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Men in (and out of) therapy: central concepts, emerging directions, and remaining challenges.

This article introduces the special issue on recent conceptual, practical, and research developments relevant to men and therapy. The paper reviews the considerable shifts that have emerged in our understanding and measurement of masculinity as it pertains to men's health and therapy. In addition, this introduction outlines the primary focus of each article in this special issue and describes the general guidelines offered to the contributors. Collectively, these special-issue articles describe promising paradigms, provide useful examples, and stress the need for further research on men, masculinity, and the therapeutic process.

Gender Identity↗

Freshmen adaptation to university life: depressive symptoms, stress, and coping.

Attending a university for the first time can be a stressful experience for many new college students. This study examines the relationships among femininity and masculinity, depressive symptomatology, levels of stress, and the types of coping strategies used by college freshmen. Results of this study suggest that these variables were related uniquely for first-year college students. Masculinity and femininity significantly predicted problem-focused coping, and femininity significantly predicted emotion-focused coping. Further, the levels of family and college stress reported by college students, as well as their endorsement of avoidant coping, significantly predicted their levels of depressive symptoms. Overall, the results of this study suggest that understanding the relationships among the gender role, the levels of depressive symptomatology, and the levels of stress exhibited by college freshmen may be important in facilitating their transition and adjustment to university life.

Adaptation, Psychological↗

Development and evaluation of new factor scales for the Expectations About Counseling Inventory in a college sample.

Given the lack of agreement over the factor structure and scoring system used with the Expectations About Counseling Inventory (EAC-B), the primary purpose of this investigation was to reevaluate the factor structure of the EAC-B and to construct factor scales based on that structure. After constructing these scales, the second objective was to evaluate the relationships among expectations about counseling, the five-factor model of personality (FFM), and gender-related variables. The responses of 460 undergraduate students to all 66 items on the EAC-B suggested three factors: facilitative conditions, counselor expertise, and client involvement. Expectations for facilitative conditions were positively correlated with extraversion, agreeableness, conscientiousness, masculinity, and femininity; expectations for counselor expertise were negatively correlated with openness and agreeableness and positively correlated with masculinity; and expectations for client involvement were positively correlated with extraversion, openness, agreeableness, conscientiousness, and femininity. Femininity was the strongest predictor of the facilitative conditions and client involvement scales when the effects of all the other variables were partialled out, whereas openness to experience and gender were the best predictors of counselor expertise when the effects of all the other variables were partialled out.

Adolescent↗

Temperature effects and genotype-temperature interactions on sex determination in the European sea bass (Dicentrarchus labrax L.).

The effect of temperature on sex-ratios in 27 families of sea bass reared in the same tank from the fertilization stage onward was investigated. An excess of males (68%) was found in the groups that were reared at high temperature (mean +/- standard deviation: 20+/-1 degrees C) until they reached the mean size of 8.1 cm (Standard Length, 149 days post-fertilization [p.f.]). Masculinization was higher (89% of males) in the groups maintained at low temperature (13 degrees C), from fertilization to a mean length of 6.5 cm (346 days p.f.). Shifts from high to low temperature at 8.1cm and from low to high temperature at 6.5 cm had no consequence on the sex-ratio. The percentage of males showing intratesticular oocytes was higher at low temperature (63%) than at high temperature (36%), suggesting that these males may be sensitive fish that have been masculinized by environmental factors. Fish sampled in the groups reared at high (2,200 fish) and low (500 fish) temperature were genotyped on three microsatellite loci. This allowed them to be assigned to the breeders used in the crossing design, thus permitting an analysis of parental influence on sex-ratios. In groups reared at high temperature, both parents had a significant additive effect on the percentage of females, and the interaction between sire and dam was not significant. Genotype temperature interactions were also detected and their existence suggests the interesting possibility of selecting nonsensitive genotypes in breeding programs.

Adaptation, Physiological↗

Role of peanut-lectin-affinity molecules (PLAM) on primordial germ cells in the initial determination of sex in anura.

