Abnormal sexual development and psychosexual issues

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Animal models of gonadal hormone influences on the sexual differentiation of brain and behaviour are reviewed and discussed as a basis for predicting hormonal influences on human neurobehavioural development. Behavioural outcomes in clinical intersex cases, including congenital adrenal hyperplasia, androgen insensitivity syndrome, enzymatic deficiencies and situations in which hormones have been prescribed during pregnancy are reviewed. It is concluded that the prenatal or neonatal hormone environment contributes to the development of human behaviours that show sex differences, particularly childhood play behaviour, sexual orientation and core gender identity. There also is some evidence for influences on aggression and cognition. It is also concluded that additional research is needed to determine why some intersex patients assigned and reared as girls are not successful in this identity and role.

References (69)

  • JuraskaJM

    Sex differences in cognitive regions of the rat brain

    Psychoneuroendocrinology

    (1991)
  • JuraskaJM et al.

    Sex and environmental influences on the size and ultrastructure of the rat corpus callosum

    Brain Research

    (1988)
  • McEwenBS et al.

    Aromatization: important for sexual differentiation of the neonatal rat brain

    Hormones and Behavior

    (1977)
  • Meyer-BahlburgHFL et al.

    Gender change from female to male in classical congenital adrenal hyperplasia

    Hormones and Behavior

    (1996)
  • MoneyJ et al.

    Adult erotosexual status and fetal hormonal masculinization and demasculinization: 46,XX congenital virilizing adrenal hyperplasia and 46,XY androgen-insensitivity syndrome compared

    Psychoneuroendocrinology

    (1984)
  • RoslerA et al.

    Male pseudohermaphroditism due to 17β-hydroxysteroid dehydrongenase deficiency

    Journal of Steroid Biochemistry

    (1983)
  • ZuckerKJ et al.

    Psychosexual development of women with congenital adrenal hyperplasia

    Hormones and Behavior

    (1996)
  • American Psychiatric Association
  • BakerSW et al.

    Prenatal androgen, intelligence and cognitive sex differences

  • BerenbaumSA et al.

    Early androgens are related to childhood sex-typed toy preferences

    Psychological Science

    (1992)
  • ClarkAS et al.

    Androgen binding and metabolism in the cerebral cortex of the developing rhesus monkey

    Endocrinology

    (1988)
  • CohenJ

    Statistical power analysis, for the behavioral sciences

    (1988)
  • CollaerML et al.

    Human behavioral sex differences: a role for gonadal hormones during early development?

    Psychological Bulletin

    (1995)
  • DiamondM et al.

    Sex reassignment at birth: long-term review and clinical implications

    Archives of Pediatric Medicine

    (1997)
  • DittmanRW et al.

    Sexual behavior in adolescent and adult females with congenital adrenal hyperplasia

    Psychoneuroendocrinology

    (1992)
  • DohlerK-D et al.

    Pre and postnatal influence of testosterone propionate and diethylstilbestrol on differentiation of the sexually dimorphic nucleus of the preoptic area in male and female rats

    Brain Research

    (1984)
  • EhrhardtAA et al.

    Progestin-induced hermaphroditism: IQ and psychosexual identity in a study of 10 girls

    Journal of Sex Research

    (1967)
  • EhrhardtAA et al.

    Fetal androgens, human central nervous system differentiation, and behavior sex differences

  • Fausto-SterlingA

    Myths of Gender

    (1992)
  • GerallAA et al.

    Effect of ovarian secretions on female behavior potentiality in the rat

    Journal of Comparative and Physiological Psychology

    (1972)
  • GorskiRA

    Localization and sexual differentiation of the nervous structures which regulate ovulation

    Journal of Reproduction and Fertility

    (1966)
  • GorskiRA et al.

    Evidence for the existence of a sexually dimorphic nucleus in the preoptic area of the Rat

    Journal of Comparative Neurology

    (1980)
  • GoyRW et al.

    Sexual differentiation of the Brain

    (1980)
  • GreenR

    Sexual Identity Conflict in Children and Adults

    (1974)

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