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.