lecture 19 - the genetics of sex differences in behaviour Flashcards

(32 cards)

1
Q

Why study sex differences?

A
  • Relevant to everyone
  • Relevant to many different
    areas of psychology eg most adults in prison are males, developmental psychology
  • Most brain disorders show
    some sort of sex bias
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2
Q

Sex and Gender

A

Sex differences: ‘variations in biology between men and
women’
Gender differences: ‘differences between men and women,
both in terms of biology and self-representation as male or
female (or both/neither), as shaped by the environment’

studying sex differences is challenging as theres a wide variety of sex chromosome variants out there and people can differ in their levels of hormones and its very complicated to define sex, its very difficult or even more difficult to define gender

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3
Q

artistotle

A

‘Woman is |more compassionate than man|, more easily
moved to tears, at the same time is more jealous, more
querulous, more apt to scold and to strike. She is,
furthermore, |more prone to despondency| and less hopeful
than the man, more void of shame or self-respect, more false
of speech, more deceptive and of |more retentive memory|’
Aristotle, Historia Animalium

‘Do you not know I am a woman? |When I think,
I must speak’|
William Shakespeare, As You Like It

most of it is nonsense but elements of truth to the parts with lines around

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4
Q

on average

A

Generally, male and female behaviour and cognition is equivalent
However, on average, there are some notable sex differences :
Miller and Halpern (2014) TICS 18(1): 37-45

  • Language acquisition - Age of 2.5 /3 female vocab double size of males
  • Physical aggression - Males higher in aggression and behavioural disinhibition
  • Behavioural disinhibition
  • sexual preference - vast majority of males will be exclusively or predominantly sexually attracted to females and majority of females will be predominately or exclusively attracted to males
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5
Q

On average …

A

Females>males on tasks:
* requiring rapid access to, and use of,
phonological and semantic information in
long-term memory
* requiring production and comprehension of
complex prose
* assessing fine motor skills
* assessing perceptual speed
More ‘cross-talk’ between hemispheres: greater Redundancy - so if a male and a female suffer the same severity of unilateral stroke on one side of the brain the females cognitive function will tend to be less impaired than the males because their cognitive resources are more evenly dirstributed across both hemispheres of the brain whereas in males cognitive resources tend to be more lateralised. so damage to one side of the brain has more profound effects in males and the recovery from stroke tends to be worse on average.

females can also discriminate better between two slightly different stimuli so their sense of persception is slightly better than males also can discriminate between two smells better than males

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6
Q

Males>females on tasks:

A
  • requiring transformations in
    visuospatial working memory eg showed someone a 3D shape and asked them to imagine what it looks like rotated males tend to be better at those sorts of tasks
  • assessing motor skills involved in aiming
  • involving spatiotemporal responding
  • involving fluid reasoning especially in abstract scientific/ mathematical domains
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7
Q

males show greater variablity in IQ than females

A

mean IQ of males and females is the same = 100
more variability in males as there is an excess of males down at the lower end of IQ at below 70 but there is also an excess of males at higher end of IQ range of about 130
Males also show greater variability in brain size

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8
Q

Sex differences in brain structure

A
  • Male brain bigger from 2 weeks of age (more cortical neurons more glutamatergic cortical neurons , Kelava et al., (2022)
    Nature 602:112-116); female brain has a more developed neuropil early on in life
    neuropil = bits of the brain which are relavelively depleted for cell bodies but are enriched for synaptic connections
  • Female brain matures more rapidly
  • Females have a larger Wernicke’s area (involved in comprehension of communication) , orbitofrontal cortex (involved in assessing the rewarding or punishing values of particular stimuli is particularly important in social function, inhibiting your brain), corpus callosum (why have greater hemispheric redundancy),
    hippocampus. Males have larger amygdala (involved in fear response processing and understanding comprehension of fear in other individuals) , fronto-medial cortex
  • Male brain wired ‘front-to-back’; female brain wired
    ‘left-to right’ - might explain why females have a greater degree of hemispheric redundancy
  • Sex differences in brain function e.g. fMRI
    Ingalhalikar et al (2014) PNAS 111(2):823-828
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9
Q

Many sexually dimorphic brain regions regulate sex-specific physiology/behaviour

A

e.g. regions of hypothalamus regulate hormonal control of:
* sexual attraction
* ovulation
* pregnancy
* milk letdown
* vaginal contraction during birth
* mother-offspring bonding/suckling
* social & affiliative behaviours
* reactivity to stress

