Prenatal hormones and sexual orientation

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https://en.wikipedia.org/wiki/Prenatal_hormones_and_sexual_orientation 

The hormonal theory of sexuality holds that, just as exposure to certain hormones plays a role in fetal sex differentiation, such exposure also influences the sexual orientation that emerges later in the adult. Prenatal hormones may be seen as the primary determinant of adult sexual orientation, or a co-factor with genes, biological factors and/or environmental and social conditions.

Sex-typed behavior

The hormonal theory of sexuality and gender identity holds that, just as exposure to certain hormones plays a role in fetal sex differentiation, such exposure also influences the sexual orientation and or gender identity that emerges later in the adult. Differences in brain structure that come about from chemical messengers and genes interacting on developing brain cells are believed to be the basis of sex differences in countless behaviors, including sexual orientation. Prenatal factors that affect or interfere with the interaction of these hormones on the developing brain can influence later sex-typed behavior in children. This hypothesis is originated from countless experimental studies in non-human mammals, yet the argument that similar effects can be seen in human neurobehavioral development is a much debated topic among scholars. Recent studies, however, have provided evidence in support of prenatal androgen exposure influencing childhood sex-typed behavior.

Fetal hormones may be seen as either the primary influence upon adult sexual orientation or as a co-factor interacting with genes and/or environmental and social conditions. However, Garcia-Falgueras and Dick Swaab disagree that social conditions influence sexual orientation to a large degree. As seen in young children as well as in vervet and rhesus monkeys, sexually differentiated behavior in toy preference is differing in males versus females, where females prefer dolls and males prefer toy balls and cars; these preferences can be seen as early as 3–8 months in humans. It is impossible to completely rule out the social environment or the child's cognitive understanding of gender when discussing sex typed play in androgen-exposed girls. Conversely, children tend towards objects which have been labelled for their own sex, or toys that they have seen members of their sex playing with previously.

An endocrinology study by Garcia-Falgueras and Swaab postulated that "In humans, the main mechanism responsible of [sic] sexual identity and orientation involves a direct effect of testosterone on the developing brain." Further, their study puts forward that intrauterine exposure to hormones is largely determinative. Sketching the argument briefly here, the authors say that sexual organs are differentiated first, and then the brain is sexually differentiated "under the influence, mainly, of sex hormones such as testosterone, estrogen and progesterone on the developing brain cells and under the presence of different genes as well ... . The changes brought about in this stage are permanent. ... Sexual differentiation of the brain is not caused by hormones alone, even though they are very important for gender identity and sexual orientation."

Organizational aspects

Fetal gonads develop primarily based on the presence or absence of androgen hormones, mainly testosterone, dihydrotestosterone (DHT) and androstenedione; production of testosterone and conversion into dihydrotestosterone during weeks 6 to 12 of pregnancy are key factors in the production of a male fetus's penis, scrotum and prostate. In a female, on the other hand, absence of these levels of androgens results in development of typically female genitals. Following this, sexual differentiation of the brain occurs; sex hormones exert organizational effects on the brain that will be activated in puberty. As a result of these two processes occurring separately, the degree of genital masculinization does not necessarily relate to the masculinization of the brain. Sex differences in the brain have been found in many structures, most notably the hypothalamus and the amygdala. However, few of these have been related to behavioral sex differences, and scientists are still working to establish firm links between early hormones, brain development and behavior. The study of the organizational theory of prenatal hormones can be difficult, as ethically researchers cannot alter hormones in a developing fetus; instead, scholars must rely on naturally occurring abnormalities of development to provide answers.

Most extensively studied in organizational effects of hormones is congenital adrenal hyperplasia (CAH). CAH is a genetic disease that results in exposure to high levels of androgens beginning early in gestation. Girls with CAH are born with masculinized genitalia, which is corrected surgically as soon as possible. CAH provides the opportunity for natural experiments, as people with CAH can be compared to people without it. However, "CAH is not a perfect experiment", since, "social responses to masculinized genitalia or factors related to the disease itself" can confound results. Nonetheless several studies have shown that CAH has a clear but not determining influence on sexual orientation; women with CAH are less likely to be exclusively heterosexual than are other women.

Since hormones alone do not determine sexual orientation and differentiation of the brain, the search for other factors that act upon sexual orientation have led genes such as the SRY and ZFY to be implicated.

Prenatal maternal stress

As of 2006 results from studies in humans had found conflicting evidence regarding the effect of prenatal exposure to hormones and psychosexual outcomes; Gooren noted in 2006 that studies in subprimate mammals are invalid measures of human sexual differentiation, as sex hormones follow a more "on-off" role in sex-typed behavior than is found in primates.

Some studies do suggest that prenatal stress significantly increases the likelihood of homosexuality or bisexuality, although varying evidence exists for which trimester is most important. Studies of endocrinology have found implications for amphetamines and thyroid-gland hormones to increase homosexuality in female offspring as well, although it has not been examined in conjunction with prenatal stress levels.

Some have postulated that postnatal (e.g., social and environmental factors) development can play a role in the sexual orientation of an individual, yet solid evidence of this has yet to be discovered. Children born through artificial insemination with donor sperm and consequently raised by lesbian couples have typically been heterosexually oriented. Summed up by Bao and Swaab, "The apparent impossibility of getting someone to change their sexual orientation ... is a major argument against the importance of the social environment in the emergence of homosexuality, as well as against the idea that homosexuality is a lifestyle choice."

Fraternal birth order

According to a multitude of studies over several decades, gay men have more older brothers on average, a phenomenon known as the fraternal birth order effect. It has been suggested that the greater the number of older male siblings the higher the level of androgen fetuses are exposed to. No evidence of birth order effects have been observed in women. The theory holds that the fraternal birth order effect is a result of a maternal immune response that is produced towards a factor of male development over several male pregnancies. Bogaert's hypothesis argues that "the target of the immune response may be male specific molecules on the surface of male fetal brain cells (e.g., including those in the anterior hypothalamus). Anti-male antibodies might bind to these molecules and thus interfere with their role in normal sexual differentiation, leading some later born males to being attracted to men as opposed to women." Garcia-Falgueras and Swaab state that "The ... fraternal birth order effect ... is putatively explained by an immunological response by the mother to a product of the Y chromosome of her sons. The chance of such an immune response to male factors would increase with every pregnancy resulting in the birth of a son."

Maternal antibodies against Y-chromosone neuroligin have been implicated in this effect, among other evidence that favours this theory. Further, while percentages of the likelihood of homosexuality have been estimated to be increased by 15–48% per older brother, these odds really account for only a few percent of the population; thus, this hypothesis cannot be universally applied to the majority of homosexual men. Most, but not all, studies have been able to reproduce the fraternal birth order effect. Some did not find any statistically significant difference in either the sibling composition or rate of older brothers of gay and straight men, including large, nationally representative studies in the US and Denmark. However, Blanchard reanalyzed Frisch's 2006 Danish study and found the birth order effect was in-fact present.

In conjunction with fraternal birth order, handedness provides further evidence of prenatal effects on sexual orientation, because handedness is regarded by many as a marker of early neurodevelopment. Other correlates to handedness (e.g., cerebral laterality, prenatal hormonal profiles, spatial ability) have been linked to sexual orientation, either empirically and/or theoretically. In right-handed individuals, the number of older brothers increased the odds of homosexual orientation, but this effect was not seen in left-handed individuals. As with other purported marks indicating higher incidence of homosexuality, however, the link with handedness remains ambiguous and several studies have been unable to replicate it.

Implicated genes in fraternal birth order

A gene of the Rh system has been discussed as a possible candidate for affecting fraternal birth order, as it has been linked to both handedness and immune system functioning. Gene variants in the Rh system are implicated in a maternal response to what is known as hemolytic disease of the newborn. Rh is a factor in blood, and in cases where the mother is absent of this (Rh-) while carrying an Rh+ fetus, an immune response may develop with deleterious effects. The Rh gene hypothesis is a strong candidate because not only does it involve the maternal immune response, but it has been implicated in handedness as well.

Variants of the androgen receptor (AR) gene have also been discussed, in that non-right-handedness in men has been linked with greater CAG repeats in the AR gene, which in turn is associated with lower testosterone. A theory that high prenatal testosterone leads to neuronal and axonal loss in the corpus callosum is supported by this hypothesis.

Male homosexuality as hypermasculine

There is evidence of a correlation between sexual orientation and traits that are determined in utero. A study by McFadden in 1998 found that auditory systems in the brain, another physical trait influenced by prenatal hormones is different in those of differing orientations; likewise the suprachiasmatic nucleus was found by Swaab and Hofman to be larger in homosexual men than in heterosexual men. The suprachiasmatic nucleus is also known to be larger in men than in women. An analysis of the hypothalamus by Swaab and Hofmann (1990;2007) found that the volume of the suprachiasmatic nucleus (SCN) in homosexual men was 1.7 times larger than a reference group of male subjects, and contained 2.1 times as many cells. During development, the volume of the SCN and the cell counts reach peak value at approximately 13 to 16 months after birth; at this age, the SCN contains the same number of cells as was found in adult male homosexuals, yet in a reference group of heterosexual males the cell numbers begin to decline to the adult value of 35% of the peak value. These results have not been replicated, however; there also has yet to be a meaningful interpretation of these results provided in the context of human sexual orientation. Some highly disputed studies suggest gay men have also been shown to have higher levels of circulating androgens and larger penises, on average, than heterosexual men.

