Mkgrady8 Neuro 5 Sexual Differentiation

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3 categories of sexual dimorphism

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anatomical, physiological, and behavioral

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what is sex/sexual identity

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male or female; based on phenotype or physical appearance; in humans this is generally but not always consistent with chromosomal sex

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what is gender

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a system of classification describing attributes commonly associated with maleness or femaleness; masculine characteristics are typically associated with persons who have male bodies; feminine characteristics are typically associated with persons who have female bodies; the exact characteristics are culturally defined and therefore variable across cultures or across time

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what is gender identity

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a person's view of their own gender which included aspects of a person's appearance, expression, or behavior; a person's gender identity may or may not conform to the conventional expectations for their assigned sex at birth

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what is sexual orientation

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the romantic and sexual attraction a person feels to a particular gender or genders (gay, lesbian, heterosexual, or bisexual); also can include asexual

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what is gender dysphoria

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the distress and unease experienced if the gender identity and sex are not completely congruent

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what is gender identity disorder

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psychiatric diagnosis that is given when a strong and persistent cross gender id, combined with a persistent discomfort with one's sex or sense of inappropriateness in the gender role of that sex causes clinically significant distress

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what is cisgender

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a description for a person whose gender identity, gender expression, and biological sex all align (e.g. man, masculine, and male)

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what is transgender

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a generally accepted umbrella term describing anyone who exhibits characteristics of a gender that does not match one's apparent or actual physical sex; the term can include people who are transsexual, crossdressers, drag kings and queens, some 2 spirit people, and anyone who breaks gender boundaries regardless of sex, gender identity, or sexual orientation

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what is gender variant

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someone whose combination of legal sex, birth sex, gender identity, gender expression, and perceived gender do not line up according to societal expectations

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what is transsexual

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a medical term applied to those transgender people who feel such incongruity between their body and their gender that they seek medical assistance in transforming their body to address the incongruity regardless of sexual orientation

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what is 2 spirit

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a term used by some members of native american and first nations communities to describe someone with both male and female spirit; this can involve someone's sexual orientation, gender identity, both, or other factors; not everyone who is 2 spirit identifies as being trans; the use of 2 spitit by non first nations people is often considered offensive

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what is a transgenderist

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a person who lives full time in the gender of his or her choice (different from the body type) without desiring gender reassignment surgery

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what is intersex

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an individual whose biological and/or genetic traits at birth do not correspond with conventional concepts of male/female anatomy; most people choose to refer to themselves as intersex rather than hermaphrodites, and the use of the term hermaphrodite by non intersex people is often considered offensive; while some intersex people are also transgender, intersex people as a group have a unique set of needs and struggles

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what is the definition of disorders of sexual development (DSDs)

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conditions involving the following elements= congenital development of ambiguous genitalia (e.g. 46 XX virilizing conenital hyperplasia, clitoromegaly, micropenis), congenital disjunction of internal and external sex anatomy (e.g. complete androgen insensitivity syndrome, 5-alpha reductase deficiency), incomplete development of anatomy (e.g. vaginal agenesis, gonadal agenesis), sex chromosome anomalies (e.g. turner syndrome, klinefelter syndrome, sex chromosome mosaicism), disorders of gonadal development (e.g. ovotestes); DSDs consequently include anomalies of the sex chromosomes, the gonads, the reproductive ducts, and the genitalia; note that the term intersex is avoided here because of its imprecision

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definition of patient centered care for DSDs

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1. provide medical and surgical care when dealing with a complication that represents a REAL AND PRESENT THREAT to the pts physical well being 2. recognize that what is normal for one individual may not be what is normal for others, care providers should not seek to FORCE THE PT INTO A SOCIAL NORM (e.g. for phallic size or gender typical behaviors) that may harm the pt 3. minimize the potential for the pt and family to feel ashamed, stigmatized, or overly obsessed with genital appearance, avoid use of stigmatizing terminology (like pseudo hermaphroditism) and medial photography, PROMOTE OPENNESS (the opposite of shame) and positive connection with others, avoid a parade of white coats and repetitive genital exams, especially those involving measurements of genitalia 4. delay elective surgical and hormonal treatments until the pt can actively participate in decision making 5. respect parents by addressing their concerns and distress 6. directly address the child's psychosocial distress 7. always tell the truth to the family and the child

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what is sex determination

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this process is based on X and Y chromosome; specifically the SRY region of Y encodes for the testis determining factor (TDF); this along with other genes, causes the indifferent gonad to develop into a testis

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what is sex differentiation

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once sex is determined the process that leads to the physical differences between male and female and is largely driven by gonadal secretions