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10
Q

Key issues in sex differences research

A
  • Small effect sizes with considerable overlap
  • Temporal specificity - differences early in life but at adult hood differences no longer present
  • Effects of menstrual cycle
  • Differences in test performance modulated by context - conforming to sex specific stereotypes if told going to be identified by sex
  • Studies in model organisms generally use males - assumption was that females have menstrual cycle constantly changing their behaviour it would be very variable so people tended to focus on males but it doesnt have that big of an effect and males have a testosterone hormonal cycle - both are used now
  • Differences in brain structure do not necessarily predict behavioural differences
  • ‘Differences are not deficiencies’ (Diane Halpern, former APA President)
  • Most psychological studies performed in WEIRD (Western, Educated, Industrialized, Rich
    and Democratic) populations
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11
Q

physical differences between sexes

A

Differences supported by evidence may be used to support prejudicial beliefs and
discriminatory actions against one sex
* Differences may arise due to social conditioning or ascertainment/selection bias

head of Harvard said females have less intrinsic aptitude for science than men - taking the idea that on average men outperform females on tasks of abstract scientific reasoning and saying women are worse than men but in science some aspects women are better than men and some men are better than women

barbie in 2000s that said maths class is hard - social factor

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12
Q

it’s not all nurture: some brain sex differences may be
hard-wired and present across species

A

studies -
- sexually dimorphic gene expression in mouse brain precedes gonadal differentiation - theres differences in gene expression in mammalian brains
- sex differences in rhesus monkey toy preferences parallel those of children - male monkeys prefer playing with the truck and the female monkeys prefer playing with the doll - makes sense in terms of evolution for females but why male monkeys are interested in trucks is uncertain could be to do with the wheels

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13
Q

Sex differences in neurodevelopmental and psychiatric disorders

A
  • Prevalence
    (biology/ascertainment?) - ADHD is four time more commonly diagnosed in males than in females, autism with learning disability is 3 times more common in males, autism without learning disability is 10 more commonly diagnosed in males, dependency disorders also more common in males but when females are diagnosed with these disorders they tend to progress through addiction much more rapidly than males, females are diagnosed more frequently with affective disorders eg anxiety, panic disorders, depression, PTSD - may be biological component or social or environment reasons
  • Age-at-onset - Sz develops late teens / early twenties in males and late 20s and early 30s in females
  • Disorder subtypes
    and co-morbidities - for ADHD females with it will tend to present co-morbidities with anxiety, depression etc and males with externalising disorders, aggressive disorders, conduct disorders, oppositional defiant disorder
  • Clinical course - clinical course in sz is more severe in males than females
  • Underlying neurobiology
  • Response to therapy - antidepressants activity can be modulated by sex differences in the acidity of the stomach, sex differences in transit time, females have more adipose tissue, more fat tissue in their body where the drug can be stored and released, sex differences in the expression of enzymes in the liver that metabolise drugs like antidepressants - all these factors influence the extent to which drugs are metabolised in the body and the extent to which they work to alleviate the symptoms of conditions like depression
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14
Q

prevalence rates of particular psychological conditions can also be affected by Ascertainment bias/differential rates of diagnosis

A
  • More overt and disruptive behaviours - eg males with autism are more aggressive and disruptive in class so this may be identified by parents and teachers.
  • Closer conformation to the diagnostic norm - when people like connie and Asperger were defining what autism is that were doing so on the basis of largely male bias samples so you will overdiagnose males relative to females \
  • More abstract (i.e. noteworthy) obsessions - Males with autism may have more odd obsessesions eg trainspotting that stand out whereas in females this is not the case as much there obsessions may be celebrities which doesnt stand out as much
  • More effective ‘masking’ strategies in females - change their behaviour in order to fit in with their neurotypical peers
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15
Q

Mechanisms underlying sexual differentiation of the brain

A

Sex differences in brain/behaviour must
ultimately be due to differences in sex
chromosome complement

Three differences between the sexes:
* Y chromosome in males only
* Two X’s in females vs. one in males
* Parental origin of X’s

male
X (always from mum)
Y (always from dad)

female
X (from mum)
X (from dad)

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16
Q

Nettie stevens

A

geneticist that discovered sex is determined by XX AND XY chromosome . discovery was falsely credited to her colleague E.B Wilson. Stevens published her paper first and her work was eventually shown to be more correct but for years she was described as a ‘lab technician’.