Male homosexuality as hypomasculine

In a 1991 study, Simon LeVay demonstrated that a tiny clump of neurons of the anterior hypothalamus—which is believed to control sexual behavior and linked to prenatal hormones—known as the interstitial nuclei of the anterior was, on average, more than twice the size in heterosexual men when contrasted to homosexual men. Due to this area also being nearly twice the size in heterosexual men than in heterosexual women, the implication is that the sexual differentiation of the hypothalamus in homosexuals is in a female direction. In 2003 scientists at Oregon State University announced that they had replicated his findings in sheep.

Female homosexuality

Most empirical or theoretical research into women's sexual orientation has, historically, been guided by the idea of lesbians as essentially masculine and heterosexual women as essentially feminine. Typically, this belief is traced to the early "inversion theory" of sex researchers who state that homosexuality is a result of biological abnormalities that "invert" sexual attraction and personality. Handedness research has provided implications; because more men than women present a preference for their left hand, the higher proportion of non-right handedness that has been discovered among lesbians when compared to heterosexual women demonstrates a possible link of prenatal masculinization and sexual orientation.

Backing this up are reports that lesbians display more masculinized 2D;4D digit ratios than heterosexual women, based on data gathered from at least six different laboratories. This effect has not yet been observed between homosexual and heterosexual males. However, the validity of this measure of digit ratios remains controversial as a predictor of prenatal androgen, as many other prenatal factors may play roles in bone growth in prenatal stages of development. While many studies have found results confirming this hypothesis, others have failed to replicate these findings, leaving the validity of this measure unconfirmed.

Diethylstilbestrol (DES), a drug that has been in the past prescribed to prevent miscarriages, has also been studied in relation to women's sexual orientation. It has been observed to exert a masculinizing/

defeminizing effect on the developing brain of the fetus. When compared to controls, higher percentages of DES-exposed women (17% vs 0%) reported that they had engaged in same-sex relations; however, the great majority of DES women stated an exclusively heterosexual orientation.

Girls with congenital adrenal hyperplasia (an autosomal recessive condition which results in high androgen levels during fetal development) have more masculinized sex role identities and are more likely to have a homosexual sexual orientation as adults than controls. An alternative explanation for this effect is the fact that girls with this condition are born with masculinized external genitalia, which leads their parents to raise them in a more masculine manner, thus influencing their sexual orientation as adults. However, the degree to which the girls' genitals are masculinized does not correlate with their sexual orientation, suggesting that prenatal hormones are a stronger causal factor, not parental influence.

Together with congenital adrenal hyperplasia, DES studies have provided little support of the prenatal hormone theory of sexual orientation; they do, however, provide the framework for possible pathways to a homosexual orientation for a small number of women.

Gender dysphoria

In individuals with gender dysphoria, previously known as gender identity disorder (GID), prenatal exposure to testosterone has been hypothesized to have an effect on gender identity differentiation. The 2D;4D finger ratio, or relative lengths of the 2nd "index" and 4th "ring" fingers, has become a popular measure of prenatal androgen because of accumulated evidence suggesting the 2D;4D ratios are related to prenatal exposure to testosterone. Many children with GID differentiate a homosexual orientation during adolescence, but not all of them; adults with "early onset", or a childhood history of cross-gender behavior, often have a homosexual orientation. Adults with "late onset", or those without a childhood history of said behavior, are more likely to have a non-homosexual orientation.

Prenatal androgen exposure has been associated with an increased chance of patient-initiated gender reassignment to male after being initially raised as female in early childhood or infancy. Gooren found that organizational effects of prenatal androgens are more prevalent in gender role behavior than in gender identity, and that there are preliminary findings that suggest evidence of a male gender identity being more frequent in patients with fully male-typical prenatal androgenization.

Individuals with complete androgen insensitivity syndrome are almost always brought up as females, and the differentiation of gender identity/role is feminine. This example is important in demonstrating that chromosomes and gonads alone do not dictate gender identity and role.

Transsexualism

Because organ differentiation and brain differentiation occur at different times, in rare cases transsexualism can result. Only 23% of childhood gender problems will result in transsexuality in adulthood.

Drawing on some transsexualism cases, Garcia-Falgueras and Swaab state that "[f]rom these examples it appears that the direct action of testosterone on the developing brain in boys and the lack of such action on the developing brain in girls are crucial factors in the development of male and female gender identity and sexual orientation ... ." Countless studies have been run on peripheral levels of sex steroids in male and female homosexuals, a considerable number of which claimed to find "less 'male hormone' and/or more 'female hormone' in male homosexuals and vice versa in female homosexuals". However, these findings have been reviewed and have subsequently been dismissed by Gooren as suffering from faulty design and interpretation.

Factors implicated in the development of transsexuality include chromosomal abnormalities, polymorphisms of certain genes, and variations in aromatase (cytochrome P450 CYP19) and CYP17. Girls with congenital adrenal hyperplasia show an increase in probability of transsexuality later in life; however, this risk is still only 1–3% in CAH. Although historically abnormal sexual differentiation has pointed to androgens as a causal factor, there are codeterminants of gender identity and sexual orientation with overriding effects of androgens on the brain, in male transsexuals or homosexuals, or making androgen effects on the brain redundant, as in female transsexuals or homosexuals. These factors are currently unknown, and thus no clear cut answer for the cause of transsexualism and homosexuality exists.

Due to relatively small population sizes, generalizability of studies on transsexuality cannot be assumed.

Endocrine disruptors

Endocrine disrupting chemicals (EDCs) are chemicals that, at certain doses, can interfere with the endocrine system in mammals. Work on possible neurotoxic effects of endocrine disruptors, and their possible effects on sexual orientation when a fetus is exposed to them, is in its infancy: "we mostly know about the relationship between EDC exposure and neurobehavioral function through an examination of outcomes within a limited sphere of questions." While studies have found that xenoestrogens and xenoandrogens can alter the brain's sexual differentiation in a number of species used as animal models, from the data in hand to date, it is "misleading ...to expect EDCs to produce profiles of effects, such as sexually dimorphic behaviors, as literal copies of those produced by native hormones. Such agents are not hormones. They should not be expected to act precisely as hormones."

Causes of transsexuality

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Causes_of_transsexuality 

The study of the causes of transsexuality investigates gender identity formation of transgender people, especially those who are transsexual. Transgender people have a gender identity that does not match their assigned sex, often resulting in gender dysphoria. The causes of transsexuality have been studied for decades. The most studied factors are biological, especially brain structure differences in relation to biology and sexual orientation. Environmental factors have also been proposed.

Transgender brain studies, especially those on trans women who are sexually attracted to women (gynephilic), and those on trans men who are sexually attracted to men (androphilic), are limited, as they include a small number of tested individuals. The available research indicates that the brain structure of androphilic trans women with early-onset gender dysphoria is closer to the brain structure of cisgender women's and less like cisgender men's. It also reports that both androphilic trans women and trans women with late-onset gender dysphoria who are gynephilic have different brain phenotypes, and that gynephilic trans women differ from both cisgender male and female controls in non-dimorphic brain areas. Cortical thickness, which is generally thicker in cisgender women's brains than in cisgender men's brains, may also be thicker in trans women's brains, but is present in a different location to cisgender women's brains. For trans men, research indicates that those with early-onset gender dysphoria and who are gynephilic have brains that generally correspond to their assigned sex, but that they have their own phenotype with respect to cortical thickness, subcortical structures, and white matter microstructure, especially in the right hemisphere. Hormone use can also affect transgender people's brain structure; it can cause transgender women's brains to become closer to those of cisgender women, and morphological increments observed in the brains of trans men might be due to the anabolic effects of testosterone.

Twin studies suggest that there are likely genetic causes of transsexuality, although the precise genes involved are not fully understood. One study published in the International Journal of Transgender Health found that 33% of identical twin pairs were both trans, compared to only 2.6% of non-identical twins who were raised in the same family at the same time, but were not genetically identical.

Ray Blanchard created a taxonomy of male-to-female transsexualism that proposes two distinct etiologies for androphilic and gynephilic individuals that has become controversial, supported by J. Michael Bailey, Anne Lawrence, James Cantor and others, but opposed by Charles Allen Moser, Julia Serano, and the World Professional Association for Transgender Health.

Biological factors

Genetics

A 2008 study compared 112 male-to-female transsexuals (MtFs), both androphilic and gynephilic, and who were mostly already undergoing hormone treatment, with 258 cisgender male controls. Male-to-female transsexuals were more likely than cisgender males to have a longer version of a receptor gene (longer repetitions of the gene) for the sex hormone androgen, which reduced its effectiveness at binding testosterone. The androgen receptor (NR3C4) is activated by the binding of testosterone or dihydrotestosterone, where it plays a critical role in the forming of primary and secondary male sex characteristics. The research suggests reduced androgen and androgen signaling contributes to the female gender identity of male-to-female transsexuals. The authors say that a decrease in testosterone levels in the brain during development might prevent complete masculinization of the brain in male-to-female transsexuals and thereby cause a more feminized brain and a female gender identity.

A variant genotype for a gene called CYP17, which acts on the sex hormones pregnenolone and progesterone, has been found to be linked to female-to-male (FtMs) transsexuality but not MtF transsexuality. Most notably, the FtM subjects not only had the variant genotype more frequently, but had an allele distribution equivalent to male controls, unlike the female controls. The paper concluded that the loss of a female-specific CYP17 T -34C allele distribution pattern is associated with FtM transsexuality.

