Masculinity Scores Research Articles

This Month in Adult Urology

This Month in Adult Urology

Gender roles and behavioral problems in children with 21-hydroxylase deficiency in Southern China

PurposeTo assess the gender roles and behavioral outcomes in children with 21-hydroxylase deficiency (21-OHD) in Southern China. MethodsA total of 50 individuals with 21-OHD participated in our study, (30 boys and 20 girls), as well as another 19 age-matched non-affected relatives of patients (12 boys and 7 girls). Psychological adjustment was assessed with a preschool activity survey and a Conner parent symptom questionnaire was modified for retrospective reporting. ResultsThe response rate of the questionnaire in the control group was only 36.5%. All the patients were diagnosed with salt-wasting of 21-OHD. Our study revealed that the masculine score was higher in male patients with 21-OHD than male controls and female patients. Compared with that in the female 21-OHD patient group, the masculine score in the female control group was lower, while comparative masculinization was found in the male controls. Regarding behavioral problems, there was a higher incidence of parent-reported problems among children with 21-OHD than controls, including conduct problems, impulsive hyperactivity, anxiety, and hyperactivity index. ConclusionParents of 21-OHD patients in Southern China were unwilling to disclose the condition of their children to the society. Masculinization and behavioral problems were prevalent among patients with 21-OHD, which highlighted the importance of psychological and social support for 21-OHD patients and their families.

Embrace the leadership challenge: The role of Gay men's internalized sexual stigma on the evaluation of others' leadership and one's own.

Grounded in the framework of the gay glass ceiling, the current research investigated the effect of gay men's internalized sexual stigma (ISS) on both the perceived effectiveness of other gay men's leadership and on their self-perceived leadership effectiveness and their intention to apply to a leadership position. In three studies (N=402), we manipulated either the leader's sexual orientation (SO) (study 1), or his adherence to traditional gender roles (TGR) (study 2), or participants' fictitious masculinity score (study 3). Our hypotheses were as follows: the leader's SO and TGR would moderate the association of gay participants' ISS with their positive attitudes towards the leader and with his leadership effectiveness; and gay participants' masculinity threat would moderate the association of their ISS with their intention to apply to a leadership position, and with their self-perceived effectiveness as potential leaders. Moderated regression analyses showed that: participants reported a more positive attitude towards a gay man (vs. heterosexual) as leader only when they had low - and not high - ISS; participants with high (vs. low) ISS perceived the masculine gay leader as more effective than the feminine gay leader; under masculinity threat, participants with high (vs. low) ISS showed less intention to apply to a leadership position. These studies provide both confirmation and novel insights into the key role of internalized sexual stigma and traditional gender roles. Indeed, these factors can strengthen and perpetuate the gay glass ceiling effect.

National culture and capital structure of the Shariah compliant firms: Evidence from Malaysia, Saudi Arabia and Pakistan

Cultural dimensions have a significant impact on capital structure decisions, particularly in Islamic economies where unique personal, social and ethical values are closely integrated with culture. This study considers the relationship between four Hofstede cultural dimensions to explain their connection with the capital structure decisions of Shariah-compliant firms. Using a panel of 342 Shariah complaint companies from Malaysia, Saudi Arabia and Pakistan for the period 2013 to 2017, this study investigates the influence of cultural dimensions on short-term, long-term and total leverage in the presence of several firm- and country-specific variables. On average, Saudi Arabian firms witnessed comparatively higher percentages of all three debt classifications considered. Typically, determinants of debt do not otherwise differ significantly across the three countries. Firms also carefully consider asset structure and growth opportunities when raising debt capital. On the other hand, when tested alongside cultural dimensions, Islamic firms from countries with (a) higher power distance scores, (b) higher levels of individualism, (c) higher masculinity scores and (d) lower degrees of uncertainty avoidance exhibit a preference for long-term debt. This finding diverges from the existing literature on non-Islamic firms. Agency theory and pecking order theory predominate in explaining our findings.

