Prenatal androgens and female-advantaged cognition: A systematic review and Bayesian meta-analysis in congenital adrenal hyperplasia.

Females with Congenital Adrenal Hyperplasia (CAH) are exposed to elevated levels of androgens during the prenatal period, offering insights into the effects of early hormonal influences on brain and cognition. Although spatial abilities, which typically favor males, have received considerable attention in the context of CAH, this is the first review to systematically examine cognitive domains that generally show a female advantage. By meta-analyzing 43 effect sizes from 11 studies, we assessed whether elevated prenatal androgens are associated with shifts toward male-typical performance across four such domains. Results offer partial support for an androgenic influence, with the strongest evidence observed in verbal fluency, where females with CAH performed worse than controls (μˆ = - 0.34), in contrast to their comparable or slightly enhanced performance on male-favoring spatial tasks (μˆ = 0.19). Weaker support emerged for perceptual speed (μˆ = - 0.17). In addition, two effect sizes suggested reduced emotion recognition, although the magnitude of these effects differed substantially (g = -0.11 and g = -1.44). Findings for episodic memory were inconclusive, characterized by substantial heterogeneity and mixed results. Overall, while the modest number of studies and the small magnitude of expected effects limit reliability and generalizability, these results contribute to a growing body of evidence suggesting that prenatal androgens shape sex-typical cognitive and behavioral development, potentially masculinizing patterns of cognition, behavior, and interests in females with CAH.