Spatial ability, episodic memory, and emotion recognition in women with congenital adrenal hyperplasia or complete androgen insensitivity syndrome

Conditions like congenital adrenal hyperplasia (CAH) and complete androgen insensitivity syndrome (CAIS) may provide information contributing to the explanation of sex differences in cognition. Using online tests and questionnaires, we examined how prenatal androgen exposure and/or sex chromosomes influence spatial ability, episodic memory, and emotion recognition in women with classic CAH (C-CAH; n = 29), non-classic CAH (NC-CAH; n = 13), CAIS (n = 11), and female (n = 147) and male (n = 142) controls. Results showed that (1) female and male controls differed on most cognitive tasks, whereas (2) women with C-CAH or CAIS did not consistently differ from either female or male controls. Investigating the relative advantage on either the female (episodic memory, emotion recognition) or male-favoring tasks (spatial ability), indicated that women with (3) C-CAH had a cognitive profile that was different from female and male controls, (4) CAIS were not different from male controls, whereas (5) NC-CAH had a relative advantage on female-favoring tasks. These findings suggest that excessive prenatal androgen exposure (C-CAH) may shift cognitive performance toward a male-typical pattern, though not to the male level. Additionally, aspects associated with having 46,XY karyotype, but lacking prenatal androgen receptivity (CAIS) may also influence cognition in a male-typical direction, providing mixed support for the prenatal androgen hypothesis.