Peanut lectin (PNA) or N-acetylgalactosamine (galNA, a part of the disaccharide unit which is recognized by PNA) was injected into the coelomic cavity of anuran larvae at the developmental stages during which the genital ridges were growing, and the effect of these compounds on the initial determination of gonadal sex was examined. The treatment with PNA tended to inhibit (or perturb) the expression of feminizing gene(s) in Rana japonica, and of both feminizing and masculinizing genes in R. nigromaculata. In contrast, treatment with galNA suppressed the expression of masculinizing gene(s) considerably. In terms of the initial determination of gonadal sex during normal development, these results suggest that the PNA-affinity molecule (PLAM) of primordial germ cells acts as a trigger for the expression of genes that control sexual differentiation of somatic cells. Furthermore, the somatic cells (perhaps mesenchymal and/or epithelial cells), which respond to the stimulus via the PLAM of primordial germ cells, may differ in terms of the threshold for such a response between genetic males and females. This result suggests the mesenchymal and/or epithelial cells are not sexually predetermined, but rather that sexual determination follows the response to some signal(s) mediated by the PLAM.

Acetylgalactosamine↗

Plasticity of gonadal development and protandry in fishes.

Sexual differentiation in eutherian mammals follows a simple governing paradigm: development proceeds in a female direction unless a masculinizing mechanism intervenes. Sexual development in fishes is much more plastic than in mammals. It permits the intervention of environmental factors and follows several different types of sequences that produce successive hermaphrodites and alternative pathways for the development of the same final sex. In spite of this plasticity, the primacy of female development is suggested by the initial ovarian phase in the development of gonads of both sexes in some gonochoristic fishes and by protogynous sex change. One barrier to the application of this principle to fishes generally is the existence of protandric hermaphrodites. Recent evidence suggests a reinterpretation of gonadal differentiation in a protandric anemonefish and a protandric sparid. In both cases, testicular development is both preceded and followed by ovarian development. These patterns are interpreted to mean that female development is primary and that male development is a temporary phase initiated by a masculinizing mechanism and terminated by its cessation.

Animals↗

Estrogenic support of motoneuron dendritic growth via the neuromuscular periphery in a sexually dimorphic motor system.

The lumbar spinal cord of rats contains the sexually dimorphic, steroid-sensitive spinal nucleus of the bulbocavernosus (SNB). In males, the growth of SNB dendrites is steroid-dependent: dendrites fail to grow after castration, but grow in castrates treated with androgens or estrogens. Blocking estradiol synthesis or estrogen receptors in gonadally intact males attenuates SNB dendritic growth, suggesting that estrogens are required and must be able to act at their receptors to support normal masculine dendritic growth. However, SNB motoneurons do not accumulate estrogens, suggesting that estrogens act indirectly to support SNB dendritic growth. In this experiment, we examined whether local estrogen action in the neuromuscular periphery was involved in the postnatal development of SNB motoneurons. Motoneuron morphology was assessed in gonadally intact and castrated males. Gonadally intact males were left untreated or given either blank or tamoxifen implants sutured to the target musculature, or tamoxifen interscapular implants. Castrated males were left untreated or were given estradiol by muscle or interscapular implants or systemic injection during the period of SNB dendritic growth. At postnatal day 28, when SNB dendritic length is normally maximal, SNB motoneurons were retrogradely labeled with cholera toxin-HRP and reconstructed in three dimensions. While interscapular tamoxifen implants were ineffective, blocking estrogen receptors at the target musculature resulted in attenuation of SNB dendritic growth. In contrast, while interscapular implants of estradiol were ineffective, local treatment with estradiol at the target musculature in castrated males resulted in masculinization of dendritic growth. Thus, estrogens may act by an indirect action in the neuromuscular periphery to support SNB dendritic growth.

Animals↗

Evidence for androgen receptors in sexually dimorphic perineal muscles of neonatal male rats. Absence of androgen accumulation by the perineal motoneurons.

During development, survival of the sexually dimorphic spinal nucleus of the bulbocavernosus (SNB) and its target perineal muscles, the bulbocavernosus (BC) and the levator ani (LA) is androgen-dependent. To define androgen's site of action in masculinizing SNB system structures, we examined whether or not androgen receptors are present in SNB motoneurons and/or BC/LA muscles of neonatal male rats. Using a receptor binding assay, we have identified androgen-binding factors in the neonatal BC/LA (Bmax = 13.5 fmol/mg protein; Kd = 4.69 nM) for the first time. In contrast, androgen autoradiography provided no evidence that neonatal spinal motoneurons accumulate androgens. These results support the hypothesis that BC/LA muscles are a primary site of androgen action for masculinizing SNB system structures, and that androgen need not interact with SNB motoneurons directly to sexually differentiate them.

