised a group of 13 patients with classical 21-hydroxylase deficiency and one with 11-beta-hydroxylase deficiency; a normal or reduced androgen (a+) group was represented by one patient with late-onset 21-hydroxylase deficiency and one with congenital adrenal hypoplasia; and a group with absent androgen (A-) consisted of 5 patients with a cholesterol side-chain cleaving-enzyme deficiency. Behavior was evaluated as male (M) or female (F) according to the pattern of play, classification of which was based on data of prevalent play in 1,275 preschool and 400 school boys and girls. Play prevalent in both sexes was classified as neutral (N). The mothers of the patients were requested to check the preferred play during childhood from a randomized play list. The androgen excess group showed M or bisexual (M/F) type, whereas all of the androgen deficient group revealed F type irrespective of gender. In preschool children, coincidence of M or F play type with genetic sex, social sex and androgen exposure was 38%, 53% and 90%, respectively, indicating androgen-dependency of playing patterns. This persisted into school age, although the coincidence rate was slightly changed by environmental effects. These results suggest that fetal androgen plays a role in the sexual differentiation of the central nervous system.