Sex matters. Being born a girl or boy carries implications for health and illness. Despite considerable interest in the development and maintenance of sex-related processes, there are noticeable gaps in the literature that we propose to address. We will study how the interplay between biological predispositions and social experiences shapes gender development at the adolescent transition;sex-related characteristics increase in importance at this time, with longterm consequences for opportunities, choices, and health. Taking a biopsychosocial perspective, we will study family socialization in 120 girls exposed to varying levels of androgen during prenatal development owing to congenital adrenal hyperplasia (CAH);we will compare them to a previously-assessed group of 150 typical girls.
The aims are: (a) to chart how gendered characteristics (identity, interests, personal-social attributes, attitudes, activities) are linked to family socialization and how the links are moderated by degree of prenatal hormone exposure and by parent-child relationship quality;and (b) to examine how gender development is linked to psychological health (self-concept and internalizing and externalizing problems). Girls aged 11-13 will be interviewed about their gendered characteristics, psychological health, and relationships with their parents;they will provide DNA via saliva for analysis of mutations in the gene causing CAH (reflecting degree of androgen exposure). During seven follow-up phone calls, girls will describe their gendered activities and companions that day. Parents will provide information about their gender socialization through questionnaires and reports during four phone calls about their own gendered characteristics and activities, expectations and beliefs for their daughter, management of their child's gendered activities, and about warmth in the parentchild relationship. As a natural experiment, girls with CAH provide a magnification of normal developmental processes;combining girls with CAH and typical girls yields a sample with variation in both hormone exposure and family socialization, and sufficient statistical power for hypothesis-testing. The work has public health impact, showing how gender matters for behavior and health, and how biological predispositions affect socialization experiences. This information can lead to interventions to improve mental and physical health. Data also will aid in management of children born with ambiguous genitalia and children with gender dysphoria.

Public Health Relevance

The goal of this study is to understand the antecedents and psychological health consequences of gender development (characteristics related to being male or female). We will study the ways in which gendered identity, interests, personality, skills, attitudes, and activities in early adolescence are influenced by biology (the hormones to which individuals are exposed before birth) and the family environment (the ways in which parents socialize children to be like typical girls). The work has impact on public health, by delineating the processes by which gender matters for behavior and health, and by showing how biological predispositions shape and modify individuals'socialization experiences;this information, in turn, can lead to interventions to improve mental and physical health. Data also will aid in management of children born with ambiguous genitalia and children with gender dysphoria.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Freund, Lisa S
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Pennsylvania State University
Schools of Arts and Sciences
University Park
United States
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Berenbaum, Sheri A (2018) Beyond Pink and Blue: The Complexity of Early Androgen Effects on Gender Development. Child Dev Perspect 12:58-64
Berenbaum, Sheri A; Beltz, Adriene M (2016) How Early Hormones Shape Gender Development. Curr Opin Behav Sci 7:53-60