Aging↗

Aromatase and 5 beta-reductase activity in cultures of developing zebra finch brain: an investigation of sex and regional differences.

Estrogen treatment of hatchling female zebra finches causes the masculine development of singing behavior and of the telencephalic brain regions involved in the control of song. However, early estrogen treatment of males also blocks masculine development of copulatory behavior, presumably controlled by diencephalic regions. In an effort to determine whether the differences in estrogen action are related to sex and regional differences in androgen metabolism (estrogen synthesis or androgen inactivation), we measured aromatase and 5 beta-reductase activity in dissociated-cell cultures made separately from the telencephalon, diencephalon, and also cerebellum of hatchling zebra finches under a variety of conditions. Cultures from all three brain regions express high levels of aromatase and 5 beta-reductase activity. Comparisons between telencephalic and diencephalic cultures of the activity and kinetics of aromatase suggest that the telencephalic cultures convert androgen to estrogen more efficiently than diencephalic cultures, which might be important in the differential action of estrogen in the two brain regions. However, the activity of neither aromatase nor 5 beta-reductase was significantly different between the sexes in either telencephalic or diencephalic cultures. Thus, comparisons between the sexes do not support the idea that differences in posthatching aromatase or 5 beta-reductase activity account for the pattern of sexual differentiation of the song and copulatory systems.

Androgens↗

The decision to have a prosthesis: A qualitative study of men with testicular cancer.

The aim of this paper is to understand why some men decide to have a testicular prosthesis while others reject the idea and to explore the extent to which the option of a testicular prosthesis is adequately presented. Forty-five men with testicular cancer were interviewed about all aspects of their illness. Some men decided against a prosthesis for a number of reasons; they thought that the loss of a testicle was not visibly obvious, did not affect self-image, was not a long-term threat to masculinity, and that living with one testicle was comfortable. Some did not want additional surgery and others were concerned about safety issues. The men who decided to have a prosthesis were concerned about self-image and a threat to masculinity. They had a desire to look 'normal' and a wish to keep the orchidectomy secret. Some men felt that the decision had been rushed. Others wished that they had had information about the possibility of implants before the orchidectomy or they considered the information presented inadequate. We conclude that it is important to counsel men with testicular cancer about the advantages and disadvantages of having a testicular prosthesis and to give them time to consider issues such as cosmetic appearance, self-image, comfort, possible short term complications and long-term safety.

Adult↗

Contextual determinants of female-female mounting in laboratory rats.

Female-female mounting is widespread among mammalian species, but little is known about the proximal function of this behaviour. While such mounting is often regarded as a 'masculine' trait, its widespread occurrence may indicate that it serves specific functions within the context of female-female social behaviour. We valuated female mounting behaviour in Long-Evans rats in standard observation chambers and in a seminatural enclosure. Under these conditions, we examined a number of potential factors that might influence mounting, including the oestrous cycle, social hierarchy, familiarity and male presence. The female's mounting was not influenced by her own oestrous cycle, but did vary with the oestrous cycle of the stimulus female. Socially dominant females mounted significantly more than subordinate females, and mounting by the dominant female was most frequent when the subordinate female was sexually receptive. Females mounted (and fought with) unfamiliar females significantly more than they did with familiar cagemates. Female-female mounting was dramatically reduced when males were present. Further testing showed that female mounting did not affect the induction of the progestational state of pregnancy, suggesting that female mounting does not function as a pseudomale behaviour that can substitute for genital stimulation provided by the male. Based on these data, female mounting does not appear to function as a sexual behaviour per se, but may serve as a form of female social behaviour related to maintenance of the female's social status within female groups. In this regard, the results of this study suggest that female mounting is part of the normal female's complex behavioural repertoire and does not necessarily reflect masculinization of some underlying neural substrate. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗

Individual differences in the hemispheric specialization of dual route variables.