Associations between prenatal phthalate exposure and sex-typed play behavior in preschool age boys and girls

Phthalates, a class of chemicals found widely in consumer products including plastic toys, food contaminants and food packaging, personal care products, cosmetics, air fresheners, and some medications, have been shown to be anti-androgenic in numerous laboratory and epidemiological studies. In a prior cohort enrolled in 2000–2002, we observed associations between prenatal urinary concentrations of di-ethyl hexyl phthalate (DEHP) and dibutyl phthalate (DBP) metabolites and less male-typed play behavior in preschool age boys. The aim of this study was to examine phthalate exposure in pregnancy in relation to play behavior at age 4 years in a larger cohort of pregnant women enrolled in The Infant Development and the Environment Study (TIDES) between 2010 and 2012 at four study sites (Minneapolis, MN; Rochester, NY; San Francisco, CA; Seattle, WA). Maternal urinary metabolites of DEHP, DiBP, DnBP, BBzP, and DEP were measured during the first (n=498) and third trimester (n=468) and mothers completed the Preschool Activities Inventory (PSAI), a validated maternal questionnaire designed to assess child toy preference and sex-typed play behavior when children were 4–5 years of age. After adjusting for child age, maternal education, race, urine dilution, parental attitudes about opposite sex-typed play behavior, and presence of a same sex older sibling, we observed associations between first trimester (mean 10.7±2.1 weeks gestation) (log10) SpG-adjusted MnBP, MiBP, and MBzP and lower masculine scores in boys (β-coefficient [95% confidence intervals]: MnBP −2.18, [-4.16, −0.20]), MiBP −2.1[-4.3,0.1], and MBzP -2.42 [-4.12, −0.71]). In girls, first trimester maternal urinary MBzP was associated with lower masculine scores (-2.12 [-3.98,-0.25]), while third trimester (mean 32.8±3.0 weeks gestation) maternal urinary MiBP was associated with higher masculine scores (2.69 [0.68,4.70]). Third trimester maternal urinary phthalate levels were not associated with play behavior in boys. These findings in boys are largely consistent with previous studies that report that prenatal phthalate exposure is associated with less masculine play behavior. No associations in girls have been previously reported.

Gender Norms, Discrimination, Acculturation, and Depressive Symptoms among Latino Men in a New Settlement State.

Drawing from major theoretical and conceptual frameworks on minority men's mental health, we designed the current observational study to assess the associations of gender norms, discrimination, and acculturation with clinically significant depressive symptoms (CESD≥16) among a sample of immigrant Latino men in North Carolina. We used data from a baseline survey of men (n=111) recruited for a peer-led health intervention. To assess the associations with depressive symptoms, we performed descriptive and bivariate analyses, followed by multiple logistic regression. Men in the sample tended to be young (mean age 18.5 years), recent immigrants (70.3% immigrated after age 16), and to have incomplete high school education (76.5%). About half (51.4%) reported experiencing discrimination due to their ethnicity and more than a third (37.8%) reported experiencing discrimination due to their race. Using the short form Conformity to Masculine Norms instrument, their mean masculinity score was 52.0; their average 12-item Short Acculturation Scale for Latinos score was 21.8. More than one-quarter of participants (26.1%) had clinically significant depressive symptoms. Multiple logistic regression models showed among this sample of immigrant Latino men in the Southeast, traditional masculine norms-but not perceived discrimination nor acculturation-were associated with clinically significant depressive symptoms. Our results suggest a potential future avenue for intervention research: testing whether changing gender norms could result in improvements to mental health.

Clinical characteristics and genotype-phenotype correlations of 130 Chinese children in a high-homogeneity single-center cohort with 5α-reductase 2 deficiency.