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what are the sex hormones

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testosterone can be acted on by 5-alpha-reductase to become dihydrotestosterone; testosterone can be acted on by aromatase to become 17-beta-estradiol

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congenital adrenal hyperplasia (CAH): what is it, what is it caused by

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46 XX; most common cause of ambiguous genitalia in newborns; CAH individuals have a genetic defect in 21-alpha-hydroxylase so that they cannot convert to 17alphaOH-P to 11beta-cortisol; this results in elevated adrenal androgens due to a lack of cortisol feedback to inhibit ACTH; females with this genetic condition are anatomically masculinized to different degrees and these individuals show more masculine behavior, more male typical cognitive function and more erotic attraction to females than do normal females

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complete androgen insensitivity syndrome (CAIS): what is it, what is it caused by

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46 XY; caused by a mutation in the androgen receptor so that the body cannot respond to testosterone or 5alpha-DHT; normal or high levels of testosterone are then converted to estradiol peripherally by aromatase; estradiol is responsible for the female phenotype; gender identity is female; this condition is strong evidence that testosterone is the hormone that masculinizes the CNS in humans

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why do so many mutations in the androgen receptor result in a phenotype?

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the gene for the androgen receptor is on the X chromosome therefore in an XY individual there is only one copy of the gene

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5alpha-reductase deficiency: what is it, what does it caused by

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5alpha-reductase-2 is necessary to convert testosterone to 5alpha-DNT for normal differentiation in external genitalia; XY individuals who look like and are raised as females until puberty then become phenotypic males (5alpha-reductase-1 is expressed at puberty and beyond); the testes descend, the penis enlarges, and most successfully assume the male role; as children these individuals show masculine behaviors and may have a male gender identity; THIS OBSERVATION CHALLENGES THE PSYCHOSEXUAL NEUTRALITY DOGMA THAT CLAIMS NURTURE IS MORE IMPORTANT THAN BIOLOGY

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determination of sex in an intersex baby

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about 1 in 2000 births is an intersex child; if the penis is 1 inch then it's a boy; if the protrusion is 3/8 inch or less then it's a girl; those in between are turned into girls; in the past sex was assigned based on penis length at birth without regard for the gender identity of that individual

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primary sexual dimorphisms in the CNS

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spinal nucleus of the bulbocavernosus

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dimorphisms related to reproduction

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sexually dimorphic nucleus of the supraoptic area= female shows increased firing rate with intromission and copulation whereas male shows increased firing rate with anticipation; appetite feedback via leptin is reduced during pregnancy so you are more hungry; when a baby cries there is lactatation

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sex hormones on neurons

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estrogen and testosterone influence neuronal growth and differentiation

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CNS sex differences

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everywhere

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differences in cognitive function

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cerebral asymmetry is more pronounced in males than in females (female brains show less FUNCTIONAL asymmetry); females better at verbal fluency/interpreting facial expressions; males score higher in math reasoning/understanding spatial relationships

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organizational hypothesis of psychosexuual development

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permanent; the sexual phenotype of the body and the CNS is determined by exposure to certain sex steroids during developmental critical periods (pre and postnatal)

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activational hypothesis of psychosexual development

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transitory; actions of sex steroids on the mature CNS stimulate certain behavioral and physiological processes

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sex differences and secually dimorphic behavior: the central tenet of modern neural science is that

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ALL BEHAVIOR is a reflection of brain function; steroids affect brain development and function and therefore behavior

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biology and sexual orientation: genetic and epigenetic (nature versus nurture) factors

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evidence is consistent with a multi factorial phenotype(s)= no one factor determines orientation, twin studies show greater monozygotic concordance, genome wide association studies --> more than one loci, genome wide epigenetic studies --> multiple loci, brain structural differences exist, in utero animal studies show hormone and gene dose differences may matter, retrospective studies show associations with birth order and fertility, other associations include finger ratio, auditory emission, handedness, hair whorl, etc

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A 16 y/o female is referred to your endocrineservice because she has not had her first period. Your exam reveals bilateral masses in herpelvis which you determine to be testes. Further tests show this individual is a genetic male and that she isCAIS (complete androgen insensitivity syndrome). What is her genotype? a. XX b. XY c. XO d. XYY

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B

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A 16 y/o female is referred to your endocrineservice because she has not had her first period. Your exam reveals bilateral masses in herpelvis which you determine to be testes. Further tests show this individual is a genetic male and that she isCAIS (complete androgen insensitivity syndrome). What is her gender? a. Masculine b. Feminine

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B