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Effects on Gender Identity of Prenatal Androgens and Genital Appearance: Evidence from Girls with Congenital Adrenal Hyperplasia

Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania 16802; and Department of Psychology, Northwestern University, Evanston, Illinois 60208

Address all correspondence and requests for reprints to: Sheri A. Berenbaum, Ph.D., Department of Psychology, 417 Moore Building, The Pennsylvania State University, University Park, Pennsylvania 16802. E-mail: sberenbaum{at}psu.edu.

To address questions about sex assignment in children with ambiguous genitalia, we studied gender identity in girls with congenital adrenal hyperplasia (CAH) in relation to characteristics of the disease and treatment, particularly genital appearance and surgery. A 9-item gender identity interview was administered to 43 girls with classical CAH ranging in age from 3–18 yr, 7 tomboys, and 29 sister control girls. Groups were compared on total score and on individual items. Results showed that, on the total gender identity score, 88% of girls with CAH had scores overlapping those of control girls, but the average score was intermediate between control girls and tomboys. On individual items of gender identity (discomfort as a girl, wish to be a boy), girls with CAH were similar to control girls. Gender identity in girls with CAH was not related to degree of genital virilization or age at which genital reconstructive surgery was done. Thus, moderate androgen excess early in development appears to produce a small increase in the risk of atypical gender identity, but this risk cannot be predicted from genital virilization.

This work was supported by the National Institutes of Health Grant HD19644.

Portions of this manuscript were presented at the meetings of the Midwestern Psychological Association, Chicago, Illinois, May 1998, and the Lawson Wilkins Pediatric Endocrine Society, Boston, Massachusetts, May 2000.

Abbreviation: CAH, Congenital adrenal hyperplasia.

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