17
Q

the human X and Y chromosomes

A

X chromosome
* ~155 million basepairs in size
* Contains ~1500 genes, many involved in neurodevelopment
- average size chromosome
- enriched for genes important in brain development and brain function - theres a diproportionate number of genes on X chromosome that are expressed in the brain at some point to the Y chromosome
https://www.nature.com/articles/s41593-021-00890-w

Y chromosome
* ~60 million basepairs in size
* Contains ~350 (pseudo)genes; 78 protein-coding
- third of size of X chromosome
* Most genes involved in sperm production; some expressed in brain

a high density of X-lined genes for general cognitive ability - a run-away process shaping human evolution?

18
Q

Male-limited expression of genes on Y chromosome

A
  • SRY (Sex-determining Region on Y) can influence brain development/function indirectly via
    gonadal hormones
  • fundamentally causes differences between males and females
  • The gene was identified as the testis-determining factor in the early 1990s:
  • XY, XXY and XXXY subjects all male
  • Sry-transgenic XX mice sterile males - these mice looked like males but were sterile, had testes and bigger than females - proof that the SRY gene that confirmed maleness
  • Translocation of part of Y chromosome containing SRY to X chromosome can cause XX
    male syndrome
  • Rare XY females with mutations of SRY so it doenst work properly (Swyer syndrome) so they appear as females
19
Q

what does SRY do

A
  • SRY expression during embryogenesis causes bipotential gonads to differentiate into testes rather than ovaries
  • Androgens (testosterone) secreted from Leydig cells of the testis following stimulation by
    luteinising hormone from pituitary gland which is then metabolised to more potty forms like Dihydrotestosterone

testosterone circles in the blood of males it binds to androgen receptors within the cells of target tissues and once it binds that complex then moves to the nucleus of those cells where it can regulate gene expression. within the cells in these target tissues things like prostate glands, various aspects, various regions of the brain etc can initiate a program of gene expression which confer sort of maleness in those tissues

Main pathway in humans
Testosterone —-
- via 5(alpha) -reductase to Dihydrotestosterone (DHT)
- Estradiol
- Androgen receptors in
target tissues

Dihydrotestosterone (DHT) links to –
Androgen receptors in
target tissues which links to
Brain gene expression changes via
‘Masculinisation’

Estradiol links to –
Oestrogen receptors in
target tissues which links to Brain gene expression changes

diagram in notes - clearer

20
Q

androgens

A

Androgen receptors are highly concentrated in sexually dimorphic brain regions e.g.
amygdala, medial pre-optic area, paraventricular nucleus, anteroventral periventricular
nucleus, temporal cortex

Androgens can affect masculinisation:
* in critical pre- and perinatal periods (organisational effects = growth effects that tend to happen early on in life whereby the gross structure of the brain is est so these organisational effects tend to be large and irreversible, makes gross structure of brain different in males to females):

  • genital virilization (4-6 weeks gestation),
  • gender determination (2nd trimester),
  • increase <4-6 months postnatally (unknown function)
  • in later postnatal life e.g. during puberty (activational effects where the androgens are transiently expressed and can influence brain structure and brain function more subtly than the organisational effects so can effect things like synaptogenisis and the extent to which you get connectivity between various regions in the brain so the effects are more subtle than organisational effects and can also be reversible)

schematic in notes

21
Q

The E-S or ‘Extreme Male Brain’ Theory of ASCs (autism spectrum conditions)

A
  • Developed by Simon Baron-Cohen in 1990s
  • Males and females differ with regard to
    ‘systemising’ (S) (understanding how the subcomponents of systems interacted with one another in particular ways to generate a sort of gestalt output eg how football fixtures and football tables worked - males are better) and ‘empathising’ (E) (females are better - understanding that other people have different opinions and different views and might potentially act different to you)
    behaviours (and underlying neural substrates)
  • in autism people tended to present an extreme version of these differences
22
Q
  • in autism people tended to present an extreme version of these differences
A

Autism posited to represent an extreme of the male pattern (impaired empathising,
enhanced systemising)

Simon developed a questionnaire called the autism quotient to assess these sort of behaviours - females have high empathising scores and low systematising scores and males have high systematising scores and lower empathising scores

Simon thought people with autism are exposed to factors that normally confer maleness during development. Thought people with autism exposed to high level of androgens during development. he tested this in a few ways.