Transsexuality among twins

In 2013, a twin study combined a survey of pairs of twins where one or both had undergone, or had plans and medical approval to undergo, gender transition, with a literature review of published reports of transgender twins. The study found that one third of identical twin pairs in the sample were both transgender: 13 of 39 (33%) monozygotic or identical pairs of assigned males and 8 of 35 (22.8%) pairs of assigned females. Among dizygotic or genetically non-identical twin pairs, there was only 1 of 38 (2.6%) pairs where both twins were trans. The significant percent of identical twin pairs in which both twins are trans and the virtual absence of dizygotic twins (raised in the same family at the same time) in which both were trans would provide evidence that transgender identity is significantly influenced by genetics if both sets were raised in different families.

Brain structure

General

Several studies have found a correlation between gender identity and brain structure. A first-of-its-kind study by Zhou et al. (1995) found that in a region of the brain called the bed nucleus of the stria terminalis (BSTc), a region which is known for sex and anxiety responses (and which is affected by prenatal androgens), cadavers of six persons who were described as having been male-to-female transsexual or transgender persons in life had female-normal BSTc size, similar to the study's cadavers of cisgender women. While those identified as transsexual had taken hormones, this was accounted for by including cadavers of non-transsexual male and female controls who, for a variety of medical reasons, had experienced hormone reversal. The controls still had sizes typical for their gender. No relationship to sexual orientation was found.

In a follow-up study, Kruijver et al. (2000) looked at the number of neurons in BSTc instead of volumes. They found the same results as Zhou et al. (1995), but with even more dramatic differences. One MtF subject, who had never gone on hormones, was also included and matched up with the female neuron counts nonetheless.

In 2002, a follow-up study by Chung et al. found that significant sexual dimorphism (variation between sexes) in BSTc did not become established until adulthood. Chung et al. theorized that either changes in fetal hormone levels produce changes in BSTc synaptic density, neuronal activity, or neurochemical content which later lead to size and neuron count changes in BSTc, or that the size of BSTc is affected by the generation of a gender identity inconsistent with one's assigned sex.

It has been suggested that the BSTc differences may be due to the effects of hormone replacement therapy. It has also been suggested that because pedophilic offenders have also been found to have a reduced BSTc, a feminine BSTc may be a marker for paraphilias rather than transsexuality.

In a review of the evidence in 2006, Gooren confirmed the earlier research as supporting the concept of transsexuality as a sexual differentiation disorder of the sex dimorphic brain. Dick Swaab (2004) concurs.

In 2008, a new region with properties similar to that of BSTc in regards to transsexuality was found by Garcia-Falgueras and Swaab: the interstitial nucleus of the anterior hypothalamus (INAH3), part of the hypothalamic uncinate nucleus. The same method of controlling for hormone usage was used as in Zhou et al. (1995) and Kruijver et al. (2000). The differences were even more pronounced than with BSTc; control males averaged 1.9 times the volume and 2.3 times the neurons as control females, yet regardless of hormone exposure, MtF transsexuals were within the female range and the FtM transsexual within the male range.

A 2009 MRI study by Luders et al. of 24 MtF transsexuals not yet treated with cross-sex hormones found that regional gray matter concentrations were more similar to those of cisgender men than to those of cisgender women, but there was a significantly larger volume of gray matter in the right putamen compared to cisgender men. Like earlier studies, it concluded that transsexuality was associated with a distinct cerebral pattern. (MRI allows easier study of larger brain structures, but independent nuclei are not visible due to lack of contrast between different neurological tissue types, hence other studies on e.g. BSTc were done by dissecting brains post-mortem.)

An additional feature was studied comparing 18 female-to-male transsexuals who had not yet received cross-sex hormones with 24 male and 19 female gynephilic controls, using an MRI technique called diffusion tensor imaging or DTI. DTI is a specialized technique for visualizing white matter of the brain, and white matter structure is one of the differences in neuroanatomy between men and women. The study took into account fractional anisotropy values for white matter in the medial and posterior parts of the right superior longitudinal fasciculus (SLF), the forceps minor, and the corticospinal tract. Rametti et al. (2010) discovered that, "Compared to control females, FtM showed higher FA values in posterior part of the right SLF, the forceps minor and corticospinal tract. Compared to control males, FtM showed only lower FA values in the corticospinal tract." The white matter pattern in female-to-male transsexuals was found to be shifted in the direction of biological males.

Hulshoff Pol et al. (2006) studied the gross brain volume of 8 male-to-female transsexuals and in six female-to-male transsexuals undergoing hormone treatment. They found that hormones changed the sizes of the hypothalamus in a gender consistent manner: treatment with male hormones shifted the hypothalamus towards the male direction in the same way as in male controls, and treatment with female hormones shifted the hypothalamus towards the female direction in the same way as female controls. They concluded: "The findings suggest that, throughout life, gonadal hormones remain essential for maintaining aspects of sex-specific differences in the human brain."

A 2016 review agreed with the other reviews when considering androphilic trans women and gynephilic trans men. It reported that hormone treatment may have large effects on the brain, and that cortical thickness, which is generally thicker in cisgender women's brains than in cisgender men's brains, may also be thicker in trans women's brains, but is present in a different location to cisgender women's brains. It also stated that for both trans women and trans men, "cross-sex hormone treatment affects the gross morphology as well as the white matter microstructure of the brain. Changes are to be expected when hormones reach the brain in pharmacological doses. Consequently, one cannot take hormone-treated transsexual brain patterns as evidence of the transsexual brain phenotype because the treatment alters brain morphology and obscures the pre-treatment brain pattern."

Androphilic male-to-female transsexuals

Studies have shown that androphilic male-to-female transsexuals show a shift towards the female direction in brain anatomy. In 2009, a German team of radiologists led by Gizewski compared 12 androphilic transsexuals with 12 cisgender males and 12 cisgender females. Using functional magnetic resonance imaging (fMRI), they found that when shown erotica, the cisgender men responded in several brain regions that the cisgender women did not, and that the sample of androphilic transsexuals was shifted towards the female direction in brain responses.

In another study, Rametti and colleagues used diffusion tensor imaging (DTI) to compare 18 androphilic male-to-female transsexuals with 19 gynephilic males and 19 androphilic cisgender females. The androphilic transsexuals differed from both control groups in multiple brain areas, including the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract. The study authors concluded that androphilic transsexuals were halfway between the patterns exhibited by male and female controls.

A 2016 review reported that early-onset androphilic transgender women have a brain structure similar to cisgender women's and unlike cisgender men's, but that they have their own brain phenotype.

Gynephilic male-to-female transsexuals

Research on gynephilic trans women is considerably limited. While MRI taken on gynephilic male-to-female transsexuals have likewise shown differences in the brain from non-transsexuals, no feminization of the brain's structure have been identified. Neuroscientists Ivanka Savic and Stefan Arver at the Karolinska Institute used MRI to compare 24 gynephilic male-to-female transsexuals with 24 cisgender male and 24 cisgender female controls. None of the study participants were on hormone treatment. The researchers found sex-typical differentiation between the MtF transsexuals and cisgender males, and the cisgender females; but the gynephilic transsexuals "displayed also singular features and differed from both control groups by having reduced thalamus and putamen volumes and elevated GM volumes in the right insular and inferior frontal cortex and an area covering the right angular gyrus".

The researchers concluded that:

Contrary to the primary hypothesis, no sex-atypical features with signs of 'feminization' were detected in the transsexual group ... The present study does not support the dogma that [male-to-female transsexuals] have atypical sex dimorphism in the brain but confirms the previously reported sex differences. The observed differences between MtF-TR and controls raise the question as to whether gender dysphoria may be associated with changes in multiple structures and involve a network (rather than a single nodal area).

Berglund et al. (2008) tested the response of gynephilic MtF transsexuals to two steroids hypothesized to be sex pheromones: the progestin-like 4,16-androstadien-3-one (AND) and the estrogen-like 1,3,5(10),16-tetraen-3-ol (EST). Despite the difference in sexual orientation, the MtFs' hypothalamic networks activated in response to the AND pheromone, like the androphilic female control groups. Both groups experienced amygdala activation in response to EST. Gynephilic male control groups experienced hypothalamic activation in response to EST. However, the MtF subjects also experienced limited hypothalamic activation to EST. The researchers concluded that in terms of pheromone activation, MtFs occupy an intermediate position with predominantly female features. The MtF transsexual subjects had not undergone any hormonal treatment at the time of the study, according to their own declaration beforehand, and confirmed by repeated tests of hormonal levels.

A 2016 review reported that gynephilic trans women differ from both cisgender male and female controls in non-dimorphic brain areas.

Gynephilic female-to-male transsexuals

Fewer studies have been performed on the brain structure of transgender men than on transgender women. A team of neuroscientists, led by Nawata in Japan, used a technique called single-photon emission computed tomography (SPECT) to compare the regional cerebral blood flow (rCBF) of 11 gynephilic FtM transsexuals with that of 9 androphilic cis females. Although the study did not include a sample of biological males so that a conclusion of "male shift" could be made, the study did reveal that the gynephilic FtM transsexuals showed significant decrease in blood flow in the left anterior cingulate cortex and a significant increase in the right insula, two brain regions known to respond during sexual arousal.

A 2016 review reported that the brain structure of early-onset gynephilic trans men generally corresponds to their assigned sex, but that they have their own phenotype with respect to cortical thickness, subcortical structures, and white matter microstructure, especially in the right hemisphere. Morphological increments observed in the brains of trans men might be due to the anabolic effects of testosterone.

