Archives of Sexual Behavior

, Volume 45, Issue 7, pp 1807–1815 | Cite as

Linking Prenatal Androgens to Gender-Related Attitudes, Identity, and Activities: Evidence From Girls With Congenital Adrenal Hyperplasia

  • Joyce J. Endendijk
  • Adriene M. Beltz
  • Susan M. McHale
  • Kristina Bryk
  • Sheri A. BerenbaumEmail author
Original Paper


Key questions for developmentalists concern the origins of gender attitudes and their implications for behavior. We examined whether prenatal androgen exposure was related to gender attitudes, and whether and how the links between attitudes and gendered activity interest and participation were mediated by gender identity and moderated by hormones. Gender attitudes (i.e., gender-role attitudes and attitudes about being a girl), gender identity, and gender-typed activities were reported by 54 girls aged 10–13 years varying in degree of prenatal androgen exposure, including 40 girls with classical congenital adrenal hyperplasia (C-CAH) exposed to high prenatal androgens and 14 girls with non-classical (NC) CAH exposed to low, female-typical, prenatal androgens. Both girls with C-CAH and NC-CAH reported positive attitudes about being a girl and egalitarian gender attitudes, consistent with their female-typical gender identity. In contrast, girls with C-CAH had more male-typed activity interest and participation than girls with NC-CAH. Gender attitudes were linked to activities in both groups, with gender identity mediating the links. Specifically, gender-role attitudes and positive attitudes about being a girl were associated with feminine gender identity, which in turn was associated with decreased male-typed activity interests and participation, and increased female-typed activity interests. Our results are consistent with schema theories, with attitudes more closely associated with gender identity than with prenatal androgens.


Gender attitudes Gender identity Gender-typed activities Prenatal androgens Congenital adrenal hyperplasia 



This research was supported by a grant from the National Institutes of Health, HD057930. Joyce J. Endendijk was supported by a grant from the Jo Kolk Studiefonds of the VVAO (Dutch Society for Women with Higher Education) and a grant from the Dutch journal Kind & Adolescent. We thank the participants; members of the CARES and MAGIC Foundations and pediatric endocrinologists for help in recruiting participants; Chun Bun Lam for assistance with data scoring and analysis; and Diana Crom and Rob Schofield for coordinating data collection and processing.