BackgroundPatients with steroid 5α‐reductase 2 deficiency (5α‐RD) caused by SRD5A2 (OMIM #607306) variants present variable genotypes and phenotypes. The genotype‐phenotype correlations remain unclear.MethodsWe investigated genotype‐phenotype correlations of SRD5A2 variants in a large Chinese single‐center cohort. Phenotypes were categorized using the external masculinization score (EMS), urethral meatus and gonad position, and penile length‐standard deviation score.ResultsOf the 130 included patients, 113 had hypospadias, and 17 had a normal urethral meatus position. Testosterone/dihydrotestosterone (T/DHT) values were not significantly associated with phenotypic severity (p = 0.539–0.989). Of the 31 SRD5A2 variants, including 10 novel variants, p.R227Q was the most prevalent (39.62%), followed by p.Q6* (16.92%), p.R246Q (13.46%), and p.G203S (10.38%). Compared to biallelic missense mutations, biallelic nonsense mutations were associated with a lower EMS and urethral meatus score (p = 0.009 and p = 0.024, respectively). Patients homozygous for p.R227Q exhibited mild and variable phenotypes, while those homozygous for p.Q6*, p.R246Q, or p.G203S showed consistently severe phenotypes. The phenotypes were variable and milder in patients with compound heterozygosity for p.R227Q and these mutations.ConclusionT/DHT does not predict phenotype severity. The most prevalent SRD5A2 variant in Han Chinese is p.R227Q, which is associated with milder phenotypes and greater phenotypic variability. SRD5A2 variants may significantly influence phenotypic variation.

Who Dreams of Badges? Gendered Self-Concept and Policing Career Aspirations

National Institute of Justice’s Policing Research Plan (2017–2022) highlights the need to understand factors that attract diverse candidates. We explored whether college students had ever considered policing and found men were significantly more likely than women to contemplate policing careers. Further, we found higher levels of masculinity were associated with greater odds of policing aspirations; the relationship between gender and aspirations was fully mediated by masculine self-concept. Although men typically reported higher masculinity scores, within-gender analyses indicated that masculinity was important for both men and women. Our findings suggest the continued association of masculinity with policing may undercut efforts to recruit a representative workforce.

Genetic Analysis of 25 Patients with 5α-Reductase Deficiency in Chinese Population.

Background A deficiency in steroid 5α-reductase type 2 is an autosomal recessive disorder. Affected individuals manifested ambiguous genitalia, which is caused by decreased dihydrotestosterone (DHT) synthesis in the fetus. Methods We analyzed 25 patients with 5α-reductase deficiency in China. Seventeen of the 25 patients (68%) were initially raised as females. Sixteen patients changed their social gender from female to male after puberty. Results Eighteen mutations were identified in these patients. p.Gly203Ser and p.Gln6∗ were found to be the most prevalent mutations. On the basis of the genotype of these patients, we divided them into different groups. There was no significant difference in hormone levels and external masculinization score (EMS) in patients with or without these prevalent mutations. Twelve common single-nucleotide polymorphisms (SNPs) near the p.Gln6∗ mutation were chosen for haplotype analysis. Three haplotypes were observed in 6 patients who had the p.Gln6∗ mutation (12 alleles). Conclusion We analyzed mutations of the SRD5A2 gene in Chinese patients with 5α-reductase deficiency. Although hotspot mutations exist, no founder effect of prevalent mutations in the SRD5A2 gene was detected in the Chinese population.

SUN-066 Prenatal Sex Steroid Serum Concentrations in Relation to Sex-Typical Play Behavior at 4 Years of Age