Prenatal androgen exposure

Prenatal androgen exposure, the lack thereof, or poor sensitivity to prenatal androgens are commonly cited mechanisms to explain the above discoveries. To test this, studies have examined the differences between transsexuals and cisgender individuals in digit ratio (a generally accepted marker for prenatal androgen exposure). A meta-analysis concluded that the effect sizes for this association were small or nonexistent.

Congenital adrenal hyperplasia in persons with XX sex chromosomes results in what is considered to be excess exposure to prenatal androgens, resulting in masculinization of the genitalia and, typically, controversial prenatal hormone treatment and postnatal surgical interventions. Individuals with CAH are usually raised as girls and tend to have similar cognitive abilities to the typical female, including spatial ability, verbal ability, language lateralization, handedness and aggression. Research has shown that people with CAH and XX chromosomes will be more likely to be same sex attracted, and at least 5.2% of these individuals develop serious gender dysphoria.

In males with 5-alpha-reductase deficiency, conversion of testosterone to dihydrotestosterone is disrupted, decreasing the masculinization of genitalia. Individuals with this condition are typically raised as females due to their feminine appearance at a young age. However, more than half of males with this condition raised as females become males later in their life. Scientists speculate that the definition of masculine characteristics during puberty and the increased social status afforded to men are two possible motivations for a female-to-male transition.

Psychological

Psychiatrist and sexologist David Oliver Cauldwell argued in 1947 that transsexuality was caused by multiple factors. He believed that small boys tend to admire their mothers to such a degree that they end up wanting to be like them. However, he believed that boys would lose this desire as long as his parents set limits when raising him, or he had the right genetic predispositions or a normal sexuality. In 1966, Harry Benjamin considered the causes of transsexuality to be badly understood, and argued that researchers were biased towards considering psychological causes over biological causes.

Ray Blanchard has developed a taxonomy of male-to-female transsexualism built upon the work of his colleague Kurt Freund, which assumes that trans women have one of two motivations for transition. Blanchard theorizes that "homosexual transsexuals" (a taxonomic category he uses to refer to trans women who are sexually attracted to men) transition because they are attracted to men, and characterizes them as displaying overt and obvious femininity since childhood; he characterizes "non-homosexual transsexuals" (a taxonomic category he uses to refer to trans women who are sexually attracted to women) as transitioning because they are autogynephilic (sexually aroused by the thought or image of themselves as a woman), and as being either attracted to women, attracted to both women and men, or asexual.

Autogynephilia is common among late-onset transgender women. A study on autogynephilic men found that they were more gender dysphoric than non-autogynephilic men. Michael Bailey speculated that autogynephilia may be genetic.

Blanchard's theory has gained support from J. Michael Bailey, Anne Lawrence, James Cantor, and others who argue that there are significant differences between the two groups, including sexuality, age of transition, ethnicity, IQ, fetishism, and quality of adjustment. However, the theory has been criticized in papers from Veale, Nuttbrock, Moser, and others who argue that it is poorly representative of MtF transsexuals and non-instructive, and that the experiments behind it are poorly controlled and/or contradicted by other data. Many authorities, including some supporters of the theory, criticize Blanchard's choice of wording as confusing or degrading because it focuses on trans women's assigned sex and disregards their sexual orientation identity. Lynn Conway, Andrea James, and Deidre McClosky attacked Bailey's reputation following the release of The Man Who Would Be Queen. Evolutionary biologist and trans woman Julia Serano wrote that "Blanchard's controversial theory is built upon a number of incorrect and unfounded assumptions, and there are many methodological flaws in the data he offers to support it." The World Professional Association for Transgender Health (WPATH) argued against including Blanchard's typology in the DSM, stating that there was no scientific consensus on the theory, and that there was a lack of longitudinal studies on the development of transvestic fetishism.

A 2016 review found support for the predictions of Blanchard's typology that androphilic and gynephilic trans women have different brain phenotypes. It stated that although Cantor seems to be right that Blanchard's predictions have been validated by two independent structural neuroimaging studies, there is "still only one study on nonhomosexual MtFs; to fully confirm the hypothesis, more independent studies on nonhomosexual MtFs are needed. A much better verification of the hypothesis could be supplied by a specifically designed study including homosexual and nonhomosexual MtFs." The review stated that "confirming Blanchard's prediction still needs a specifically designed comparison of homosexual MtF, homosexual male, and heterosexual male and female people."

Parenting

The failure of an attempt to raise David Reimer from infancy through adolescence as a girl after his genitals were accidentally mutilated is cited as disproving the theory that gender identity is determined solely by parenting. Between the 1960s and 2000, many other newborn and infant boys were surgically reassigned as females if they were born with malformed penises, or if they lost their penises in accidents. Many surgeons believed such males would be happier being socially and surgically reassigned female. Available evidence indicates that in such instances, parents were deeply committed to raising these children as girls and in as gender-typical a manner as possible. Six of seven cases providing orientation in adult follow-up studies identified as heterosexual males, with one retaining a female identity, but who is attracted to women. Such cases do not support the theory that parenting influences gender identity or sexual orientation of those assigned male at birth. Reimer's case is used by organizations such as the Intersex Society of North America to caution against needlessly modifying the genitals of unconsenting minors.

In 2015, the American Academy of Pediatrics released a webinar series on gender, gender identity, gender expression, transgender, etc. In the first lecture Dr. Sherer explains that parents' influence (through punishment and reward of behavior) can influence gender expression but not gender identity. She cites a Smithsonian article that shows a photo of a 3 year old President Franklin D. Roosevelt with long hair, wearing a dress. Children as old as 6 wore gender neutral clothing, consisting of white dresses, until the 1940s. In 1927, Time magazine printed a chart showing sex-appropriate colors, which consisted of pink for boys and blue for girls. Dr. Sherer argued that kids will modify their gender expression to seek reward from their parents and society but this will not affect their gender identity (their internal sense of self).

Biology and sexual orientation

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Biology_and_sexual_orientation 

The relationship between biology and sexual orientation is a subject of research. While scientists do not know the exact cause of sexual orientation, they theorize that it is caused by a complex interplay of genetic, hormonal, and environmental influences. Hypotheses for the impact of the post-natal social environment on sexual orientation, however, are weak, especially for males.

Biological theories for explaining the causes of sexual orientation are favored by scientists. These factors, which may be related to the development of a sexual orientation, include genes, the early uterine environment (such as prenatal hormones), and brain structure.

Scientific research and studies

Fetal development and hormones

The influence of hormones on the developing foetus has been the most influential causal hypothesis of the development of sexual orientation. In simple terms, the developing fetal brain begins in a "female" typical state. The presence of the Y-chromosome in males prompts the development of testes, which release testosterone, the primary androgen receptor-activating hormone, to masculinize the fetus and fetal brain. This masculinising effect pushes males towards male typical brain structures, and most of the time, attraction to females. It has been hypothesized that gay men may have been exposed to little testosterone in key regions of the brain, or had different levels of receptivity to its masculinizing effects, or experienced fluctuations at critical times. In women, it is hypothesized that high levels of exposure to testosterone in key regions may increase likelihood of same sex attraction. Supporting this are studies of the finger digit ratio of the right hand, which is a robust marker of prenatal testosterone exposure. Lesbians on average, have significantly more masculine digit ratios, a finding which has been replicated numerous times in studies cross-culturally. While direct effects are hard to measure for ethical reasons, animal experiments where scientists manipulate exposure to sex hormones during gestation can also induce life long male-typical behavior and mounting in female animals, and female-typical behavior in male animals.

Maternal immune responses during fetal development are strongly demonstrated as causing male homosexuality and bisexuality. Research since the 1990s has demonstrated that the more male sons a woman has, there is a higher chance of later born sons being gay. During pregnancy, male cells enter a mother's bloodstream, which are foreign to her immune system. In response, she develops antibodies to neutralize them. These antibodies are then released on future male foetuses and may neutralize Y-linked antigens, which play a role in brain masculinization, leaving areas of the brain responsible for sexual attraction in the female-typical position, or attracted to men. The more sons a mother has will increase the levels of these antibodies, thus creating the observed fraternal birth order effect. Biochemical evidence to support this effect was confirmed in a lab study in 2017, finding that mothers with a gay son, particularly those with older brothers, had heightened levels of antibodies to the NLGN4Y Y-protein than mothers with heterosexual sons. J. Michael Bailey has described maternal immune responses as "causal" of male homosexuality. This effect is estimated to account for between 15-29% of gay men, while other gay and bisexual men are thought to owe sexual orientation to genetic and hormonal interactions.

Socialization theories, which were dominant in the 1900s, favored the idea that children were born "undifferentiated" and were socialized into gender roles and sexual orientation. This led to medical experiments in which newborn and infant boys were surgically reassigned into girls after accidents such as botched circumcisions. These males were then reared and raised as females without telling the boys, which, contrary to expectations, did not make them feminine nor attracted to men. All published cases providing sexual orientation grew up to be strongly attracted to women. The failure of these experiments demonstrate that socialization effects does not induce feminine type behavior in males, nor make them attracted to men, and that the organizational effects of hormones on the fetal brain prior to birth have permanent effects. These are indicative of 'nature', not nurture, at least with regards to male sexual orientation.

INAH-3 volume in the human brain
	Heterosexual (straight) men   Homosexual (gay) men   Women
Average volumes of INAH3 in straight and gay men and in women.

