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behavior. Most of the time, a girl like Emma would be the one in ten who is simply a tomboy. In this case, Emma had CAH.
Congenital adrenal hyperplasia causes fetuses to produce large amounts of testosterone, the sex and aggression hormone, from their adrenal glands starting at about eight weeks after conception—the very moment their brains begin to take shape into the male or female design. If we look at genetic females whose brains are exposed to surges of testosterone during this period, we see that these girls’ behavior and presumably brain structures are more similar to those of males than to those of females. I say “presumably” because a toddler’s brain isn’t so easy to study. Can you imagine a two-year-old sitting still for a couple of hours in an MRI scanner without being sedated? But we can deduce a lot from behavior.
The study of congenital adrenal hyperplasia provides evidence that testosterone erodes the normally robust brain structures in girls. At one year old, CAH girls make measurably less eye contact than other girls the same age. As these testosterone-exposed girls get older, they are far more inclined to scuffling, roughhousing, and fantasy play about monsters or action heroes than to pretending to take care of their dolls or dressing up in princess costumes. They also do better than other girls on spatial tests, scoring similarly to boys, while they do less well on tests that tap verbal behavior, empathy, nurturing, and intimacy—traits that are typically female. The implications are that the male and female brains’ wiring for social connection is significantly affected not just by genes but by the amount of testosterone that gets into the fetal brain. Lynn was relieved to have a scientific reason for some of her daughter’s behaviors, since no one had taken the time to explain to her what happens in the CAH brain.
G ENDER E DUCATION
Nature certainly has the strongest hand in launching sex-specific behaviors, but experience, practice, and interaction with others can modify neurons and brain wiring. If you want to learn to play the piano, you must practice. Every time you practice, your brain assigns more neurons to that activity, until finally you have laid new circuits between these neurons so that, when you sit down at the bench, playing is second nature.
As parents, we naturally respond to our children’s preferences. We will repeat, sometimes ad nauseam, the activity—Mommy’s smile or the noisy whistle of a wooden train—that makes our little one giggle or grin. This repetition strengthens those neurons and circuits in the baby’s brain that process and respond to whatever initially captivated her or his attention. The cycle continues, and children thus learn the customs of their gender. Since a little girl responds so well to faces, chances are Mom and Dad will make a lot of faces and she’ll get even better at responding. She’ll be engaged in an activity that reinforces her face-studying skill, and her brain will assign more and more neurons to that activity. Gender education and biology collaborate to make us who we are.
Adult expectations for girls’ and boys’ behavior play an important role in shaping brain circuits, and Wendy could have blown it for her daughter Samantha if she had given in to her own preconceptions about girls being more fragile and less adventurous than boys. Wendy told me that the first time Samantha climbed the jungle gym ladder to go down the slide by herself, she immediately looked back at Wendy for permission. If she had sensed disapproval or fear in her mother’s facial expression, she probably would have stopped, climbed back down, and asked for her mother’s help—as would 90 percent of little girls. When Wendy’s son was that age, he would never have bothered checking for her reaction, not caring if Wendy disapproved of this step of independence. Samantha obviously felt ready to take this “big girl” leap, so Wendy managed to