Congenital adrenal hyperplasia II: Gender-related behavior and attitudes in female salt-wasting and simple-virilizing patients

The salt-wasting (SW) and simple-virilizing (SV) forms of congenital adrenal hyperplasia (CAH) are characterized by distinct prenatal hormonal milieus. To test whether these hormonal milieus differentially influence the development of a “more masculine” behavioral pattern in female CAH patients (Dittmann et al., 1990), SW patients (N=13) were compared both to SV patients (N=20) and healthy sisters of both groups (N=16). The data are based on semi-structured interviews in which subjects (11–41 yr) and mothers were asked about aspects of “Gender-related interests and behavior,” “Level of activity,” “Social behavior,” (reflecting e.g., assertiveness, dominance, and acceptance by peer groups) and “Appearance”; these areas of interest were represented by composite scales. On most scales, and by both mother-assessment and self-assessment, SW patients differed significantly from both SV patients and sisters in having a “more masculine” orientation. SW patients also showed a higher “Level of activity.” These SW group results probably account for much of the CAH/sister differences reported in the companion article (Dittmann et al., 1990). In contrast, SV patients differed from the sister sample on only a few scales. There were no significant differences between SV and SW subjects in the degree of virilization of the external genitalia (indicating no group difference in prenatal androgenization). SW patients were treated “earlier” and “better” after birth (indicating less postnatal androgenization). However, these medical conditions, as well as several psychosocial/demographic variables, could not explain the group behavioral differences. These results do not support a primarily psychosocial explanation of behavioral development in CAH patients, especially those with the SW condition; they rather suggest differential organizational effects of two different hormonal environments (SV vs. SW) during critical periods of prenatal CNS development.