The sexually dimorphic nucleus of the preoptic area (SDN-POA) is a key region of the brain which differs between males and females in humans and a number of mammals (e.g., sheep/rams, mice, rats), and is caused by sex differences in hormone exposure. The INAH-3 region is bigger in males than in females, and is thought to be a critical region in sexual behavior. Dissection studies found that gay men had significantly smaller sized INAH-3 than heterosexual males, which is shifted in the female typical direction, a finding first demonstrated by neuroscientist Simon LeVay, which has been replicated. Dissection studies are rare, however, due to lack of funding and brain samples.

Equivalent SDN in sheep
	Heterosexually oriented rams   Homosexually oriented rams   Ewes (females)
Average volumes of the equivalent cell group in sheep (oSDN) for heterosexual and homosexual rams and for ewes. Sex differences are formed under the influence of prenatal hormones in utero, rather than acquired after birth.

Long-term studies of domesticated sheep lead by Charles Roselli have found that 6-8% of rams have a homosexual preference through their life. Dissection of ram brains also found a similar smaller (feminized) structure in homosexually oriented rams compared to heterosexually oriented rams in the equivalent brain region to the human SDN, the ovine sexually dimorphic nucleus (oSDN). The size of the sheep oSDN has also been demonstrated to be formed in utero, rather than postnatally, underscoring the role of prenatal hormones in masculinization of the brain for sexual attraction.

Other studies in humans have relied on brain imaging technology, such as research lead by Ivanka Savic which compared hemispheres of the brain. This research found that straight men had right hemispheres 2% larger than the left, described as modest but "highly significant difference" by LeVay. In heterosexual women, the two hemispheres were the same size. In gay men, the two hemispheres were also the same size, or sex atypical, while in lesbians, the right hemispheres were slightly larger than the left, indicating a small shift in the male direction.

A model proposed by evolutionary geneticist William R. Rice argues that a misexpressed epigenetic modifier of testosterone sensitivity or insensitivity that affected development of the brain can explain homosexuality, and can best explain twin discordance. Rice et al. propose that these epimarks normally canalize sexual development, preventing intersex conditions in most of the population, but sometimes failing to erase across generations and causing reversed sexual preference. On grounds of evolutionary plausibility, Gavrilets, Friberg and Rice argue that all mechanisms for exclusive homosexual orientations likely trace back to their epigenetic model. Testing this hypothesis is possible with current stem cell technology.

Genetic influences

Multiple genes have been found to play a role in sexual orientation. Scientists caution that many people misconstrue the meanings of genetic and environmental. Environmental influence does not automatically imply that the social environment influences or contributes to the development of sexual orientation. Hypotheses for the impact of the post-natal social environment on sexual orientation are weak, especially for males. There is, however, a vast non-social environment that is non-genetic yet still biological, such as prenatal development, that likely helps shape sexual orientation.

Twin studies

Identical twins are more likely to have the same sexual orientation than non-identical twins. This indicates that genes have some influence on sexual orientation; however, scientists have found evidence that other events in the womb play a role. Twins may have separate amniotic sacs and placentas, resulting in different exposure and timing of hormones.

A number of twin studies have attempted to compare the relative importance of genetics and environment in the determination of sexual orientation. In a 1991 study, Bailey and Pillard conducted a study of male twins recruited from "homophile publications", and found that 52% of monozygotic (MZ) brothers (of whom 59 were questioned) and 22% of the dizygotic (DZ) twins were concordant for homosexuality. 'MZ' indicates identical twins with the same sets of genes and 'DZ' indicates fraternal twins where genes are mixed to an extent similar to that of non-twin siblings. In a study of 61 pairs of twins, researchers found among their mostly male subjects a concordance rate for homosexuality of 66% among monozygotic twins and a 30% one among dizygotic twins. In 2000, Bailey, Dunne and Martin studied a larger sample of 4,901 Australian twins but reported less than half the level of concordance. They found 20% concordance in the male identical or MZ twins and 24% concordance for the female identical or MZ twins. Self reported zygosity, sexual attraction, fantasy and behaviours were assessed by questionnaire and zygosity was serologically checked when in doubt. Other researchers support biological causes for both men and women's sexual orientation.

A 2008 study of all adult twins in Sweden (more than 7,600 twins) found that same-sex behaviour was explained by both heritable genetic factors and unique environmental factors (which can include the prenatal environment during gestation, exposure to illness in early life, peer groups not shared with a twin, etc.), although a twin study cannot identify which factor is at play. Influences of the shared environment (influences including the family environment, rearing, shared peer groups, culture and societal views, and sharing the same school and community) had no effect for men, and a weak effect for women. This is consistent with the common finding that parenting and culture appears to play no role in male sexual orientation, but may play some small role in women. The study concludes that genetic influences on any lifetime same-sex partner were stronger for men than women, and that "it has been suggested individual differences in heterosexual and homosexual behavior result from unique environmental factors such as prenatal exposure to sex hormones, progressive maternal immunization to sex-specific proteins, or neurodevelopmental factors", although does not rule out other variables. The use of all adult twins in Sweden was designed to address the criticism of volunteer studies, in which a potential bias towards participation by gay twins may influence the results:

Biometric modeling revealed that, in men, genetic effects explained .34–.39 of the variance [of sexual orientation], the shared environment .00, and the individual-specific environment .61–.66 of the variance. Corresponding estimates among women were .18–.19 for genetic factors, .16–.17 for shared environmental, and .64–.66 for unique environmental factors. Although wide confidence intervals suggest cautious interpretation, the results are consistent with moderate, primarily genetic, familial effects, and moderate to large effects of the nonshared environment (social and biological) on same-sex sexual behavior.

Chromosome linkage studies

Chromosome	Location	Associated genes	Sex	Study1	Origin	Note
X chromosome	Xq28	Speculative	male only	Hamer et al. 1993 Sanders et al. 2015	genetic
Chromosome 1	1p36	Rh system	both sexes	Ellis et al. 2008		potential genetic linkage2
Chromosome 4	4p14		female only	Ganna et al. 2019
Chromosome 7	7q31		both sexes	Ganna et al. 2019
Chromosome 8	8p12	Unknown	male only	Mustanski et al. 2005 Sanders et al. 2015
Chromosome 9	9q34	ABO	both sexes	Ellis et al. 2008		potential genetic linkage2
Chromosome 11	11q12	OR51A7 (speculative)	male only	Ganna et al. 2019		Olfactory system in mating preferences
Chromosome 12	12q21		both sexes	Ganna et al. 2019
Chromosome 13	13q31	SLITRK6	male only	Sanders et al. 2017		Diencephalon-associated gene
Chromosome 14	14q31	TSHR	male only	Sanders et al. 2017
Chromosome 15	15q21	TCF12	male only	Ganna et al. 2019
1Reported primary studies are not conclusive evidence of any relationship. 2Not believed to be causal.

Chromosome linkage studies of sexual orientation have indicated the presence of multiple contributing genetic factors throughout the genome. In 1993, Dean Hamer and colleagues published findings from a linkage analysis of a sample of 76 gay brothers and their families. Hamer et al. found that the gay men had more gay male uncles and cousins on the maternal side of the family than on the paternal side. Gay brothers who showed this maternal pedigree were then tested for X chromosome linkage, using twenty-two markers on the X chromosome to test for similar alleles. In another finding, thirty-three of the forty sibling pairs tested were found to have similar alleles in the distal region of Xq28, which was significantly higher than the expected rates of 50% for fraternal brothers. This was popularly dubbed the "gay gene" in the media, causing significant controversy. Sanders et al. in 1998 reported on their similar study, in which they found that 13% of uncles of gay brothers on the maternal side were homosexual, compared with 6% on the paternal side.

A later analysis by Hu et al. replicated and refined the earlier findings. This study revealed that 67% of gay brothers in a new saturated sample shared a marker on the X chromosome at Xq28. Two other studies (Bailey et al., 1999; McKnight and Malcolm, 2000) failed to find a preponderance of gay relatives in the maternal line of homosexual men. One study by Rice et al. in 1999 failed to replicate the Xq28 linkage results. Meta-analysis of all available linkage data indicates a significant link to Xq28, but also indicates that additional genes must be present to account for the full heritability of sexual orientation.

Mustanski et al. (2005) performed a full-genome scan (instead of just an X chromosome scan) on individuals and families previously reported on in Hamer et al. (1993) and Hu et al. (1995), as well as additional new subjects. In the full sample they did not find linkage to Xq28.

Results from the first large, comprehensive multi-center genetic linkage study of male sexual orientation were reported by an independent group of researchers at the American Society of Human Genetics in 2012. The study population included 409 independent pairs of gay brothers, who were analyzed with over 300,000 single-nucleotide polymorphism markers. The data strongly replicated Hamer's Xq28 findings as determined by both two-point and multipoint (MERLIN) LOD score mapping. Significant linkage was also detected in the pericentromeric region of chromosome 8, overlapping with one of the regions detected in the Hamer lab's previous genomewide study. The authors concluded that "our findings, taken in context with previous work, suggest that genetic variation in each of these regions contributes to development of the important psychological trait of male sexual orientation". Female sexual orientation does not seem to be linked to Xq28, though it does appear moderately heritable.

In addition to sex chromosomal contribution, a potential autosomal genetic contribution to the development of homosexual orientation has also been suggested. In a study population composed of more than 7000 participants, Ellis et al. (2008) found a statistically significant difference in the frequency of blood type A between homosexuals and heterosexuals. They also found that "unusually high" proportions of homosexual males and homosexual females were Rh negative in comparison to heterosexuals. As both blood type and Rh factor are genetically inherited traits controlled by alleles located on chromosome 9 and chromosome 1 respectively, the study indicates a potential link between genes on autosomes and homosexuality.