  1. Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88, 354–364. doi: 10.1037/0033-295X.88.4.354.CrossRefGoogle Scholar
  2. Berenbaum, S. A. (1999). Effects of early androgens on sex-typed activities and interests in adolescents with congenital adrenal hyperplasia. Hormones and Behavior, 35, 102–110. doi: 10.1016/j.yhbeh.2013.04.002.CrossRefPubMedGoogle Scholar
  3. Berenbaum, S. A., & Bailey, J. M. (2003). Effects on gender identity of prenatal androgens and genital appearance: Evidence from girls with congenital adrenal hyperplasia. Journal of Clinical Endocrinology and Metabolism, 88, 1102–1106. doi: 10.1210/jc.2002-020782.CrossRefPubMedGoogle Scholar
  4. Berenbaum, S. A., & Beltz, A. M. (2011). Sexual differentiation of human behaviour: Effects of prenatal and pubertal organizational hormones. Frontiers in Neuroendocrinology, 32, 183–200. doi: 10.1016/j.yfrne.2011.03.001.CrossRefPubMedGoogle Scholar
  5. Bigler, R. S., Brown, C. S., & Markell, M. (2001). When group attitudes are not created equal: Effects of group status on the formation of intergroup attitudes in children. Child Development, 72, 1151–1162. doi: 10.1111/1467-8624.00339.CrossRefPubMedGoogle Scholar
  6. Blakemore, J. E. O., Berenbaum, S. A., & Liben, L. S. (2009). Gender development. New York: Psychology Press.Google Scholar
  7. Bradbard, M. R., & Endsley, R. C. (1983). The effects of sex-typed labeling on preschool children’s information-seeking and retention. Sex Roles, 9, 247–260. doi: 10.1007/BF00289627.CrossRefGoogle Scholar
  8. Bradbard, M. R., Martin, C. L., Endsley, R. C., & Halverson, C. F. (1986). Influence of sex stereotypes on children’s exploration and memory: A competence versus performance distinction. Developmental Psychology, 22, 481–486. doi: 10.1037/0012-1649.22.4.481.CrossRefGoogle Scholar
  9. Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation. Psychological Review, 106, 676–713. doi: 10.1037/0033-295X.106.4.676.CrossRefPubMedGoogle Scholar
  10. Crouter, A. C., Whiteman, S. D., McHale, S. M., & Osgood, W. (2007). Development of gender attitude traditionality across middle childhood and adolescence. Child Development, 78, 911–926. doi: 10.1111/j.1467-8624.2007.01040.x.CrossRefPubMedGoogle Scholar
  11. Davies, D. R. (1989). The effects of gender-typed labels on children’s performance. Current Psychology: Research & Reviews, 8, 267–272. doi: 10.1007/BF02686725.CrossRefGoogle Scholar
  12. Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37, 451–463. doi: 10.1037//0012-I649.37.4.45I.CrossRefPubMedGoogle Scholar
  13. Galambos, N. L., Berenbaum, S. A., & McHale, S. M. (2009). Gender development in adolescence. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology (3rd ed., pp. 305–357). Hoboken, NJ: Wiley.Google Scholar
  14. Hall, C. M., Jones, J. A., Meyer-Bahlburg, H. F. L., Dolezal, C., Coleman, M., Foster, P., … Clayton, P. E. (2004). Behavioral and physical masculinization are related to genotype in girls with congenital adrenal hyperplasia. Journal of Clinical Endocrinology and Metabolism, 89, 419–424. doi: 10.1210/jc.2003-030696.
  15. Hargreaves, D. J., Bates, H. M., & Foot, J. M. (1985). Sex-typed labelling affects task performance. British Journal of Social Psychology, 24, 153–155. doi: 10.1111/j.2044-8309.1985.tb00674.x.CrossRefPubMedGoogle Scholar
  16. Hayes, A. F. (2013). Macro package for SPSS. Retrieved from
  17. Hopper, R. (2005). What are teenagers reading? Adolescent fiction reading habits and reading choices. Literacy, 39, 113–120. doi: 10.1111/j.1467-9345.2005.00409.x.CrossRefGoogle Scholar
  18. Kohlberg, L. (1966). A cognitive-developmental analysis of children’s sex-role concepts and attitudes. In E. E. Maccoby (Ed.), The development of sex differences (pp. 82–173). Stanford, CA: Stanford University Press.Google Scholar
  19. Leaper, C., Farkas, T., & Spears Brown, C. (2012). Adolescent girls’ experiences and gender-related beliefs in relation to their motivation in math/science and English. Journal of Youth and Adolescence, 41, 268–282. doi: 10.1007/s10964-011-9693-z.CrossRefPubMedGoogle Scholar
  20. Liben, S. L., & Bigler, R. S. (2002). The developmental course of gender differentiation: Conceptualizing, measuring, and evaluating constructs and pathways. Monographs of the Society for Research in Child Development, 67, 1–147. doi: 10.1111/1540-5834.t01-1-00187.CrossRefGoogle Scholar
  21. Martin, C. L., & Dinella, L. M. (2012). Congruence between gender stereotypes and activity preference in self-identified tomboys and non-tomboys. Archives of Sexual Behavior, 41, 599–610. doi: 10.1007/s10508-011-9786-5.CrossRefPubMedGoogle Scholar
  22. Martin, C. L., Eisenbud, L., & Rose, H. (1995). Children’s gender-based reasoning about toys. Child Development, 66, 1453–1471. doi: 10.2307/1131657.CrossRefPubMedGoogle Scholar
  23. Martin, C. L., & Halverson, C. F. (1981). A schematic processing model of sex typing and stereotyping in children. Child Development, 52, 1119–1134. doi: 10.1111/1467-8624.CrossRefGoogle Scholar