INTRODUCTION: Sex differences in play behavior have been seen in rodents, primates and humans with literature showing some associations with maternal sex steroids. The PreSchool Activities Inventory (PSAI) is a validated tool to assess sexually-dimorphic play behavior. We assessed the associations between prenatal maternal estradiol (E2), free testosterone (fT) and total testosterone (T) and children’s PSAI scores at age 4.METHODS: Data were collected in The Infant Development and the Environment Study (TIDES), a US-based multi-center pregnancy cohort. The analysis included 399 pregnant women with complete data on sex steroids, PSAI and covariates. Early pregnancy E2 and T were analyzed by liquid chromatography tandem mass spectrometry and fT by equilibrium dialysis using labeled testosterone. PSAI scores (masculine, feminine and composite) were calculated from questionnaires completed by mothers when child was approximately 4 years old. Covariates included: maternal age and education, child age at questionnaire completion, number of older brothers and sisters, infant race and parental attitudes towards sex-atypical play behavior. After demonstrating nonlinear associations between PSAI scores and sex steroids, we used multivariable sex-stratified quadratic regression to model these relationships.RESULTS: The analysis included 192 boys and 207 girls (mean age: 4.5 years). Sex steroids in serum collected at 6-20 weeks’ gestation (mean: 11 weeks) were similar in mothers of boys and girls. In girls, E2 showed a quadratic relationship with the masculine score (beta (E2) = 0.003, p = 0.002, beta (E22) = -7.3E-7, p <0.001). Masculine scores were lower among girls whose mothers had E2 above the 75th percentile (2160 pg/ml). In boys, we observed a positive linear association of borderline significance (beta (fT) = 9.11, p = 0.06) and a significant negative association for the quadratic term (beta (fT2) = -7.44, p = 0.04). PSAI measures were not associated with E2 in mothers of boys, fT in mothers of girls, or T in either sex.DISCUSSION: This study did not replicate previously reported associations between T and masculine scores in girls. However, we found that, while most maternal E2 levels were not associated with play behavior in either sex, levels above the 75th percentile were associated with reduced masculine scores in girls at age 4. Our data also suggest a somewhat reduced feminine scores in boys born to mothers with fT above the 75th percentile. These results, based on a small sample using a maternal assessment of play behavior, should be examined in a larger sample using an objective measure of play.

SUN-709 MiR-200c Expression Profiles in Plasma of 46,XY DSD Patients of Unknown Etiology

Introduction: Despite the use of robust techniques for diagnosis, such as arrays and large-scale sequencing of patients with differences of sex development (DSD), the etiology of a great number of DSD patients remains unclear. Investigation of alternative signaling pathways and epigenetic factors is scarce in 46,XY DSD patients. The ZEB proteins have been related to the occurrence of hypospadias in humans, a feature often observed in the atypical genitalia of patients with 46,XY DSD. Additionally, miR-200c has been reported to regulate ZEB. Objective: To evaluate the expression of miR-200c in plasma samples of 46,XY DSD patients with unknown etiology. Methods: Plasma miR-200c of six adult 46,XY DSD patients with unknown etiology (age 18-33, mean 19±8) and 15 adult male controls (age 18-55, mean 29±10 yo) were analyzed. External Masculinization Score (EMS) was used to describe the undervirilization degree of patients’ external genitalia and to classify them in two groups with low EMS (LEMS: 0-4.9 points) and high EMS (HEMS: 5-10 points). All patients presented atypical genitalia with hypospadias. miR-200c was selected based on its targeting to ZEB1 and in silico analysis; miR-23a was used as internal normalization control. RNA was extracted from plasma samples with Magmax Mirvana Total RNA isolation kit. cDNA was synthesized using TaqMan Advanced miRNA cDNA Synthesis Kit and qPCR was performed using TaqMan Advanced miRNA. The data analysis of qPCR results of patients, of each individualized patient and also the EMS groups were compared with the control group by statistical test. Results: LEMS group presented lower expression values of miR-200c when compared to HEMS group (P=0.0001) and control group (p=0.0009), but no difference was observed when comparing HEMS group and controls, the two patients with lower miR-200c expression presented the lowest EMS (EMS- 3 and 3.5). Altogether, patients presented lower values of miR-200c, although not significantly (p=0.09). Discussion: These findings corroborate with previous literature data correlating miR200-c, ZEB1 and hypospadias. The regulatory loop of miR-200c/Zeb1 was previously demonstrated in rats with hypospadias, confirming that low expression of miR-200c induce a higher Zeb1 expression. The ZEB1 upregulation in penile tissue is positively correlated with the severity of hypospadias in animal models and humans. In the present study, 46,XY DSD patients with severe genital undervirilization had lower miR-200c expression in plasma. Conclusion: Plasma miRNA expression patterns may be a new strategy research in 46,XY DSD, contributing for understanding the processes involved in the external genitalia development.