23
Q

simons tests

A

-Some evidence that in utero testosterone levels may correlate with later male behaviours
and autistic traits
* However, indirect measures (2D:4D finger length ratio) or small sample sizes from amniotic
fluid samples
- in males the ring finger is longer than the index finger and in females they are roughly the same length due to the function of the fact that you have different concentrations of the androgen receptors in each of those fingers and the fingers grow at different rates depending upon their exposure to androgens during early life
- the more extreme the 2D to 4D ratio the higher the levels of testosterone and androgens you’ve been exposed to during prenatal life
- he found that people with autism had a particularly low 2D to 4D ratio indicating that potentially they had been exposed to particularly high levels of androgens prenatally which was consistent with his idea

  • Genes involved? - also evidence that you can see an association between autism and genetic variance within genes which are important in the metabolism, production, reception of androgens - support Simon’s ideas

As levels of testosterone exposed to prenatally increased so did level of autistic traits

another study he did was he took some mothers who were about to give brith and they were undergoing amniocentesis so they took samples of amniotic fluid from these pregnant mums and looked at testosterone levels and waited for the mums to give birth and the kids to grow up then assessed the kids for autistic traits and found that the levels of testosterone that the kids were exposed to prenatally increased the levels of autism related traits during childhood
- positive correlation between amount of testosterone exposed to prenatally and level of autistic traits consistent with idea that exposure to high levels of androgens prenatally might predispose you to autism/ autism related traits

issues with interpreting this
- population of women undergoing aminocentisis tend to be slightly older than normal and that tends to be a risk of having children with chromosomal abnormalities so whether these findings can be generalised to the population is open to debate

24
Q

Experiments in guinea pigs in 1950s (castration/supplementation) gave rise to the dogma
that:

A

‘gonadal hormonal factors are chiefly
responsible for sexual differentiation of
the brain’
- if you take a male guinea pig and chop off its testicles, it reduces its levels of androgens and then it tends to become less aggressive and tends not to be as interested in bouncing females, etc
- if you take a female guinea pig inject it with a testosterone tend to become more aggressive, start to ,mate with females etc
* New data have suggested that sex-linked genes may act directly on the brain and
contribute to sexually dimorphic phenotypes independently of hormones

‘Gynandromorphic birds’
genes are also important and they have direct impacts on brain function

‘Gynandromorphic birds’ - the zebra finch it’s right half of its body has the male characteristic plumage there has got a little Testicle and in his head has a male song socket in its brain but the left-hand side of the body has typical female plumage found, has a little ovary and in its brain on the left hand side has female specific circuit - every cell in this birds body is surrounded by the same level of hormones so it’s not hormones that are explaining these sex differences - but on male side of body cells have bird equivalent of XY chromosome and other side has bird equivalent of XX - so implied it must be the chromsomes and genes on those chromosomes that are directly influencing the biology and presentation of the bird

