The relationship between prenatal androgens and later behaviour is a robust finding. The relationship with the same prenatal androgens and “gender identity” is much less consistent.
CAH girls show substantial masculinisation of play, interests and activities. Yet when we move from what children do to who they understand themselves to be, that relationship weakens.
Across CAH samples, 88% of girls have fallen within the control-female range for “gender identity”, while degree of genital virilisation (a marker of prenatal androgenisation) did not predict “gender identity”. Other cohorts show masculinisation in CAH girls across many behavioural measures, but no significant difference across measures of gender confusion/dysphoria.
There has been evidence for increased “cross-gender identification”. But this is where terminology becomes important.
In one CAH sample, 51% preferred cross-gender games, 44% opposite-sex playmates and 41% cross-gender roles in play, while only 5% frequently expressed a wish to be the other sex.
But this raises a broader measurement problem: many historical measures of “gender identity” incorporate toys, clothes, playmates, activities and sex-typed roles. If prenatal androgens strongly influence those behaviours, then correlations between androgens and a “gender identity” scale partly containing those same behaviours cannot automatically be interpreted as evidence that prenatal androgens masculinise identity itself.
The emerging pattern seems more interesting than the simple “prenatal hormones determine gender identity” story: the further we move from sex-typed behaviour toward core identity/dysphoria, the weaker and less consistent the association with prenatal androgens becomes.