The Berenbaum Lab
Sex and gender matter
A longitudinal study of people with Congenital Adrenal Hyperplasia (CAH)
How do prenatal sex hormones influence gender development?
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Starting in 1985, we met with boys and girls with CAH as well as their unaffected siblings or cousins. We met up with them several times over the course the next two decades to find out about how children with CAH differ from children without CAH in their gendered behaviors, interests, and psychological development.
Click on the images below for more information on our findings.
Girls with CAH are interested in boys' toys and activities in childhood and adolescence.
Girls with CAH are more interested in boys' toys and less interested in girls' toys than are girls without CAH. When the girls (age 3-12) played with a standard set of toys, girls with CAH (compared to their sisters without CAH) played more with boys' toys, such as cars, trucks, and Lincoln Logs, and less with girls' toys, such as dolls and kitchen toys
When the children told us about their activities, girls with CAH reported playing more with boys' toys and less with girls' toys. And when parents told us about their children's activities, they reported the same pattern.
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This is one of the most consistent findings from studies of girls with CAH. In subsequent studies, we asked whether girls with CAH continue to be interested in "male -typical" activities beyond childhood – and we found that the answer is “yes.” Other researchers have too.
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Women with CAH are interested in jobs typically preferred by men.
Young adult women with CAH are more likely than their unaffected sisters to be interested in careers that involve investigation (such as astronomer or surgeon), and technical work (such as mechanical engineer or carpenter).
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Our colleagues in Sweden have extended this work to shown that women with CAH are not just interested in these kinds of jobs, but they actually are more likely than women without CAH to work in them. And there is some suggestion that women with CAH have higher income than women without CAH.
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These interests seem to be specifically related to prenatal androgens: Girls and women with severe forms of CAH (for example, severe salt-wasting) are more likely to be interested in male-typical activities than girls and women with mild forms of CAH.
There is still variation among women and girls with CAH.
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Women and girls with CAH are not like men. They are more interested in male-typed activities than typical girls, but less interested than typical boys.
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There is variation among women with CAH, just like people without CAH. Some women are going to show these differences in activity interests, and some will not.
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Just because women with CAH may not have female-typical interests, does not mean there is anything wrong with them. In fact there is increased societal support for these women and girls.
Overall, findings from many researchers in different countries show that it is typical for girls and women (especially those with salt-wasting CAH) to have “male-typical” interests early in development because of hormones acting on the brain before birth.
Girls and women with CAH appear to have better spatial abilities than girls and women without CAH.
Spatial abilities are measured in a number of ways. Consider the example below. The shape on the left is the same as 2 on the right.
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If you are good at this, you are probably good at packing the trunk of your car for a long trip.
Men, on average, are better at these kinds of problems than women (although some men are not good at all, and some women are great). Women with CAH are better at them than their sisters without CAH.
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Boys with CAH don't seem to be different from their brothers.
There is no difference between males with and without CAH in their activities: not surprisingly, most like "male-typical" activities. This suggests that the differences we see between girls with CAH and girls without CAH are due to increased prenatal androgens and not to general factors associated with having the disease.
CAH is not associated with psychological problems.
Our results also show that children, adolescents, and young adults with CAH –both male and female – have good emotional adjustment. In several studies, we showed that people with CAH are not different from their siblings without CAH on a number of traditional measures of emotional functioning.
Girls with CAH overwhelmingly identify as girls.
To study this, we ask about feelings about being a girl or woman and desires to be a boy or man. Most girls and women with CAH clearly identify themselves as girls or women and have no wish to be boys or men. But, about 5-10% of females with CAH are unhappy as females and identify as male, and this percentage is greater than in females without CAH. It is not yet clear what accounts for the variations in gender identity among females with CAH, but a lot of researchers are interested in this question.