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SRY
SRY can influence brain function directly (e.g. dopaminergic activity) * Many male-biased disorders eg ADHD, parkinsons exhibit dopaminergic dysfunction Role for SRY? - SRY may confer vulnerability to these types of disorders Other Y-linked genes may confer risk (or protection) in males - UK Y chromosome ‘haplogroups’ - 30% will have type 1, 50% type 2 and 20% type 3 - you can take males with different haplogroups and compare their behaviour - people with haplogroup will tend to have lower IQ scores than people with haplogroup 3 - Modifying effect of Y chromosome on ADHD phenotype
26
Higher expression of X-linked genes in females
* Generally, one female X is silenced to ensure equal X-linked activity with males - happens to make sure females are generally comparable to males - it can give rise to sex differences in babies * However, ~20% of all X-linked genes are more highly expressed in female brain as they are expressed from both X chromosomes and escape the silencing process - might explain why female Brains differ from male brains diagram in notes
27
Reduced X-linked gene dosage can affect behaviour and cognition
e.g. Turner syndrome (45,X): developmemtal conditions where females have one X chromosome instead of two * impaired attention and social cognition (↑x20 ADHD and x4 autism rates compared to females with 2xX Chromosomes) * impaired maths/reading * impaired visuospatial skills Therefore, increased expression of certain X-linked genes in females relative to males could confer protection against neurodevelopmental or psychiatric disorders * Deletion/mutation of X-linked STS gene (steroid sulfatase) influences ADHD risk * STS escapes X-inactivation - normally expressed from two copies of X chromosomes in females and one in males so potentially the fact that females have greater expression then males might confer some degree of protection against developing ADHD in females and might explain why the disorder tends to be more commonly diagnosed in males * Does higher expression in females protect against developing ADHD?
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Parental origin of the X chromosome
1990s studies by Skuse et al * girls with Turner syndrome- have one X chromosome : 45,XP (X of paternal origin 1/3 of time) or 45,XM (X of maternal origin 2/3 of time) - compared two groups of girls to see if they differed in behaviour - sent a questionnaire on cognition * 45,XM (x from mum) group more likely to show deficits in social cognition (autism) than 45,XP group (x from dad) * Experiment suggests protective effect of XP - protective against social dysfunction * Males are 46,XMY, and females 46,XMXP - only females who inherit x from dad - so may be some gene on x from dad protecting against disorders of social cogniton * Therefore, finding may explain why females exhibit different social cognition to males and why they are at reduced risk of e.g. autism * Need to identify X-linked genes whose expression is dependent upon the parent from which they were inherited
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Summary
* On average, males and females differ with respect to several aspects of behaviour and cognition * Sex can influence vulnerability to, and the course of, many psychiatric disorders * Ultimately, sex differences must be due to the differential complement of sex chromosomes in males (XY) and females (XX), and three related genetic mechanisms * Differences in the sex chromosome complement can influence phenotype via intermediary mechanisms (notably gonadal hormones) or directly * There are several psychiatric disorders that differentially affect the sexes (e.g. disorders associated with pregnancy/childbirth) and whose pathophysiology is currently poorly-defined * Understanding how and why the sexes differ in terms of neurodevelopment and behaviour is key to diagnosing and treating psychiatric disorders more effectively
30
* Holden, C. (2005) Sex and the suffering brain Science 308:1574
🧠 Summary: Sex Differences in Mental Health 🔍 Overview The article explores gender differences in the prevalence, biology, and expression of mental disorders. Women and men show different patterns of mental illness, influenced by biological, hormonal, and social factors. Brain imaging and pharmacological studies are uncovering structural and functional differences in how male and female brains respond to stress, drugs, and emotional stimuli. 📊 Epidemiological Trends Women: More prone to affective and anxiety disorders (e.g., depression, PTSD, phobias). Men: More prone to externalizing disorders (e.g., substance abuse, antisocial behavior, schizophrenia). These trends hold across cultures and time, suggesting a biological basis. 🧬 Biological and Hormonal Influences Sex hormones (e.g., estrogen, testosterone) influence brain development and stress response: Estrogen regulates the HPA axis (stress system), and imbalances can trigger depression. Testosterone may buffer men against depression by dampening stress responses. Differences in brain activation: Women show greater activation in the amygdala and prefrontal cortex during stress. Women also show stronger autonomic reactions (e.g., heart rate, startle response) to negative stimuli. 