The biology of sexual orientation has been studied in detail in several animal model systems. In the common fruit fly Drosophila melanogaster, the complete pathway of sexual differentiation of the brain and the behaviors it controls is well established in both males and females, providing a concise model of biologically controlled courtship. In mammals, a group of geneticists at the Korea Advanced Institute of Science and Technology bred a female mice specifically lacking a particular gene related to sexual behavior. Without the gene, the mice exhibited masculine sexual behavior and attraction toward urine of other female mice. Those mice who retained the gene fucose mutarotase (FucM) were attracted to male mice.

In interviews to the press, researchers have pointed that the evidence of genetic influences should not be equated with genetic determinism. According to Dean Hamer and Michael Bailey, genetic aspects are only one of the multiple causes of homosexuality.

In 2017, Scientific Reports published an article with a genome wide association study on male sexual orientation. The research consisted of 1,077 homosexual men and 1,231 heterosexual men. A gene named SLITRK6 on chromosome 13 was identified. The research supports another study which had been done by the neuroscientist Simon LeVay. LeVay's research suggested that the hypothalamus of gay men is different from straight men. The SLITRK6 is active in the mid-brain where the hypothalamus is. The researchers found that the thyroid stimulating hormone receptor (TSHR) on chromosome 14 shows sequence differences between gay and straight men. Graves' disease is associated with TSHR abnormalities, with previous research indicating that Graves' disease is more common in gay men than in straight men. Research indicated that gay people have lower body weight than straight people. It had been suggested that the overactive TSHR hormone lowered body weight in gay people, though this remains unproven.

In 2018, Ganna et al. performed another genome wide association study on sexual orientation of men and women with data from 26,890 people who had at least one same-sex partner and 450,939 controls. The data in the study was meta-analyzed and obtained from the UK Biobank study and 23andMe. The researchers identified four variants more common in people who reported at least one same-sex experience on chromosomes 7, 11, 12, and 15. The variants on chromosomes 11 and 15 were specific to men, with the variant on chromosome 11 located in an olfactory gene and the variant on chromosome 15 having previously been linked to male-pattern baldness. The four variants were also correlated with mood and mental health disorders; major depressive disorder and schizophrenia in men and women, and bipolar disorder in women. However, none of the four variants could reliably predict sexual orientation.

In August 2019, a genome-wide association study of 493,001 individuals concluded that hundreds or thousands of genetic variants underlie homosexual behavior in both sexes, with 5 variants in particular being significantly associated. Some of these variants had sex-specific effects, and two of these variants suggested links to biological pathways that involve sex hormone regulation and olfaction. All the variants together captured between 8 and 25% of the variation in individual differences in homosexual behavior. These genes partly overlap with those for several other traits, including openness to experience and risk-taking behavior. Additional analyses suggested that sexual behavior, attraction, identity, and fantasies are influenced by a similar set of genetic variants. They also found that the genetic effects that differentiate heterosexual from homosexual behavior are not the same as those that differ among nonheterosexuals with lower versus higher proportions of same-sex partners, which suggests that there is no single continuum from heterosexual to homosexual preference, as suggested by the Kinsey scale.

Epigenetics studies

A study suggests linkage between a mother's genetic make-up and homosexuality of her sons. Women have two X chromosomes, one of which is "switched off". The inactivation of the X chromosome occurs randomly throughout the embryo, resulting in cells that are mosaic with respect to which chromosome is active. In some cases though, it appears that this switching off can occur in a non-random fashion. Bocklandt et al. (2006) reported that, in mothers of homosexual men, the number of women with extreme skewing of X chromosome inactivation is significantly higher than in mothers without gay sons. 13% of mothers with one gay son, and 23% of mothers with two gay sons, showed extreme skewing, compared to 4% of mothers without gay sons.

Birth order

Blanchard and Klassen (1997) reported that each additional older brother increases the odds of a man being gay by 33%. This is now "one of the most reliable epidemiological variables ever identified in the study of sexual orientation". To explain this finding, it has been proposed that male fetuses provoke a maternal immune reaction that becomes stronger with each successive male fetus. This maternal immunization hypothesis (MIH) begins when cells from a male fetus enter the mother's circulation during pregnancy or while giving birth. Male fetuses produce H-Y antigens which are "almost certainly involved in the sexual differentiation of vertebrates". These Y-linked proteins would not be recognized in the mother's immune system because she is female, causing her to develop antibodies which would travel through the placental barrier into the fetal compartment. From here, the anti-male bodies would then cross the blood/brain barrier (BBB) of the developing fetal brain, altering sex-dimorphic brain structures relative to sexual orientation, increasing the likelihood that the exposed son will be more attracted to men than women. It is this antigen which maternal H-Y antibodies are proposed to both react to and 'remember'. Successive male fetuses are then attacked by H-Y antibodies which somehow decrease the ability of H-Y antigens to perform their usual function in brain masculinization.

In 2017, researchers discovered a biological mechanism of gay people who tend to have older brothers. They think Neuroligin 4 Y-linked protein is responsible for a later son being gay. They found that women had significantly higher anti-NLGN4Y levels than men. In addition, mothers of gay sons, particularly those with older brothers, had significantly higher anti-NLGN4Y levels than did the control samples of women, including mothers of heterosexual sons. The results suggest an association between a maternal immune response to NLGN4Y and subsequent sexual orientation in male offspring.

The fraternal birth order effect, however, does not apply to instances where a firstborn is homosexual.

Female fertility

In 2004, Italian researchers conducted a study of about 4,600 people who were the relatives of 98 homosexual and 100 heterosexual men. Female relatives of the homosexual men tended to have more offspring than those of the heterosexual men. Female relatives of the homosexual men on their mother's side tended to have more offspring than those on the father's side. The researchers concluded that there was genetic material being passed down on the X chromosome which both promotes fertility in the mother and homosexuality in her male offspring. The connections discovered would explain about 20% of the cases studied, indicating that this is a highly significant but not the sole genetic factor determining sexual orientation.

Pheromone studies

Research conducted in Sweden has suggested that gay and straight men respond differently to two odors that are believed to be involved in sexual arousal. The research showed that when both heterosexual women and gay men are exposed to a testosterone derivative found in men's sweat, a region in the hypothalamus is activated. Heterosexual men, on the other hand, have a similar response to an estrogen-like compound found in women's urine. The conclusion is that sexual attraction, whether same-sex or opposite-sex oriented, operates similarly on a biological level. Researchers have suggested that this possibility could be further explored by studying young subjects to see if similar responses in the hypothalamus are found and then correlating these data with adult sexual orientation.

Studies of brain structure

A number of sections of the brain have been reported to be sexually dimorphic; that is, they vary between men and women. There have also been reports of variations in brain structure corresponding to sexual orientation. In 1990, Dick Swaab and Michel A. Hofman reported a difference in the size of the suprachiasmatic nucleus between homosexual and heterosexual men. In 1992, Allen and Gorski reported a difference related to sexual orientation in the size of the anterior commissure, but this research was refuted by numerous studies, one of which found that the entirety of the variation was caused by a single outlier.

Research on the physiologic differences between male and female brains are based on the idea that people have male or a female brain, and this mirrors the behavioral differences between the two sexes. Some researchers state that solid scientific support for this is lacking. Although consistent differences have been identified, including the size of the brain and of specific brain regions, male and female brains are very similar.

Sexually dimorphic nuclei in the anterior hypothalamus

LeVay also conducted some of these early researches. He studied four groups of neurons in the hypothalamus called INAH1, INAH2, INAH3 and INAH4. This was a relevant area of the brain to study, because of evidence that it played a role in the regulation of sexual behaviour in animals, and because INAH2 and INAH3 had previously been reported to differ in size between men and women.

He obtained brains from 41 deceased hospital patients. The subjects were classified into three groups. The first group comprised 19 gay men who had died of AIDS-related illnesses. The second group comprised 16 men whose sexual orientation was unknown, but whom the researchers presumed to be heterosexual. Six of these men had died of AIDS-related illnesses. The third group was of six women whom the researchers presumed to be heterosexual. One of the women had died of an AIDS-related illness.

The HIV-positive people in the presumably heterosexual patient groups were all identified from medical records as either intravenous drug abusers or recipients of blood transfusions. Two of the men who identified as heterosexual specifically denied ever engaging in a homosexual sex act. The records of the remaining heterosexual subjects contained no information about their sexual orientation; they were assumed to have been primarily or exclusively heterosexual "on the basis of the numerical preponderance of heterosexual men in the population".

LeVay found no evidence for a difference between the groups in the size of INAH1, INAH2 or INAH4. However, the INAH3 group appeared to be twice as big in the heterosexual male group as in the gay male group; the difference was highly significant, and remained significant when only the six AIDS patients were included in the heterosexual group. The size of INAH3 in the homosexual men's brains was comparable to the size of INAH3 in the heterosexual women's brains.

William Byne and colleagues attempted to identify the size differences reported in INAH 1–4 by replicating the experiment using brain sample from other subjects: 14 HIV-positive homosexual males, 34 presumed heterosexual males (10 HIV-positive), and 34 presumed heterosexual females (9 HIV-positive). The researchers found a significant difference in INAH3 size between heterosexual men and heterosexual women. The INAH3 size of the homosexual men was apparently smaller than that of the heterosexual men, and larger than that of the heterosexual women, though neither difference quite reached statistical significance.

