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Sexual Orientation in Women with Classical or Non-classical Congenital Adrenal Hyperplasia as a Function of Degree of Prenatal Androgen Excess

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Abstract

46,XX individuals with classical congenital adrenal hyperplasia (CAH) due to deficiency of the enzyme, 21-hydroxylase, show variable degrees of masculinization of body and behavior due to excess adrenal androgen production. Increased bisexuality and homosexuality have also been reported. This article provides a review of existing reports of the latter and presents a new study aimed at replicating the previous findings with detailed assessments of sexual orientation on relatively large samples, and at extending the investigation to the mildest form, non-classical (NC) CAH. Also, this is the first study to relate sexual orientation to the specific molecular genotypes of CAH. In the present study, 40 salt-wasters (SW), 21 SV (simple-virilizing), 82 NC, and 24 non-CAH control women (sisters and female cousins of CAH women) were blindly administered the Sexual Behavior Assessment Schedule (SEBAS-A, 1983 ed.; H. F. L. Meyer-Bahlburg & A. A. Ehrhardt, Privately printed). Most women were heterosexual, but the rates of bisexual and homosexual orientation were increased above controls not only in women with classical CAH, but also in NC women, and correlated with the degree of prenatal androgenization. Classifying women by molecular genotypes did not further increase the correlation. Diverse aspects of sexual orientation were highly intercorrelated, and principal components analysis yielded one general factor. Bisexual/homosexual orientation was (modestly) correlated with global measures of masculinization of non-sexual behavior and predicted independently by the degree of both prenatal androgenization and masculinization of childhood behavior. We conclude that the findings support a sexual-differentiation perspective involving prenatal androgens on the development of sexual orientation.

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Acknowledgments

The project described was supported in part by USPHS Grants HD-38409, RR06020 (GCRC), and by Grant Number U54 RR01-9484 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Its contents are solely the responsibilities of the authors and do not necessarily represent the official views of NCRR or NIH. We thank the study women for their participation in this research. Ms. Rhoda Gruen served as interviewer trainer. Ms. Patricia Connolly assisted in word processing.

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Authors and Affiliations

  1. New York State Psychiatric Institute & Department of Psychiatry, Columbia University, 1051 Riverside Drive, NYSPI Unit 15, New York, NY, 10032, USA

    Heino F. L. Meyer-Bahlburg & Curtis Dolezal

  2. Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA

    Susan W. Baker & Maria I. New

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  1. Heino F. L. Meyer-Bahlburg
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  2. Curtis Dolezal
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  3. Susan W. Baker
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  4. Maria I. New
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Correspondence to Heino F. L. Meyer-Bahlburg.

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Meyer-Bahlburg, H.F.L., Dolezal, C., Baker, S.W. et al. Sexual Orientation in Women with Classical or Non-classical Congenital Adrenal Hyperplasia as a Function of Degree of Prenatal Androgen Excess. Arch Sex Behav 37, 85–99 (2008). https://doi.org/10.1007/s10508-007-9265-1

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