Sexual orientation in women with classical or non-classical congenital adrenal hyperplasia as a function of degree of prenatal androgen excess.
Level 4 - case-series / case-control
Case-control study comparing CAH clinical subgroups to unaffected familial controls
PubMed 18157628 · doi:10.1007/s10508-007-9265-1
What was done
The authors reviewed existing literature and conducted a comparative study of 46,XX women with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH). Participants comprised 40 salt-wasting (SW), 21 simple-virilizing (SV), 82 non-classical (NC) CAH cases, and 24 non-CAH control women (sisters and female cousins). Sexual orientation was assessed blindly using the Sexual Behavior Assessment Schedule (SEBAS-A) and analyzed across CAH clinical subtypes, molecular genotypes, and global measures of childhood non-sexual behavioral masculinization.
What was found
Most women across all groups were heterosexual. Bisexual and homosexual orientation rates were elevated above controls in both classical (SW and SV) and NC CAH groups and correlated with the degree of prenatal androgenization. Classification by molecular genotype did not increase this correlation. Bisexual/homosexual orientation correlated modestly with measures of non-sexual behavioral masculinization and was independently predicted by both prenatal androgenization and childhood masculinized behavior. Exact numerical values, percentages, and effect sizes were not reported in the abstract.
Why it matters
This study provides comparative evidence that shifts toward bisexual and homosexual orientation track in a dose-dependent manner with prenatal androgen exposure across the full severity spectrum of CAH, extending previous findings to mild non-classical forms.
Limits
The abstract reports no numerical proportions, odds ratios, or test statistics. The unaffected control cohort was relatively small (n = 24) compared to the patient sample. Because CAH involves ongoing endocrine management and varying degrees of genital virilization, unmeasured psychological and treatment-related factors cannot be entirely separated from prenatal hormone exposure based on these data.
Cited by
- supports Women with congenital adrenal hyperplasia are more likely to report same-sex sexual attraction than the general population, with the reported percentage of lesbian orientation increasing with age.