Byne and colleagues also weighed and counted numbers of neurons in INAH3 tests not carried out by LeVay. The results for INAH3 weight were similar to those for INAH3 size; that is, the INAH3 weight for the heterosexual male brains was significantly larger than for the heterosexual female brains, while the results for the gay male group were between those of the other two groups but not quite significantly different from either. The neuron count also found a male-female difference in INAH3, but found no trend related to sexual orientation.

LeVay has said that Byne replicated his work, but that he employed a two-tailed statistical analysis, which is typically reserved for when no previous findings had employed the difference. LeVay has said that "given that my study had already reported a INAH3 to be smaller in gay men, a one tailed approach would have been more appropriate, and it would have yielded a significant difference [between heterosexual and homosexual men]".

J. Michael Bailey has criticized LeVay's critics – describing the claim that the INAH-3 difference could be attributable to AIDS as "aggravating", since the "INAH-3 did not differ between the brains of straight men who died of AIDS and those who did not have the disease". Bailey has further criticized the second objection that was raised, that being gay might have somehow caused the difference in INAH-3, and not vice-versa, saying "the problem with this idea is that the hypothalamus appears to develop early. Not a single expert I have ever asked about LeVay’s study thought it was plausible that sexual behavior caused the INAH-3 differences."

The SCN of homosexual males has been demonstrated to be larger (both the volume and the number of neurons are twice as many as in heterosexual males). These areas of the hypothalamus have not yet been explored in homosexual females nor bisexual males nor females. Although the functional implications of such findings still have not been examined in detail, they cast serious doubt over the widely accepted Dörner hypothesis that homosexual males have a "female hypothalamus" and that the key mechanism of differentiating the "male brain from originally female brain" is the epigenetic influence of testosterone during prenatal development.

A 2010 study by Garcia-Falgueras and Swaab stated that "the fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. There is no indication that social environment after birth has an effect on gender identity or sexual orientation."

Ovine model

The domestic ram is used as an experimental model to study early programming of the neural mechanisms which underlie homosexuality, developing from the observation that approximately 8% of domestic rams are sexually attracted to other rams (male-oriented) when compared to the majority of rams which are female-oriented. In many species, a prominent feature of sexual differentiation is the presence of a sexually dimorphic nucleus (SDN) in the preoptic hypothalamus, which is larger in males than in females.

Roselli et al. discovered an ovine SDN (oSDN) in the preoptic hypothalamus that is smaller in male-oriented rams than in female-oriented rams, but similar in size to the oSDN of females. Neurons of the oSDN show aromatase expression which is also smaller in male-oriented rams versus female-oriented rams, suggesting that sexual orientation is neurologically hard-wired and may be influenced by hormones. However, results failed to associate the role of neural aromatase in the sexual differentiation of brain and behavior in the sheep, due to the lack of defeminization of adult sexual partner preference or oSDN volume as a result of aromatase activity in the brain of the fetuses during the critical period. Having said this, it is more likely that oSDN morphology and homosexuality may be programmed through an androgen receptor that does not involve aromatisation. Most of the data suggests that homosexual rams, like female-oriented rams, are masculinized and defeminized with respect to mounting, receptivity, and gonadotrophin secretion, but are not defeminized for sexual partner preferences, also suggesting that such behaviors may be programmed differently. Although the exact function of the oSDN is not fully known, its volume, length, and cell number seem to correlate with sexual orientation, and a dimorphism in its volume and of cells could bias the processing cues involved in partner selection. More research is needed in order to understand the requirements and timing of the development of the oSDN and how prenatal programming effects the expression of mate choice in adulthood.

Childhood gender nonconformity

Childhood gender nonconformity, or behaving like the other sex, is a strong predictor of adult sexual orientation that has been consistently replicated in research, and is thought to be strong evidence of a biological difference between heterosexual and non-heterosexuals. A review authored by J. Michael Bailey states: "childhood gender nonconformity comprises the following phenomena among boys: cross-dressing, desiring to have long hair, playing with dolls, disliking competitive sports and rough play, preferring girls as playmates, exhibiting elevated separation anxiety, and desiring to be—or believing that one is—a girl. In girls, gender nonconformity comprises dressing like and playing with boys, showing interest in competitive sports and rough play, lacking interest in conventionally female toys such as dolls and makeup, and desiring to be a boy". This gender nonconformist behavior typically emerges at preschool age, although is often evident as early as age 2. Children are only considered gender nonconforming if they persistently engage in a variety of these behaviors, as opposed to engaging in a behavior on a few times or on occasion. It is also not a one-dimensional trait, but rather has varying degrees.

Children who grow up to be non-heterosexual were, on average, substantially more gender nonconforming in childhood. This is confirmed in both retrospective studies where homosexuals, bisexuals and heterosexuals are asked about their gender typical behavior in childhood, and in prospective studies, where highly gender nonconforming children are followed from childhood into adulthood to find out their sexual orientation. A review of retrospective studies that measured gender nonconforming traits estimated that 89% of homosexual men exceeded heteroseuxal males level of gender nonconformity, whereas just 2% of heterosexual men exceeded the homosexual median. For female sexual orientation, the figures were 81% and 12% respectively. A variety of other assessments such as childhood home videos, photos and reports of parents also confirm this finding. Critics of this research see this as confirming stereotypes; however, no study has ever demonstrated that this research has exaggerated childhood gender nonconformity. J. Michael Bailey argues that gay men often deny that they were gender nonconforming in childhood because they may have been bullied or maltreated by peers and parents for it, and because they often do not find femininity attractive in other gay males and thus would not want to acknowledge it in themselves. Additional research in Western cultures and non-Western cultures including Latin America, Asia, Polynesia, and the Middle East supports the validity of childhood gender nonconformity as a predictor of adult non-heterosexuality.

This research does not mean that all non-heterosexuals were gender nonconforming, but rather indicates that long before sexual attraction is known, non-heterosexuals, on average, are noticeably different from other children. There is little evidence that gender nonconforming children have been encouraged or taught to behave that way; rather, childhood gender nonconformity typically emerges despite conventional socialization. Medical experiments in which infant boys were sex reassigned and reared as girls did not make them feminine nor attracted to males.

Boys who were surgically reassigned female

Between the 1960s and 2000, many newborn and infant boys were surgically reassigned as females if they were born with malformed penises, or if they lost their penises in accidents. Many surgeons believed such males would be happier being socially and surgically reassigned female. In all seven published cases that have provided sexual orientation information, the subjects grew up to be attracted to females. Six cases were exclusively attracted to females, with one case 'predominantly' attracted to females. In a review article in the journal Psychological Science in the Public Interest, six researchers including J. Michael Bailey state this establishes a strong case that male sexual orientation is partly established before birth:

"This is the result we would expect if male sexual orientation were entirely due to nature, and it is opposite of the result expected if it were due to nurture, in which case we would expect that none of these individuals would be predominantly attracted to women. They show how difficult it is to derail the development of male sexual orientation by psychosocial means."

They further argue that this raises questions about the significance of the social environment on sexual orientation, stating, "If one cannot reliably make a male human become attracted to other males by cutting off his penis in infancy and rearing him as a girl, then what other psychosocial intervention could plausibly have that effect?" It is further stated that neither cloacal exstrophy (resulting in a malformed penis), nor surgical accidents, are associated with abnormalities of prenatal androgens, thus, the brains of these individuals were male-organized at birth. Six of the seven identified as heterosexual males at follow up, despite being surgically altered and reared as females, with researchers adding: "available evidence indicates that in such instances, parents are deeply committed to raising these children as girls and in as gender-typical a manner as possible." Bailey et al. describe these sex reassignments as 'the near-perfect quasi-experiment' in measuring the impact of 'nature' versus 'nurture' with regards to male homosexuality.

'Exotic becomes erotic' theory

Daryl Bem, a social psychologist at Cornell University, has theorized that the influence of biological factors on sexual orientation may be mediated by experiences in childhood. A child's temperament predisposes the child to prefer certain activities over others. Because of their temperament, which is influenced by biological variables such as genetic factors, some children will be attracted to activities that are commonly enjoyed by other children of the same gender. Others will prefer activities that are typical of another gender. This will make a gender-conforming child feel different from opposite-gender children, while gender-nonconforming children will feel different from children of their own gender. According to Bem, this feeling of difference will evoke psychological arousal when the child is near members of the gender which it considers as being 'different'. Bem theorizes that this psychological arousal will later be transformed into sexual arousal: children will become sexually attracted to the gender which they see as different ("exotic"). This proposal is known as the "exotic becomes erotic" theory. Wetherell et al. state that Bem "does not intend his model as an absolute prescription for all individuals, but rather as a modal or average explanation."

Two critiques of Bem's theory in the journal Psychological Review concluded that "studies cited by Bem and additional research show that [the] Exotic Becomes Erotic theory is not supported by scientific evidence." Bem was criticized for relying on a non-random sample of gay men from the 1970s (rather than collecting new data) and for drawing conclusions that appear to contradict the original data. An "examination of the original data showed virtually all respondents were familiar with children of both sexes", and that only 9% of gay men said that "none or only a few" of their friends were male, and most gay men (74%) reported having "an especially close friend of the same sex" during grade school. Further, "71% of gay men reported feeling different from other boys, but so did 38% of heterosexual men. The difference for gay men is larger, but still indicates that feeling different from same-sex peers was common for heterosexual men." Bem also acknowledged that gay men were more likely to have older brothers (the fraternal birth order effect), which appeared to contradict an unfamiliarity with males. Bem cited cross-cultural studies which also "appear to contradict the EBE theory assertion", such as the Sambia tribe in Papua New Guinea, which ritually enforced homosexual acts among teenagers; yet once these boys reached adulthood, only a small proportion of men continued to engage in homosexual behaviour - similar to levels observed in the United States. Additionally, Bem's model could be interpreted as implying that if one could change a child's behavior, one could change their sexual orientation, but most psychologists doubt this would be possible.

