Dorte Mølgaard Christiansen

Go to: B05 Biological Psychology

pollev.com/sdudochrist
VIDENSCENTER FOR
PSYKOTRAUMATOLOGI September 2023
Who am I?

Dorte Mølgaard Christiansen

 Assistant professor, PhD, psychologist
 Department of Psychology, SDU
 National Center for Psychotraumatology
(Videnscenter for Psykotraumatologi)
 Primary areas of research: Psychotraumatology
 Sex and gender differences (and similarities)
 Peritraumatic and acute stress response
 Strong biopsychosocial basis

VIDENSCENTER FOR
PSYKOTRAUMATOLOGI
https://youtube.com/shorts/Xc4OvKYLSMk?si=qUJE6kkY2LAms6FH
Part 1:
What is sex?
Answers from B03
developmental psychology:
“What is sex/gender?”
(same word in Danish)
Sex vs. gender
 Breedlove & Watson (2022) define gender
solely as the behaviours and attitudes that a
given culture considers to be masculine or
feminine

 I will argue that this definition is extremely limited, as it would imply that gender lies
exclusively within the culture, (akin to, femininity, and masculinity, normally
considered gender roles), implying that gender in itself does not reside or include
the individual experience. Though they do recognise gender identity, they see it as
something separate from gender, not as part of it. This definition is problematic,
because it implies that gender can exclusively be labelled by society, not by the
individual themself.
 Sex
(biological)
• Genotype (XX, XY, X, XXY, XXYY,
etc.)
• Generally dichotomous (with
exceptions)
• Male vs female
• Observable phenotype:
• Primary sex characteristics
• Secondary sex characteristics
• Hormones
• Sex differences in brain
structure and function
• Most animals (to some degree)
• Mostly stable
• Mostly innate
Gender
(socio-cultural)
• Behavioural phenotype (jvf. Scarr)
• Unique to humans
• Fluent (to some extent)
• “Femaleness” vs. “maleness”,
femininity vs. masculinity, gender
roles, gender identity, sexual
orientation, sexual identity
• Multivariate – variations across
cultures and sub-cultures, social class,
age, experience
• Emerges postnatally (prepared
prenatally) and is developed
throughout the life course based on
sex, socialisation, experience, and
development of identity
 Classroom discussion:
What relevance – if any – do animal studies
have for understanding human sex?

A parabiotic preparation in which two female rats are

surgically joined, sharing a single blood supply, shows
the effects of maternal hormones.
A nonpregnant female exposed to the circulating
hormones of a pregnant rat will display the
same maternal behaviors.
 https://youtu.be/kMWxuF9YW38?si=axRj_TvgzRDEdy6E (5:45)
 By Aaron Reedy (PhD, biologist): via http://buzzzco.com
 Sex differentiation in humans

 The process by which individuals develop male or female bodies and behaviors
 Begins at conception: sex determination (chromosomal)
 Relies almost exclusively on the sex determining region of the Y chromosome: the SRY
gene
 Extensive differentiation during the prenatal period
 Maturational processes during childhood influenced
by environment (nutrition, toxins, experience)
 Extensive changes during puberty
 Continues into adulthood
 https://youtu.be/z1Kdoja3hlk?si=uq5Ovvldm-Jiu7uV (1:50)
 Sex differentiation (to read at home)
 Very early in prenatal development, each embryo contains a pair of indifferent gonads. These
begin developing into either ovaries or testes during the first month of gestation, once the sex-
determining region of the Y chromosome, the SRY gene, Initiates this development.
 Once the testes have developed, they immediately begin to produce gonadal, hormones,
particularly testosterone.
 This further triggers a domino effect of prenatal development affecting prenatal tissue
development throughout the brain and body.
 One of the most apparent consequences of this early sexual differentiation involves the early
development of the genital tubercle, along with the Wolffian ducts or the Müllerian ducts.
Depending on the hormonal input, the Müllerian ducts will develop into fallopian tubes,
uterus, and inner vagina, while the, Wolffian, ducts degenerates, or the Wolffian ducts will
develop into epididymis, vas deferens, and and seminal vesicles, while the Müllerian ducts
shrink.
 Once again, in the absence of testes and/or the gonadal hormones they produce, the
genital tract will develop in a feminine pattern with the Müllerian ducts developing into
components of the female internal reproductive tract
 Prenatal sexual differentiation
• Conception:
• Genotype: sex determination (XX, XY, X, XXY, etc.)
• Approximately 105 males to 100 females at birth
• evens out by adulthood to approximately 101:100 (increased male mortality)

