Sexual differentiation into a male or a female includes sexual differentiation of the brain. The paradigm of mammalian sexual differentiation is that in the presence of androgens (normally produced by the fetal testis) a male brain differentiation occurs, while in the absence of androgens (normal in females) a female brain differentiation follows. In the human there is a sex-dimorphism in gender identity/role, sexual orientation, sexual functioning, and in non-sexual functions, such as spatial ability, and verbal fluency. Inasmuch these properties can be studied in other mammals the effects of androgens are solidly demonstrable. In the human the evidence for androgen effects is equally plausible, evident from observations in subjects with errors in the process of sexual differentiation and in morphological studies of brain structures presumably related to these properties. But clinical observations show compellingly that other, largely unidentified, factors may modulate, or even override the effects of androgens. © 2002 Published by Elsevier Science Ireland Ltd.
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