🧪 Drug Response and Sex Differences Women respond better to SSRIs (e.g., antidepressants), men to tricyclics. Opiates targeting kappa receptors work better for women (e.g., post-surgery pain). COX-2 inhibitors may interfere with estrogen’s protective effects in women. Sex hormones can modulate pharmacogenomic effects, e.g., red-haired women show heightened opiate sensitivity. 🧠 Brain Structure and Function Male brains are more lateralized, leading to localized function. Female brains show more inter-hemispheric communication, possibly offering protection in some disorders (e.g., post-stroke language recovery, lower ADHD rates in girls). 😰 Stress, Fear, and Depression Women tend to be hyper-reactive to stress and fear. Men are hypo-reactive, which may contribute to antisocial behavior. Differences in the HPA axis response may be evolutionarily adaptive (e.g., maternal protection). 🧨 Aggression and Impulsivity Men externalize (aggression, substance abuse); women internalize (depression, anxiety). Disorders like borderline personality disorder (BPD) show different patterns by sex: Males with BPD: More impulsivity and aggression. Females: More emotional instability. BPD is linked with brain abnormalities in areas controlling inhibition and emotion regulation. 🧠 Schizophrenia and Cognitive Disorders Men: Earlier onset, more severe symptoms, and greater deficits in attention, language, and perception. Schizophrenia-related brain changes may arise prenatally, during sexual differentiation. Estrogen may have neuroprotective effects, leading to better outcomes in women. 🌍 Global & Socioeconomic Context (Women in Developing Countries) Depression and anxiety are exacerbated by poverty, violence, reproductive loss, and lack of rights. Tsunami in Tamil Nadu: Women suffered more psychologically, men turned to alcohol. High suicide rates in developing countries: More women than men die by suicide in places like China and India. Postnatal depression is higher in countries like India and Pakistan (20–30%). Ongoing WHO studies aim to separate biological vs. social role influences on female mental health. 🧠 Key Takeaways for Exams Mental disorders are shaped by interactions between biology, hormones, social roles, and environment. Sex differences are significant but not absolute—there’s overlap and variation within sexes. Understanding these differences is key to personalized medicine, drug development, and targeted mental health interventions.
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* Cahill, L. (2006) Why sex matters for neuroscience Nature Reviews Neuroscience 7(6):477-84
🧠 Core Thesis Sex influences are pervasive and crucial in the brain. Neuroscience must integrate sex as a variable to avoid incomplete or misleading conclusions about brain function and mental health. 🔍 1. Key Misconceptions Debunked Cahill identifies five misconceptions about sex differences in the brain: Sex differences are small and unreliable — False. Brain imaging and animal studies show consistent, significant differences. Differences arise only from outliers — No evidence supports this. Within-sex variability outweighs between-sex differences — Statistically invalid reasoning. Sex hormones explain all differences — Inaccurate. Some differences are hormone-independent or developmentally ingrained. No behavioural difference = no neural difference — False. Neural mechanisms can differ even with similar outward behaviour (e.g., emotional memory retrieval shows different brain activity in men vs. women). 🧠 2. Functional & Structural Brain Differences 🔸 Hippocampus (Memory & Learning) Shows anatomical, neurochemical, and functional sex differences. Females: Larger hippocampus (relative to brain size); more sensitive to estrogens. Males: Stress increases dendritic spine density and learning; opposite effect in females. Learning strategy depends on hormonal state (e.g., estrogen shifts preference from spatial to habitual strategies). 🔸 Amygdala (Emotion & Memory) Structurally larger in men. Sex-lateralization: Men: Right amygdala involved in emotional memory. Women: Left amygdala dominant. Differences observed even at rest, and in response to emotional faces. 🔸 Prefrontal Cortex (PFC) (Decision-Making & Stress) Highly influenced by sex hormones. Sex × hemisphere interactions: Men: Right PFC lesions impair decision-making. Women: Left PFC lesions have this effect. Development and stress reactivity differ by sex. 🧪 3. Neurochemical Dimorphisms Sex differences affect multiple neurotransmitter systems: Serotonin: Synthesis rate 52% higher in men. Monoamines: Vary by sex in content and stress response. GABA: Different effects in male vs. female rat pups. Opioids: Differences in analgesic response (e.g., morphine works differently in women). 🧬 4. Developmental & Hormonal Influences Organizational effects: Early hormonal exposure influences brain structure and function. Activational effects: Adult hormonal cycles (e.g., menstrual cycle) influence memory, emotion, learning strategies. Example: Estrogen improves spatial memory during motherhood (mouse studies). 💥 5. Clinical Implications: Sex Differences in Disorders 🧠 Alzheimer's Disease (AD) Pathology differs: men show more tau in hypothalamus; women in nucleus basalis. APOE*E4 gene has greater impact in women (20× increased risk). Depression is a risk factor for AD in men, but not women. 