• Week 6-8:
• Indifferent gonads —> ovaries or testes
• Week 8-9:
• Sex-specific hormonal environments
• Androgens (testosterone) trigger the defemininisation of brain and body
• Week 16 and throughout the remainder of the prenatal period:
• The male foetus produces approximately the same level of testosterone
as a grown man
• Sex differences in brain structure, connections, and functions
Gonadal hormones
 Traditionally termed sex hormones (still are in Danish)
 Steroids produced primarily by the gonads
 Ovaries: oestrogen (especially oestradiol) and progesterone
 Testes: androgens (especially testosterone)
 Testosterone is more prevalent in males
 Oestrogens and progesterone are more prevalent in women
 Both have functions in both sexes, though some are sex-specific
 Due to processes of aromatisation, androgens are often converted to
and from oestrogen
 Many of the details about how sex and gender develops, both in the
embryonic, foetal, and postnatal phase, have yet to be worked out,
including any role played by aromatisation.
From genotypic
to
phenotypic sex

But what if all doesn’t go to

plan?
 Intersex
 Incompatible with the male vs. female sex binary
 Incompatibilities in term of one or more of the
following:
 Chromosomes
 Genitals
 Reproductive system
 Gonads: ovaries or testicles
 Hormones
 Previously: disorder of sex development (DSD) (animals: hermaphrodite)
 Not a disorder, disease, or condition in itself, but it may be associated with somatic
and psychological problems (specific diseases, infertility, gender dysphoria,
depression)
 Is more likely than binary sex to be associated with transgender identity and/or
homosexuality
 XXY Klinefelters syndrome
 Genetic error occuring during egg/sperm production or at conception (most 47 XXY)
 1:660 males (DK): Most (75%) don’t know they have it
 Inability to produce sufficient testosterone (in spite of SRY gene)
 Low levels of testosterone affect the development of male characteristics
 The extra X chromosome affects the ability to produce sperm (most have no sperm in
their ejaculate = ‘azoospermia’) —> infertility
 Mild to severe symptoms:
 Childhood: difficulties with walking, talking, language, speech, learning, and behaviour,
emotional immaturity, poor muscle tone
 Puberty: small/normal penis, small testes, less facial and body hair, bigger breasts, tall, most
masculine gender identity
 Adulthood: some low sex drive and/or erection problems, fertility problems (sometimes sperm
may be harvested)
 Comorbidity: diabetes, certain cancers, osteoporosis, diabetes, ADHD, anxiety, depression,
gender dysphoria
 Cases Klinefelter’s syndrome
Geoff:
 I had not heard of KS, but I’ve since learnt a lot more about it. As well as fertility, it
can affect everything from cognitive function to energy levels to sex drive. Being
diagnosed made some things fall into place – why I’m as tall as I am, why I’ve
always carried more weight around my hips, waist and chest, and why I often felt
tired.
 After the diagnosis, I was referred to an endocrinologist, which is a male fertility
specialist. I had a biopsy, where tissue is taken from each of the testes. This got sent
away to see if they could harvest any healthy sperm from the tissue. The result
showed that it wasn’t possible. It was hard news for both my wife and I to take. We
became each other’s rock, and we somehow navigated our way through. Let’s just
say it was a pretty grounding experience.
Source: https://www.healthymale.org.au/story/putting-one-foot-in-front-of-the-other

