[Sexual differentiation of the human brain]

Normal human development requires the compatibility between genetic sex (sex chromosomes), sex of gonades (tests or ovaries), genitalia (external and internal sex organs), somatic features (body characteristics) and psychic sex. The psychic sex, called frequently gender, consist of gender identity (self-estimation), gender role (objective estimation) and sexual orientation (hetero- or homosexual). It was believed that the psychic gender depends only on socio-environmental influences such as rearing, learning and individual choice. Although, the process of sexual differentiation of human brain is not completely elucidated, it has became recently evident that endogenous hormones more then socio-environmental factors influence gender differences. Experimental studies on animals revealed that transient action of sex steroids during perinatal period of life is crucial for the dymorphism of sexual behavior (male or female) in adulthood. It seems, that also in the human male neonates testosterone produced by testes perinatally takes the main role in the irreversible masculinization of the brain i.e. creation of the differences vs. female brain. The evaluation of patients with disturbances of sexual differentiation of external genitalia (the lack of the testosterone transformation into 5-alpha dihydrotestosterone in peripheral tissues of men or the inborn excess of androgens in women with the congenital adrenal hyperplasia) has served as a useful clinical model for understanding factors, affecting the formation of gender. In these individuals the formal sex established according to genetic sex and somatic sex may be incompatible with gender identity and role. However, it has been found that the female gender identity is most frequently associated with the presence of ovaries or the lack of gonads (gonadal dysgenesis), while the male gender identity appear most frequently in the presence of testicular tissue irrespective of female or hermaphrodite (intersex) phenotype. In genetic men with the absence of male genitalia formation, caused by the aberrant function of androgen receptor, the gender identity depends on the severity of the disorder: female gender identity in the complete androgen insensitivity syndrome and female or male gender identity in the complete androgen insensitivity syndrome and female or male in the partial androgen insensitivity. These clinical observations confirm the experimental data indicating androgen role in the male gender identity creation. This knowledge is necessary for the decision of the direction of surgical correction of sex organs in children with ambiguous genitalia, which should not depend on the expected efficiency to perform sexual intercourse, but mostly on the expected or already present individual gender identity.