SUN-056 Long Term Outcomes in Patients with Disorders of Sex Development in Lucknow, North India

Due to the deviant genitalia and infertility, the ill effects of DSD are on sexual and psychosocial life. Our aim was to assess the self-reported psychosocial and sexual quality of life in older individuals who are living with a DSD. Quality of life in 31 patients with a DSD (age >16 years, median [IQR] 23 [19-27] years, 16 males) was compared with age, sex and socioeconomic status matched normal (n = 46) and chronic disease controls (type 1 diabetes patients, n = 43) using SF-36v2 Health Survey. Another structured questionnaire was administered touching upon domains of sexual and psychosocial life. Eighteen patients reported history of persistent teasing, with no difference in prevalence between males and females. Eighteen reported suicidal thoughts (no association with being teased), 6 having attempted suicide. Gender identity (GI) of 30 patients was identical with their given sex of rearing, which had been decided by the caregiver in 19 families (including one who had gender change suggested by the parents at 4 years of age), and with physician assistance in 11. One patient had spontaneous change of GI at 16 years age. Sexual orientation was heterosexual in 25 of 29 who responded to this question, homosexual in 1 and bisexual in 3, including the 2 who had gender change. Romantic relationship was reported by 12 patients, sexual activity by 7, aversion to sex (due to fear of rejection) by 11 and abuse by 4. Seventeen patients thought the timing of genital surgery should be before age 5 years and another 10 before age 10 years. Only 2 of 31 patients thought decision for the timing and choice of surgery should rest with themselves, the remainder preferring a decision by parents in 25% and by the physician in 67%. The physical and mental quality of life scores (QOLS) were not different between patients and the controls. Mental QOLS were significantly lower for those with history of teasing. Physical QOLS in males correlated with external masculinisation score (r=0.55, p=0.04). Conclusion: Serious psychological stress is common in patients with DSD in our region. Despite early sex assignment, the absence of prominent gender dysphoria in adulthood, along with their stated preference for corrective genital surgery at an early age, favour an early sex assignment and genital reconstruction before the age of romantic relationships.

MON-060 P-450 Oxidoreductase Deficiency with Antley Bixler Phenotype: A Novel Mutation