https://youtu.be/J-AzuFj1iS4?si=6z5L8Q6a1HyMlFS7 https://youtu.be/DtSidgeqfEo?si=1B-l63qu59s9KeV8
 X Turner’s syndrome
 Most 45,X (only one X), but also partially missing or re-arranged X, including mosaic:
45,X/46,XX or 45,X/46,X,iXq (where constellations differ across cells)
 1 in 2000-2500 females
 No SRY gene → recognisable, but under-developed ovaries
 Symptoms vary:
 Childhood: often congenital defects in heart and kdneys, learning problems (especially
spatial-temporal processing, nonverbal memory, attention), some physical features
 Puberty: no puberty, insufficient oestrogen and testosterone, short stature, ovaries not
functioning: no egg production, no hormonal excretion, generally (hyper-)feminine gender
identity
 Adulthood: pregnancy only possible with treatment
 Comorbidities: ear infections, impaired hearing, impaired sight, diabetes, obesity, low self-
esteem, anxiety, depression
 Cases Turner’s syndrome
Lindsey:
 Adolescence and puberty are hard enough; now imagine it planned, measured, and discussed
at length. Like any other adolescent girl, I just wanted to fit in. I didn’t, and I never would. At
age 14, I had the opportunity to attend a camp exclusively for girls with Turner Syndrome. It
changed my life. For the first time in my life, I met other girls with Turner Syndrome. I finally met
others who shared similar body and social issues. I had the opportunity to travel halfway across
the country on my own. I attended two years, and I credit camp for giving me the confidence
to study abroad repeatedly during my years at Michigan State. By having the opportunity to
meet others with TS, I realized that I am not a freak, and I am certainly not alone.
 Today, after having earned degrees in supply chain management and Spanish from Michigan
State University, I am going back to school to teach Spanish and/or social studies at the middle
school and/or high school level. Once I am established in my new career, I hope to adopt. Even
though the pain of infertility never fully goes away, I do believe that I am meant to adopt. I am
looking forward to the next chapter in my life.
Source: https://ourturner.org/turner-syndrome-my-story/

https://youtu.be/VoJFs7ExYT4?si=L4M7aGJpL4L05rJP https://youtu.be/DhypDYP3OI4?si=1CGuY77xZt5ou7PD
XX* Congenital Adrenal Hyperplasia
 Gene mutation —> adrenal glands produce androgens over corticosteroids —> Group of
genetic disorders:
 Classical CAH: genotypically female, but phenotypically male: 1:14.000 females
 Gene mutation —> adrenal glands produce androgens over corticosteroids
 Symptoms vary:
 Childhood: phallus intermediate in size between a typical clitoris and a typical penis, skinfolds
resemble both labia and scrotum (extreme cases: apparently well-formed penis and scrotum), no
testes, abdominal ovaries. Excess adrenal androgen production may be corrected, but will not
reverse prenatal sexual differentiation
 Puberty: most feminine gender identity, most straight, but increased homosexuality/bisexuality,
short height, early/very early puberty, irregular or no menstrual periods, facial hair, excessive body
hair, deep voice
 Adulthood: sexual problems, fertility issues.
 Comorbidity: Insufficient cortisol x-> irregular blood pressure, , low blood sugar and energy levels,
poor stress management, adrenal crisis (life-threatening), severe achne, gender dysphoria
*XY: not intersex, but problems related to excessive androgens and insufficient corticosteroids
 Cases CAH
Jubi:
 I heard the term CAH for the first time when I was already 22 years old, desperately
searching Google for others who shared the same traits I had. I was newly homeless
without access to regular healthcare, but needed answers. While searching the
internet an image caught my eye, text underneath sounded like it could’ve been
my autobiography, down to the smallest details about everything I’d blamed myself
for: the puberty, hormonal complications—the coincidences were extreme. That
probably doesn’t sound like a serendipitous revelation, but after a lifetime of fearing I
was the only one with a body like mine, suddenly I had the confidence to live my
truth instead of hiding it.
Source: https://interactadvocates.org/intersex-congenital-adrenal-hyperplasia/