The dual route model suggests that reading of letter strings can occur through both a lexical and a nonlexical route. Hemispheric specialization of these routes has also been posited, suggesting that the left hemisphere has both lexical and nonlexical routes while the right hemisphere has only a lexical route. However, some recent data conflict with this hemispheric dual route model, suggesting that both hemispheres may have access to both routes. The purpose of the present study was to investigate individual differences in the hemispheric specialization of these routes and to determine whether these group differences in their specialization might explain conflicts in the literature. The effect of four individual difference factors was explored: handedness, biological sex, menstrual stage (i.e., fluctuations in estrogen), and self-rated degree of masculinity (i.e., sexual attribution). We looked at the interaction of these individual differences with the following dual route variables: (i) string length, (ii) word frequency, (iii) regularity of grapheme-phoneme correspondences of words, and (iv) the interaction of frequency and regularity using a bilateral lexical decision task. We observed that sex, menstrual stage, and masculinity each affected hemispheric specialization of the dual route variables, but did so in different ways. We posit that both hemispheres have orthographical (lexical) access as well as phonological (nonlexical) access to words. Further, we suggest that the presence of phonological processing in the right hemisphere depends on available resources and the strategies used, which are subject to individual differences.

Adult↗

mag-1, a homolog of Drosophila mago nashi, regulates hermaphrodite germ-line sex determination in Caenorhabditis elegans.

The Caenorhabditis elegans gene mag-1 can substitute functionally for its homolog mago nashi in Drosophila and is predicted to encode a protein that exhibits 80% identity and 88% similarity to Mago nashi (P. A. Newmark et al., 1997, Development 120, 3197-3207). We have used RNA-mediated interference (RNAi) to analyze the phenotypic consequences of impairing mag-1 function in C. elegans. We show here that mag-1(RNAi) causes masculinization of the germ line (Mog phenotype) in RNA-injected hermaphrodites, suggesting that mag-1 is involved in hermaphrodite germ-line sex determination. Epistasis analysis shows that ectopic sperm production caused by mag-1(RNAi) is prevented by loss-of-function (lf) mutations in fog-2, gld-1, fem-1, fem-2, fem-3, and fog-1, all of which cause germ-line feminization in XX hermaphrodites, but not by a her-1(lf) mutation which causes germ-line feminization only in XO males. These results suggest that mag-1 interacts with the fog, fem, and gld genes and acts independently of her-1. We propose that mag-1 normally allows oogenesis by inhibiting function of one or more of these masculinizing genes, which act during the fourth larval stage to promote transient sperm production in the hermaphrodite germ line. When the Mog phenotype is suppressed by a fog-2(lf) mutation, mag-1(RNAi) also causes lethality in the progeny embryos of RNA-injected, mated hermaphrodites, suggesting an essential role for mag-1 during embryogenesis. The defective embryos arrest during morphogenesis with an apparent elongation defect. The distribution pattern of a JAM-1::GFP reporter, which is localized to boundaries of hypodermal cells, shows that hypodermis is disorganized in these embryos. The temporal expression pattern of the mag-1 gene prior to and during morphogenesis appears to be consistent with an essential role of mag-1 in embryonic hypodermal organization and elongation.

Animals↗

Androgen metabolism in the brain of the green anole lizard (Anolis carolinensis).

Activities of the steroid metabolizing enzymes aromatase and 5 alpha-reductase have been documented in species ranging from fish to humans, yet relatively little work has been done in this area in reptiles. In the green anole lizard, Anolis carolinensis, steroid hormones are critical to the display of both masculine and feminine sexual behaviors. For example, dihydrotestosterone and testosterone can stimulate both masculine courtship and copulatory behaviors, and estrogen and testosterone facilitate feminine receptivity. These results suggest roles for both aromatase (which catalyzes the conversion of testosterone to estradiol) and 5 alpha-reductase (which converts testosterone to dihydrotestosterone). This study documents the presence of both enzymes in the brain of the green anole and indicates that the activity of 5 alpha-reductase is much higher than that of aromatase in whole brain homogenates. However, differences exist among brain regions, such that aromatase activity is higher in preoptic area/hypothalamic dissections, whereas 5 alpha-reductase is much more active in the brain stem. These variations in regional enzyme activity may influence steroid hormone regulation of specific sexual behaviors in male and female anoles.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗

Effects of testosterone propionate upon the sexual and aggressive behavior of adult male marmosets (Callithrix jacchus) castrated as neonates.