😵‍💫 Schizophrenia Earlier onset and worse symptoms in men. Brain structure and asymmetry changes differ by sex. Sex-specific facial asymmetries found in patients. 💊 Addiction Women more sensitive to reinforcing drug effects (e.g., cocaine). Brain activation to drug cues differs (e.g., right amygdala increases in men but decreases in women). Dopamine responses vary with sex hormones. 🧭 6. Evolutionary Perspectives Sexual selection pressures may explain some neural differences. Mothers benefit from enhanced spatial memory (e.g., oxytocin boosts memory in female mice after birth). 🔮 7. Future Directions & Conclusions Neuroscience must abandon the assumption that sex is unimportant. Researchers must: Justify single-sex studies or Conduct parallel sex-specific research. Sex influences operate at every level: genetic, structural, chemical, and behavioural. “Sex does matter” — often in unexpected ways — and ignoring it limits scientific progress.
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* Davies, W. (2014) Sex differences in ADHD: candidate genetic and endocrine mechanisms Frontiers in Neuroendocrinology 35(3):331-46
📘 Overview ADHD is a heterogeneous developmental disorder involving inattention, impulsivity, and hyperactivity. It affects ~1–6% of children globally and often persists into adulthood. Sex differences are significant in ADHD—males are diagnosed far more frequently than females, especially in childhood. ⚖️ 1. Clinical Sex Differences in ADHD 📊 Prevalence & Presentation Boys are up to 10× more likely to be diagnosed in clinical samples, though community data show a lower ratio (approx. 2–4:1). Girls tend to be underdiagnosed due to less disruptive behaviour and later symptom onset. Subtypes differ by sex: Boys: more likely to have hyperactive/impulsive or combined subtype. Girls: more likely to be diagnosed with the inattentive subtype. 🧠 Cognition Boys with ADHD: more deficits in motor skills, behavioural inhibition, and attentional control. Girls: show more planning difficulties and selective attention deficits. 🤝 Comorbidities Girls: more likely to develop depression, anxiety, and eating disorders. Boys: show higher rates of conduct disorder, aggression, and comorbid ASDs. Learning disabilities are more common in males. 🧠 2. Neural & Neurochemical Sex Differences 🧠 Brain Imaging Findings ADHD involves abnormalities in corticostriatal circuits, especially basal ganglia and prefrontal cortex. Males with ADHD show broader neural deficits than females in MRI and EEG studies. Functional imaging shows sex-specific patterns: e.g., men show altered cerebellar-prefrontal-striatal activation. 💊 Monoamines and Cholinergic Systems Dopamine (DA) and noradrenaline (NA) dysfunction are central to ADHD pathology. Treatments (e.g. methylphenidate, atomoxetine) affect DA/NA but show similar efficacy across sexes, with small sex-specific nuances. The cholinergic system may also be impaired, affecting attention and executive function. 🧬 3. Genetic & Epigenetic Mechanisms Behind Sex Differences 🧬 Y-Chromosome (Male-specific) SRY gene (on Y chromosome) may directly affect brain regions (e.g. substantia nigra) involved in DA synthesis. Mouse models show SRY affects impulsivity, motor control, and possibly hyperactivity. ✖️ X-Chromosome (Dosage & Imprinting) Males (XY) are hemizygous for X genes, increasing vulnerability to mutations (e.g., MAOA, HTR2C). STS gene (Steroid Sulfatase) escapes X-inactivation and has been linked to ADHD: Lower STS activity → reduced DHEA levels → inattention, hyperactivity, and serotonin dysfunction. Turner Syndrome (XO) and Klinefelter Syndrome (XXY) offer evidence of X-linked gene dosage affecting ADHD risk. 🧬 Genomic Imprinting Some X-linked genes may be imprinted (expressed only from mother/father), which could drive sex-specific expression. Early data (e.g., from Turner Syndrome) hint that parent-of-origin effects might influence ADHD traits. 🧪 4. Hormonal (Endocrine) Contributions 🧠 Androgens (Testosterone) Male-limited SRY expression drives testosterone production, shaping brain development. High prenatal testosterone may contribute to ADHD vulnerability: Supported by 2D:4D digit ratio studies (lower ratio = higher testosterone = more ADHD symptoms). Rodent studies show testosterone increases hyperactivity, impairs working memory, and alters dopamine pathways. ⚖️ Mixed Evidence Some studies suggest testosterone protects females; others contradict this. Complexity may relate to timing, dosage, and gene-hormone interactions. 🧩 5. Implications for Diagnosis and Treatment Diagnostic criteria may be male-biased, leading to underdiagnosis in females. Treatment response shows minor sex differences (e.g., atomoxetine more effective in females in some studies). Social therapies may work better in sex-specific groups. Future research must incorporate sex as a biological variable, both genetically and hormonally. 📝 Conclusion ADHD exhibits significant sex differences in prevalence, symptoms, comorbidities, and neurobiology. These differences are shaped by genetic, hormonal, and epigenetic mechanisms. Integrating sex differences in research and clinical practice is crucial for accurate diagnosis and effective treatment