https://youtu.be/j3lur1WHtzg?si=fpl7iclNlF-LdwqB https://youtu.be/X03ewbbHj3w?si=xFu4j6197HvAHavq
 XY Androgen Insensitivity Syndrome
 Genotypically male, but phenotypically female
 Genetic defects on X chromosome: SRY—> androgens, but no defiminisation
 No uterus, no cervix, often partial closing of the outer vagina, short vagina, enlarged clitoris
 Underdeveloped penis and undescended testes
 Complete AIS (CAIS):1 in 20.000 males
 Symptoms vary (complete or partial AIS)
 Childhood:
 CAIS rarely discovered, typical girl
 PAIS: male + female physical traits, play more like boys
 Puberty: little body hair, breasts develop, no menstruation, feminine gender identity
 Adulthood: infertility
 Comorbidity: urogenital disorders, testicular cancer
 Cases AIS
Cindy
 In my teen years my parents took me to the family doctor and he put me on a variety
of hormones. I wish Mom hadn’t pushed me, “Keep taking these birth control pills,
Cindy, and sooner or later they will jump start your period!” And oh, the other thing I
wish I hadn’t heard from them: “there’s nothing for you to worry about, you can adopt
children and live happily ever after.” Ugh! When you’re a teen and you think you are
supposed to get married, have children and a house in the suburbs like all those 1960’s
TV shows, the last thing you want are your parents saying is that it really doesn’t matter
whether you can have your own kids or not. I wish just once my parents had said this
was all pretty serious, and we should get you to a counselor and get you some more
help.
https://dsdguidelines.org/htdocs/parents/adults_memories.html#cindy-stone
 XX male (la chapelle) syndrome
 Approximately 1:20.000 males
 Crossover between the X and Y chromosomes during —> in 80-90% of cases SRY gene
transfers to the X chromosome pre-conception —> XX develops into male phenotype
 Symptoms may vary
 Childhood: most normal external and internal genitalia, few ambiguous, some small or
undescended testes. Most go undiscovered, unless prenatal testing is done
 Puberty: low-to-normal testosterone, high FSH and LH, average lower height and weight, some
less body hair, some lower sex drive, masculine gender identity
 Adulthood: infertillity (No azzospermia factor (AZF) region Y chromosome —> no sperm
production)
 Comorbidity: none reported
Congenital or environmental
damage to the penis and possibly testes
 Cloacal exstrophy:
 Severe birth defect: bladder and a part of the intestines open to the outside,
bony pelvis split open
 Male infants: the penis is either flat and short or sometimes split
 Female infants: the clitoris is split and there may be two vaginal openings, the
intestine may be short and the anus may not open
 Circumcision injury
 Males without unambiguously male genitalia have traditionally been raised
as girls
 Many transition to masculine when confronted with their condition
 Most develop masculine gender identity
 Reflect at home or
discuss with peers

How do we best define sex?

Part 2:
Does sex matter?
Should sex matter to psychologists?
Your poll answers:
 Only one said that it shouldn’t, but with no explanation provided
 One stated “hmm”
 One stated it depends on the context
 26 stated yes for the following (summarised) reasons:
 Biological sex influences psychology in general
 Hormones affect psychology
 Sex affects gender, identity, and experience
 Sex differences in the brain affect psychology in general and neuropsychology in particulark
 Sex differences are well-established in psychology – especially in clinical psychology
 Sex affects treatment
 Sex is often important to clients
 Psychologists should contribuute to the sex vs. dender debate
 Are humans really so
unique?
 Sex in animals influences multiple behaviours
 Parenting practices (or lack thereof)
 Hunting behaviour
 Territorial behaviour
 Social behaviour
 A number of professionals, policy makers, and
even researchers continue to downplay the
influences of sex on human behaviour, arguing
that any difference between men and women is
exclusively caused by sociocultural gender.
 Sexual differentiation of brain and
behaviour
 The same hormones that masculinise the developing genitalia in utero also
masculinise the brain.
 Organisational effects
 Occur during critical periods
 Cause permanent organisation of/alteration in behaviour
 Examples: puberty, menopause
 Activational effects
 Trigger temporary changes in behaviour
 Examples: Sexual arousal, labour
Sexual
dimorphism in
the human brain
 Sex on the brain
 Most tissues and cells throughout the body, including
in the brain, are affected by sex
 Sex biased genes are present in the central nervous
system in great numbers
 Many neuroanatomical sex differences have been
reported in the human brain
 Structure
 Function
 Connections
 Maturation: Pace of development and maturation of the CNS, including large areas of the brain
(eg. PFC, hippocampus) is higher in girls

 BUT these are subject to considerable heterogeneity

 Equifinality vs. Multifinality
 The human brain is not male or female
 It is best described as a mosaic of relative masculinity and femininity
 Sex- and gender-based pre- and
postnatal influences on the nervous system
 Genes and epigenetics
 Hormones:
 Androgens
 Oestrogens
 Peptides: oxytocin, argenin vasopressin
 Environmental influences and
experiences
 Gender-based influences possibly
plays an equal role to that of sex-based influences
Should men and
women be studied
separately in
research?
It was argued that:
- Both men and women should be
included in (most) studies, but they
may be analysed separately to
allow identification of moderation
effects (sex differences in
associations).
Sex- and gender-based influences on
human psychology
Complex interactions between environmental and biological
ethological factors, including:
• Genetics
• Epigenetics
• Uterine environment
• Endocrinology
• Neurobiology
• Physiology
• Upbringing
• Socialisation
• Experience
 Sex as a multidetermined phenomenon
 Biological sex is the one polymorphy* that excerts the
greatest influence on human health and illness over
the lifespan Men
Women
 Gender further adds to this
 Sex (like gender) may be measured dichotomously,
categorically, or continuously
 Examples?
 Intra-sex variation > inter-sex variation does not
necessarily reflect an absence of sex differences Men
Women 45+
*the result of a discontinuous genetic variation dividing the individuals of a population into two or
more sharply distinct forms Women 18-44
 Part 3