Neuroscientist Simon LeVay said that while Bem's theory was arranged in a "believable temporal order", that it ultimately "lacks empirical support". Social psychologist Justin Lehmiller stated that Bem's theory has received praise "for the way it seamlessly links biological and environmental influences" and that there "is also some support for the model in the sense that childhood gender nonconformity is indeed one of the strongest predicators of adult homosexuality", but that the validity of the model "has been questioned on numerous grounds and scientists have largely rejected it."^[72]

Sexual orientation and evolution

General

Sexual practices that significantly reduce the frequency of heterosexual intercourse also significantly decrease the chances of successful reproduction, and for this reason, they would appear to be maladaptive in an evolutionary context following a simple Darwinian model (competition amongst individuals) of natural selection—on the assumption that homosexuality would reduce this frequency. Several theories have been advanced to explain this contradiction, and new experimental evidence has demonstrated their feasibility.

Some scholars have suggested that homosexuality is indirectly adaptive, by conferring a reproductive advantage in a non-obvious way on heterosexual siblings or their children, a hypothesised instance of kin selection. By way of analogy, the allele (a particular version of a gene) which causes sickle-cell anemia when two copies are present, also confers resistance to malaria with a lesser form of anemia when one copy is present (this is called heterozygous advantage).

Brendan Zietsch of the Queensland Institute of Medical Research proposes the alternative theory that men exhibiting female traits become more attractive to females and are thus more likely to mate, provided the genes involved do not drive them to complete rejection of heterosexuality.

In a 2008 study, its authors stated that "There is considerable evidence that human sexual orientation is genetically influenced, so it is not known how homosexuality, which tends to lower reproductive success, is maintained in the population at a relatively high frequency." They hypothesized that "while genes predisposing to homosexuality reduce homosexuals' reproductive success, they may confer some advantage in heterosexuals who carry them". Their results suggested that "genes predisposing to homosexuality may confer a mating advantage in heterosexuals, which could help explain the evolution and maintenance of homosexuality in the population". However, in the same study, the authors noted that "nongenetic alternative explanations cannot be ruled out" as a reason for the heterosexual in the homosexual-heterosexual twin pair having more partners, specifically citing "social pressure on the other twin to act in a more heterosexual way" (and thus seek out a greater number of sexual partners) as an example of one alternative explanation. The study acknowledges that a large number of sexual partners may not lead to greater reproductive success, specifically noting there is an "absence of evidence relating the number of sexual partners and actual reproductive success, either in the present or in our evolutionary past".

The heterosexual advantage hypothesis was given strong support by the 2004 Italian study demonstrating increased fecundity in the female matrilineal relatives of gay men. As originally pointed out by Hamer, even a modest increase in reproductive capacity in females carrying a "gay gene" could easily account for its maintenance at high levels in the population.

Gay uncle hypothesis

The "gay uncle hypothesis" posits that people who themselves do not have children may nonetheless increase the prevalence of their family's genes in future generations by providing resources (e.g., food, supervision, defense, shelter) to the offspring of their closest relatives.

This hypothesis is an extension of the theory of kin selection, which was originally developed to explain apparent altruistic acts which seemed to be maladaptive. The initial concept was suggested by J. B. S. Haldane in 1932 and later elaborated by many others including John Maynard Smith, W. D. Hamilton and Mary Jane West-Eberhard. This concept was also used to explain the patterns of certain social insects where most of the members are non-reproductive.

Vasey and VanderLaan (2010) tested the theory on the Pacific island of Samoa, where they studied women, straight men, and the fa'afafine, men who prefer other men as sexual partners and are accepted within the culture as a distinct third gender category. Vasey and VanderLaan found that the fa'afafine said they were significantly more willing to help kin, yet much less interested in helping children who are not family, providing the first evidence to support the kin selection hypothesis.

The hypothesis is consistent with other studies on homosexuality, which show that it is more prevalent amongst both siblings and twins.

Vasey and VanderLaan (2011) provides evidence that if an adaptively designed avuncular male androphilic phenotype exists and its development is contingent on a particular social environment, then a collectivistic cultural context is insufficient, in and of itself, for the expression of such a phenotype.

Biological differences in gay men and lesbian women

Anatomical

Some studies have found correlations between physiology of people and their sexuality; these studies provide evidence which suggests that:

• Gay men and straight women have, on average, equally proportioned brain hemispheres. Lesbian women and straight men have, on average, slightly larger right brain hemispheres.
• The suprachiasmatic nucleus of the hypothalamus was found by Swaab and Hopffman to be larger in gay men than in non-gay men, the suprachiasmatic nucleus is also known to be larger in men than in women.
• Gay men report, on average, slightly longer and thicker penises than non-gay men.
• The average size of the INAH 3 in the brains of gay men is approximately the same size as INAH 3 in women, which is significantly smaller, and the cells more densely packed, than in heterosexual men's brains.
• The anterior commissure is larger in women than men and was reported to be larger in gay men than in non-gay men, but a subsequent study found no such difference.
• The functioning of the inner ear and the central auditory system in lesbians and bisexual women are more like the functional properties found in men than in non-gay women (the researchers argued this finding was consistent with the prenatal hormonal theory of sexual orientation).
• The startle response (eyeblink following a loud sound) is similarly masculinized in lesbians and bisexual women.
• Gay and non-gay people's brains respond differently to two putative sex pheromones (AND, found in male armpit secretions, and EST, found in female urine).
• The amygdala, a region of the brain, is more active in gay men than non-gay men when exposed to sexually arousing material.
• Finger length ratios between the index and ring fingers have been reported to differ, on average, between non-gay and lesbian women.
• Gay men and lesbians are significantly more likely to be left-handed or ambidextrous than non-gay men and women; Simon LeVay argues that because "[h]and preference is observable before birth... [t]he observation of increased non-right-handness in gay people is therefore consistent with the idea that sexual orientation is influenced by prenatal processes," perhaps heredity.
• A study of over 50 gay men found that about 23% had counterclockwise hair whorl, as opposed to 8% in the general population. This may correlate with left-handedness.
• Gay men have increased ridge density in the fingerprints on their left thumbs and little fingers.
• Length of limbs and hands of gay men is smaller compared to height than the general population, but only among white men.

J. Michael Bailey has argued that the early childhood gender nonconforming behavior of homosexuals, as opposed to biological markers, are better evidence of homosexuality being an inborn trait. He argues that gay men are "punished much more than rewarded" for their childhood gender nonconformity, and that such behavior "emerges with no encouragement, and despite opposition", making it "the sine qua non of innateness".

Political aspects

Whether genetic or other physiological determinants form the basis of sexual orientation is a highly politicized issue. The Advocate, a U.S. gay and lesbian newsmagazine, reported in 1996 that 61% of its readers believed that "it would mostly help gay and lesbian rights if homosexuality were found to be biologically determined". A cross-national study in the United States, the Philippines, and Sweden found that those who believed that "homosexuals are born that way" held significantly more positive attitudes toward homosexuality than those who believed that "homosexuals choose to be that way" or "learn to be that way".

Equal protection analysis in U.S. law determines when government requirements create a “suspect classification" of groups and therefore eligible for heightened scrutiny based on several factors, one of which is immutability.

Evidence that sexual orientation is biologically determined (and therefore perhaps immutable in the legal sense) would strengthen the legal case for heightened scrutiny of laws discriminating on that basis.

The perceived causes of sexual orientation have a significant bearing on the status of sexual minorities in the eyes of social conservatives. The Family Research Council, a conservative Christian think tank in Washington, D.C., argues in the book Getting It Straight that finding people are born gay "would advance the idea that sexual orientation is an innate characteristic, like race; that homosexuals, like African-Americans, should be legally protected against 'discrimination;' and that disapproval of homosexuality should be as socially stigmatized as racism. However, it is not true." On the other hand, some social conservatives such as Reverend Robert Schenck have argued that people can accept any scientific evidence while still morally opposing homosexuality. National Organization for Marriage board member and fiction writer Orson Scott Card has supported biological research on homosexuality, writing that "our scientific efforts in regard to homosexuality should be to identify genetic and uterine causes... so that the incidence of this dysfunction can be minimized.... [However, this should not be seen] as an attack on homosexuals, a desire to 'commit genocide' against the homosexual community... There is no 'cure' for homosexuality because it is not a disease. There are, however, different ways of living with homosexual desires."

Some advocates for the rights of sexual minorities resist what they perceive as attempts to pathologise or medicalise 'deviant' sexuality, and choose to fight for acceptance in a moral or social realm. The journalist Chandler Burr has stated that "[s]ome, recalling earlier psychiatric "treatments" for homosexuality, discern in the biological quest the seeds of genocide. They conjure up the specter of the surgical or chemical "rewiring" of gay people, or of abortions of fetal homosexuals who have been hunted down in the womb." LeVay has said in response to letters from gays and lesbians making such criticisms that the research "has contributed to the status of gay people in society".