IntroductionWe present first case of 46 XY Disorder of Sex Development (DSD) from India due to P-450 Oxidoreductase Deficiency with Novel variant (p.Ala541Thr) in a heterozygous state.Case Discussion6 months old boy presented with ambiguous genitalia since birth. No history of neonatal crisis, failure to thrive and pigmentation of skin, maternal virilisation or drug ingestion during pregnancy. On examination: weight 6.2 Kg (3rd centile), height 64 cm (3rd centile), MPH-170 (25-50th centile), head circumference 38 cm (−2.7 SD), vitals stable, trigonocephaly with fused anterior and posterior fontanelle, prominent pointed forehead, midfacial hypoplasia, up slanting eyes, hypertelorism and low set ears were present. Genitalia: 1.5 cm phallus like structure with foreskin, chordee, single perineal opening in form of peno-scrotal hypospadias, bifid scrotum with poor rugosity and poor pigmentation and both gonads (1 ml) were palpable in labio-scrotal fold with external masculinization score (EMS), 6/12 and Prader stage 4.Investigations showed normal electrolytes and blood sugar, High basal ACTH, post stimulation cortisol 14mcg/dl, Basal 17-OHP was 8.6 ng/ml and post stimulation 12ng/ml, with low DHEAS 36.4 mcg/dl and androstenedione 0.42 ng/ml, LH 16.09 mIU/ml (elevated), FSH 2.97 mIU/ml (normal) and low Testosterone for his age. T/DHT 9.6 (normal<10) and Testosterone /Androstenedione ratio 0.95 (normal >0.8). Abdominal and Pelvic imaging showed normal adrenal glands and absent female internal genitalia, bilateral testis in labio-scrotal fold (right testis-6x6.5x11 mm, left testis-6.6x7x10 mm), corpora cavernosa and bifid scrotum. NCCT Head showed metopic craniosynostosis with trigonocephaly and hypotelorism. Skeletal survey showed bowing of femora. 20 cell Karyotype of peripheral blood lymphocyte was 46 XY. NGS was done of the POR gene, which revealed a heterozygous missense variation in exon 13 of the POR gene variant (p.Ala541Thr) which has not been reported yet.The patient was initiated hydrocortisone, fludrocortisone, DHT gel and corrective surgery is planned.Clinical learningAlthough in PORD classically the inheritance is generally autosomal recessive, but manifesting heterozygotes are not uncommon1. This case also shows the value of Next gen sequencing and the role it can play in DSD1. Scott RR, Gomes LG, Huang N, Van Vliet G, Miller WL. Apparent manifesting heterozygosity in P450 oxidoreductase deficiency and its effect on coexisting 21-hydroxylase deficiency. J Clin Endocrinol Metab. 2007;92:2318–2322

The Confluence Model of Sexual Aggression: An Application With Adolescent Males.

The Confluence Model of Sexual Aggression is a well-established framework for understanding factors that contribute to men's perpetration of sexual aggression against women, highlighting the roles of hostile masculinity, impersonal sex orientation, and exposure to pornography. To date, only one study has applied aspects of the Confluence Model to examine predictors of sexual aggression in adolescent males, and the study did not include pornography exposure as a predictor. The current study evaluates the Confluence Model as a framework for understanding the perpetration of both contact and noncontact sexual aggression in a sample of 935 heterosexual 10th-grade adolescent boys. Composite scores for hostile masculinity and impersonal sex orientation were generated. Nearly all the variables included in the hostile masculinity and impersonal sex constructs were associated with perpetration. Zero-inflated Poisson regression models revealed distinct combinations of salient predictors when the dependent variable was identified as boys' frequency of perpetration, compared with when the dependent variable was defined as any perpetration of sexual aggression. Impersonal sex orientation and violent pornography exposure were associated with perpetrating noncontact sexual aggression in the last 6 months, while violent pornography exposure and the interaction of hostile masculinity and impersonal sex orientation increased the frequency of recent contact sexual aggression. Results suggest that hostile masculinity, impersonal sex orientation, and violent pornography exposure are important factors to address within sexual assault prevention approaches for adolescent boys.

Pornography, Masculinity, and Sexual Aggression on College Campuses.

Past research has indicated that there is a relationship between pornography consumption and sexually aggressive behavior. This study sought to expand an understanding of that relationship by examining measures of masculinity among a sample of undergraduate heterosexual males (N = 152) along with pornography consumption variables to assess the predictive value that both pornography consumption and varying levels of masculinity have on sexual aggression. Linear regression analyses indicate that males who had higher scores on the Likelihood of Sexual Force (LSF) measure consumed pornography more often and were more likely to watch male-dominant pornography. In addition, males who had higher scores on LSF exhibited higher masculinity scores on two scales. Results are discussed in the context of the complexities of masculinity and pornography consumption and the implications for prevention programs on college campuses.