Sex differences
in sex
 What role does sexual satisfaction
play in romantic relationships?
Your answers indicated that it:
 Differs from each individual and each couple
 Is very important to most couples because of its influence on
 Intimacy
 General relationship satisfaction
 Commitment
 Physical affection is as important as emotional affection
 There are sex differences in ways of achieving satisfaction
 Finally, one person indicated that sexual satisfaction is only important for
men, and one person indicated that it is only relevant for women
 Sexual desire
 Contemporary conceptualisation:
 Can be experienced both biologically and psychologically
 Functions both within and beyond awareness
 May or may not lead to sexual behavior
 Traditional male models
 Spontaneous
 Easily identified
 Primarily physical
 Hormonal influences
 Androgens play a permissive role: presence > amount
 Cortisol may affect libido, erectile function, and/or regulation

Johansen et al., 2023; Rodríguez-Nieto et al., 2020

Female sexual desire

 Described in qualitative research

as a buildup of energy,
or a state of being
 Impacted by:
 Emotional intimacy
 Sociocultural norms
 Partner’s
contribution to
household work
 Hormones: androgens,
oestrogens, corticosteroids

Johansen et al., 2023

Model for
female
sexual
arousal
The human orgasm
 Occurrence single women: 62.9% of interactions
 Homosexual: 75% (p<.001)
 Heterosexual: 62%
 Bisexual: 58%
 Approximately 10% of women never orgasm
 Occurence single men: 85.1% of interactions
 Orgasms in women:
 Longer (20+ seconds vs. 3+ seconds in men)
 Less predictable
 Extremely varied between and within individuals
 Often require clitoral stimulation
 Affected by genetics
 PET scans: similar to male orgasm
 Clitoral vs. penile stimulation
 Sex differences during excitatory phase
Garcia et al., 2014
 Prenatal predictors for homosexuality
 Women:
 Nicotine, amphetamine, thyroid hormones
 Diethylstilbestrol (DES) for miscarriage prevention (+ bisexuality)
 Prenatal androgen exposure (e.g. finger ratio)
 Men:
 Fraternal-birth-order effect
 Maternal stress levels (cortisol?)
 Genetics (X-chromosome)
 Both
 Genetics (→ prevalence and sensitivity of
gonadal hormones)
 Structural and functional brain differences (eg.
Suprachiasmatic nucleus, hypothalamus, serotonergic system)
Sources: Bao & Swaab (2011); Breedlove & Watson (2022); LeVay (2011)
Sexual orientation

 Breedlove & Watson (2022):

 About 50% of variability in human sexual orientation is accounted
for by genetic factors

 Where does the rest come from?

 Prenatal development –especially sex differentiation
 Intrauterine environment – including gonadal hormones
 Possibly postnatal factors (though none have been
identified)
Sex and gender coming together
Sex development is not all about biology, and
gender development is not all about
socio-cultural influences
 Environmental influences on sex: environmental agents
(e.g., bisphenol), nutrition, maternal pregnancy stress,
later stressors (e.g. work environment, trauma, illness,
depression, parenthood)
 In macaque monkeys, social factors, such as rank
within the troop, moderates the influences of gonadal
hormones on behaviour (Zumpe et al., 1996)
 Biological influences on gender:
 Gender identity has a strong biological basis
 Sexual orientation has a strong biological basis
How to practice safe sex
 Be clear on what you and others are
talking about
 Research on sex (and gender)
differences is still in its infancy and
constantly developing
 Remainnuanced: sex and gender
cannot be fully understood
independently of each other
 Becareful not to mix ideology and
science
 Beware ofbias – in research, in society,
and in yourself
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Neuropsychopharmacology, 42(2), 386–396.
https://doi.org/10.1038/npp.2016.215
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