  24. Martin, C. L., & Ruble, D. (2004). Children’s search for gender cues: Cognitive perspectives on gender development. Current Directions in Psychological Science, 13, 67–70. doi: 10.1111/j.0963-7214.2004.00276.x.CrossRefGoogle Scholar
  25. Mattila, A. K., Fagerholm, R., Santtila, P., Miettinen, P. J., & Taskinen, S. (2012). Gender identity and gender role orientation in female assigned patients with disorders of sex development. Journal of Urology, 188, 1930–1934. doi: 10.1016/j.juro.2012.07.018.CrossRefPubMedGoogle Scholar
  26. McHale, S. M., Crouter, A. C., & Tucker, C. J. (1999). Family context and gender role socialization in middle childhood: Comparing girls to boys and sisters to brothers. Child Development, 70, 990–1004. doi: 10.1111/1467-8624.00072.CrossRefPubMedGoogle Scholar
  27. McHale, S. M., Kim, J., Dotterer, A. M., Crouter, A. C., & Booth, A. (2009). The development of gendered interests and personality qualities from middle childhood through adolescence: A bio-social analysis. Child Development, 80, 482–495. doi: 10.1111/j.1467-8624.2009.01273.x.CrossRefPubMedPubMedCentralGoogle Scholar
  28. McHale, S. M., Kim, J., Whiteman, S., & Crouter, A. C. (2004). Links between sex-typed time use in middle childhood and gender development in early adolescence. Developmental Psychology, 40, 868–881. doi: 10.1037/0012-1649.40.5.868.CrossRefPubMedGoogle Scholar
  29. Merke, D. P., & Bornstein, S. R. (2005). Congenital adrenal hyperplasia. Lancet, 365, 2125–2136. doi: 10.1016/S0140-6736(05)66736-0.CrossRefPubMedGoogle Scholar
  30. Meyer-Bahlburg, H. F. L., Dolezal, C., Baker, S. W., Carlson, A. D., Obeid, J. S., & New, M. I. (2004). Prenatal androgenization affects gender-related behavior but not gender identity in 5-12-year-old girls with congenital adrenal hyperplasia. Archives of Sexual Behavior, 33, 97–104. doi: 10.1023/B:ASEB.0000014324.25718.51.CrossRefPubMedGoogle Scholar
  31. Moran, C., Azziz, R., Carmina, E., Dewailly, D., Fruzzetti, F., Ibañez, L., … Witchel, S. F. (2000). 21-Hydroxylase-deficient nonclassic adrenal hyperplasia is a progressive disorder: A multicenter study. American Journal of Obstetrics and Gynecology183(6), 1468–1474.Google Scholar
  32. Nordenström, A., Servin, A., Bohlin, G., Larsson, A., & Wedell, A. (2002). Sex-typed toy play behavior correlates with the degree of prenatal androgen exposure assessed by CYP21 genotype in girls with congenital adrenal hyperplasia. Journal of Clinical Endocrinology and Metabolism, 87, 5119–5124. doi: 10.1210/jc.2001-011531.CrossRefPubMedGoogle Scholar
  33. Ohannessian, C. M. (2009). Media use and adolescent psychological adjustment: An examination of gender differences. Journal of Child and Family Studies, 18, 582–593. doi: 10.1007/s10826-009-9261-2.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Pasterski, V., Zucker, K. J., Hindmarsh, P. C., Hughes, I. A., Acerini, C., Spencer, D., … Hines, M. (2015). Increased cross-gender identification independent of gender role behavior in girls with congenital adrenal hyperplasia: Results from an standardized assessment of 4- to 11-year-old children. Archives of Sexual Behavior, 44, 1363–1375. doi: 10.1007/s10508-014-0385-0.
  35. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731. doi: 10.3758/BF03206553.CrossRefGoogle Scholar
  36. Rekers, G. A., Sanders, J. A., Rasbury, W. C., Strauss, C. C., & Morey, S. M. (1989). Differentiation of adolescent activity participation. Journal of Genetic Psychology, 150, 323–335. doi: 10.1080/00221325.1989.9914601.CrossRefPubMedGoogle Scholar
  37. Ruble, D. N., Martin, C., & Berenbaum, S. (2006). Gender development. In W. Damon (Ed.), Handbook of child psychology (6th ed., Vol. 3, pp. 858–932). Hoboken, NJ: Wiley.Google Scholar
  38. Ruble, D. N., Taylor, L. J., Cyphers, L., Geulich, F. K., Lurye, L. E., & Shrout, P. E. (2007). The role of gender constancy in early gender development. Child Development, 78, 1121–1136. doi: 10.1111/j.1467-8624.2007.01056.x.CrossRefPubMedGoogle Scholar
  39. Steffens, M. C., Jelenec, P., & Noack, P. (2010). On the leaky math pipeline: Comparing implicit math-gender stereotypes and math withdrawal in female and male children and adolescents. Journal of Educational Psychology, 102, 947–963. doi: 10.1037/a0019920.CrossRefGoogle Scholar
  40. Weinraub, M., Pritchard Clemens, L., Sockloff, A., Ethridge, T., Gracely, E., & Myers, B. (1984). The development of sex role stereotypes in the third year: Relationships to gender labeling, gender identity, sex-typed toy preference, and family characteristics. Child Development, 55, 1493–1503. doi: 10.1111/1467-8624.ep7303030.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Joyce J. Endendijk
    • 1
  • Adriene M. Beltz
    • 2
    • 3
  • Susan M. McHale
    • 2
  • Kristina Bryk
    • 3
  • Sheri A. Berenbaum
    • 3
    • 4
    Email author
  1. 1.Centre for Child and Family StudiesLeiden UniversityLeidenThe Netherlands
  2. 2.Department of Human Development & Family StudiesThe Pennsylvania State UniversityUniversity ParkUSA
  3. 3.Department of PsychologyThe Pennsylvania State UniversityUniversity ParkUSA
  4. 4.Department of PediatricsThe Pennsylvania State UniversityUniversity ParkUSA

Personalised recommendations