Differences in gay and heterosexual men’s emotional restriction through their femininity: an Irish study

ABSTRACTEmotional expression plays a vital role in men’s mental health. However, emotionality is still perceived as a feminine response and its restriction is enmeshed in male identity. Gay men’s supposed relationship to femininity infers they are less emotionally restrictive. This paper offers evidence and theory that counters this. A quantitative study (n = 300) was undertaken on self identified heterosexual and gay adult men contacted through targeted social media websites. Research questions explored if there were differences in emotional restriction in gay and heterosexual men, and if stereotypical gender characteristics (masculinity, femininity) influence these variations. Constructs and corresponding scales measured conflicted gender roles, restricted emotionality and gender role scores. Findings revealed no statistical emotional restriction differences between gay and heterosexual men. However, there were significant differences in their gender roles. Specifically, heterosexual men’s emotional restriction was dictated by a combination of high masculinity and low femininity scores (which calculates a masculine category), and the avoidance of femininity suggested by low femininity scores. Gay men’s higher femininity scores and reduced frequency in the masculine category would (mistakenly) suggest lower emotional restriction scores. The findings suggest that gay men construe femininity differently to heterosexual men, affecting their emotional expression.

Relationship between Testosterone and Self-Perceived Masculinity in an Australian Cohort of Community-Dwelling Men

Background and objective Traditional masculinity is characterised by traits of independence, toughness, assertiveness, competitive-ness and physical competence. Multiple factors modulate the expression of masculinity, including age, social class, ethnicity and occupation. While there is a perception that physiological testosterone concen-tration impacts self-perceived masculinity in men, there are limited supporting data. This study aimed to examine the relationship between testosterone concentration and self-perceived masculinity as measured by the Masculinity in Chronic Disease Inventory (MCD-I), controlling for health-related and biopsycho-social factors in community-dwelling, middle-aged to elderly men. Materials and methods Participants were drawn from a longitudinally followed cohort (N=1195) of men participating in the Florey Adelaide Male Aging Study based in Adelaide, Australia. A final sample of 460 (mean age 65.15, stan-dard deviation 9.72) men consisted of those with serum testosterone concentrations measured at wave one (2002&ndash;2005) and wave two (2007&ndash;2010), and who, in 2017, completed the Masculinity in Chronic Disease Inventory questionnaire and provided information related to demographics, medical conditions, health and lifestyle behaviours. Adjusted multivariable regression analyses were undertaken to determine the relationship between serum testosterone concentration at wave 2 and MCD-1 total masculinity score and sub-scores. Given the temporal difference between the testosterone concentration assessment and MCD-1 completion, a further analysis was performed including participants with a stable serum testosterone concentration over a 5-year period. Results There was no association between serum testosterone concentration and MCD-1 total masculinity score (p = 0.54) or sub-scores (p = 0.12&ndash;0.85). There was also no association between testosterone concentration and total masculinity score in men with stable serum testosterone over time (p = 0.35). Testosterone con-centration was associated with serum sex-hormone-binding globulin (SHBG) concentration (p &lt; 0.001), age (p &lt; 0.001), waist circumference (p &lt; 0.001) and a history of diabetes (p = 0.021). Total masculinity score was lower in men without a partner (widowed p &lt; 0.013, separated/divorced p &lt; 0.019), a history of anxiety (p = 0.036) and moderate (p = 0.05) to severe erectile dysfunction (p &lt; 0.001). Conclusion This study provides evidence against the perception that physiological testosterone concentration impacts self-perceived masculinity. Rather, in middle-aged to older men, self-perceived masculinity is abrogated by psychosocial factors and chronic physical disorders.

The External Genitalia Score (EGS): A European Multicenter Validation Study.

