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Sex-Typed Toy Play Behavior Correlates with the Degree of Prenatal Androgen Exposure Assessed by CYP21 Genotype in Girls with Congenital Adrenal Hyperplasia

Department of Pediatrics, Karolinska Institute, Huddinge University Hospital (A.N., A.L.), S-141 86 Stockholm, Sweden; Department of Psychology, University of Uppsala (A.S., G.B.), S-751 42 Uppsala, Sweden; and Department of Molecular Medicine, Karolinska Institute, Karolinska Hospital (A.W.), S-171 76 Stockholm, Sweden

Address all correspondence and requests for reprints to: Dr. Anna Nordenström, Department of Pediatrics, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden. E-mail: anna.nordenstrom{at}klinvet.ki.se.

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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