Standardized description of external genitalia is needed in the assessment of children with atypical genitalia. To validate the External Genitalia Score (EGS), to present reference values for preterm and term babies up to 24 months and correlate obtained scores with anogenital distances (AGDs). A European multicenter (n = 8) validation study was conducted from July 2016 to July 2018. EGS is based on the external masculinization score but uses a gradual scale from female to male (range, 0-12) and terminology appropriate for both sexes. The reliability of EGS and AGDs was determined by the interclass correlation coefficient (ICC). Cross-sectional data were obtained in 686 term babies (0-24 months) and 181 preterm babies, and 111 babies with atypical genitalia. The ICC of EGS in typical and atypical genitalia is excellent and good, respectively. Median EGS (10th to 90th centile) in males < 28 weeks gestation is 10 (8.6-11.5); in males 28-32 weeks 11.5 (9.2-12); in males 33-36 weeks 11.5 (10.5-12) and in full-term males 12 (10.5-12). In all female babies, EGS is 0 (0-0). The mean (SD) lower/upper AGD ratio (AGDl/u) is 0.45 (0.1), with significant difference between AGDl/u in males 0.49 (0.1) and females 0.39 (0.1) and intermediate values in differences of sex development (DSDs) 0.43 (0.1). The AGDl/u correlates with EGS in males with typical genitalia and in atypical genitalia. EGS is a reliable and valid tool to describe external genitalia in premature and term babies up to 24 months. EGS correlates with AGDl/u in males. It facilitates standardized assessment, clinical decision-making and multicenter research.

Preliminary investigation of gender assignment in 46,XY disorders of sex development with severe male undermasculinisation

Objective: To explore the feasibility of gender assignment in 46,XY disorders of sex development (DSD) with severe undermasculinisation mainly based on molecular diagnosis. Methods: A retrospective study of 45 patients of 46, XY DSD with severe undermasculinisation were admitted between November 2015 and October 2018 at Children's Hospital, Zhejiang University School of Medicine. The initial social gender were all female, of whom the external genital manifestations were Prader 0 to 2; the degree of masculinity was scored using external masculinisation score (EMS); the position and development of the gonads were examined by ultrasound, cystoscopy and laparoscopy, also including assessing the development of the Wolffian tube and the Müllerian tube. The level and ratio of testosterone to dihydrotestosterone before and after hCG stimulation were evaluated for the function of Leydig cell and 5α-reductase-2. Gender role scales and sandbox games were used to assess gender role behavior. Genital sensitivity to androgen stimulation was assessed; A panel including 163 genes related to gender development were determined by second-generation sequencing in all 45 patients. Finally, a multidisciplinary team (MDT) makes a gender assignment after a comprehensive analysis mainly based on the molecular etiological diagnosis. Results: Thirty-nine out of 45 patients (87%) had an identifiable genetic etiology, and the remaining 6 (13%) were negative for genetic testing. Forty-five patients had EMS less than or equal to 3 points. Sexual psychological assessment was performed in 39 patients, with male dominance in 24 (62%) and female dominance in 15 (38%). The gender assignment was 23 cases (51%) for male and 19 cases (42%) for female, and 3 cases (7%) were not completely determined. Conclusions: Molecular diagnosis provides a strong basis for appropriate gender assignment of 46, XY DSD children with severe undermasculinisation. Based on molecular diagnosis, each DSD should be analyzed by professional MDT to analyze the clinical symptoms/signs, gonadal development, gonad tumor risk, external genital morphology, sexual psychological assessment, potential fertility opportunities, parental views, Social and cultural factors, etc. make appropriate gender assignment.

Female management, overconfidence and debt maturity: European evidence

This paper investigates how female involvement in management shapes the nature of the firm’s financial decisions in terms of debt maturity. It is suggested that female managers, being less overconfident and more conservative than men, will opt for more short-term debt to preserve financial viability in the capital structure. Using panel data for listed and unlisted European companies, we show that the presence of female executives increases the level of short-term debt financing. Moreover, we examine the financial impact of gender heterogeneity moderated by cultural differences among countries related to masculine/feminine traits in society. Female executives seem to prefer a higher level of short-term debt, especially in countries with high masculinity scores, where competitiveness and material rewards for success are very relevant. These results show that companies run by women, particularly in a “masculine” environment, tend to prefer a more flexible capital structure, reinforcing the hypothesis that female executives are less overconfident.