In New World monkeys of the family Callitrichidae (marmosets and tamarins), females frequently give birth to dizygotic twins. Twins share a placental circulation throughout fetal development and are hemopoietic chimeras. Despite this, there is no masculinization (freemartinism) in females which develop next to a male co-twin. It has been suggested that the organizing effects of testicular androgen upon sexual differentiation of the brain occur mainly during early postnatal development in male callitrichids, rather than in utero. However, this report demonstrates activation of masculine copulatory behavior by testosterone propionate (TP) administered to adult male marmosets (N = 8) which were castrated in infancy (between Days 1-7). Effects of neonatal castration upon aggressive behavior during pair tests with females (high frequencies of aggression) and intact adult males (low frequencies of aggression) were also reversed by TP treatment in adulthood. While early postnatal androgen secretion plays an important role in behavioral development in marmosets, it appears that a substantial degree of neural sexual differentiation occurs in utero in males of this callitrichid species.

Aggression↗

Gender change from female to male in classical congenital adrenal hyperplasia.

The psychoendocrinology of the development of normal gender identity and its variations is poorly understood. Studies of gender development in individuals born with endocrinologically well-characterized intersex conditions are heuristically valuable for the disaggregation of factors that are acting in concert during normal development. Four 46,XX individuals with classical congenital adrenal hyperplasia (CAH) and atypical gender identity entered a comprehensive research protocol including systematic interviews and self-report inventories on gender role behavior and identity, sexual history, and psychiatric history. Some of the data on gender variables were compared to data from 12 CAH women with the salt-wasting variant (CAH-SW) with female gender identity. The four patients (ages 28, 35, 38, and 30 years) represented three different subtypes of classical early-onset CAH: 21-OH deficiency, simple virilizing (CAH-SV); 21-OH deficiency, salt-wasting (CAH-SW); and 11-beta-OH deficiency. Their medical histories were characterized by delay beyond infancy or lack of surgical feminization of the external genitalia and progressive virilization with inconsistent or absent glucocorticoid replacement therapy. Although three patients had undergone one or more genital surgeries, all had retained at least some orgasmic capacity. In regard to childhood gender-role behavior, the four gender-change patients tended to be more masculine or less feminine than (behaviorally masculinized) CAH-SW controls. All patients were sexually attracted to females only. The process of gender change was gradual and extended well into adulthood. The most plausible factors contributing to cross-gender identity development in these patients appeared to be neither a particular genotype or endocrinotype nor a sex-typing bias on the part of the parents but a combination of a gender-atypical behavioral self-image, a gender-atypical body image, and the development of erotic attraction to women. Implications for psychosocial management are also discussed.

Adrenal Hyperplasia, Congenital↗

Sexual differentiation of cognitive abilities in women exposed to diethylstilbestrol (DES) prenatally.

In nonhuman animals, prenatal exposure to androgens or estrogens enhances development of male-typical characteristics (masculinizes) and impairs development of female-typical characteristics (defeminizes). We investigated the hypothesis that prenatal exposure to the synthetic estrogen, diethylstilbestrol (DES), similarly masculinizes or defeminizes cognitive development in women. Forty-two DES-exposed women and 26 of their unexposed sisters were studied. No group differences were seen for abilities at which females excel on average (verbal fluency, perceptual speed and accuracy, and associative memory), for abilities at which males excel on average (visuospatial abilities), or for abilities that do not show sex differences (vocabulary, nonverbal intelligence). The time of prenatal exposure to DES correlated with visuospatial performance with later exposure associated with better performance. However, the subgroup of women exposed to DES late in gestation did not differ from unexposed women on these measures. Results support the conclusion that prenatal exposure to DES has little or no influence on cognitive development in women. However, they do not preclude other types of early hormonal influences on human cognition, such as prenatal influences of androgen or influences of androgens or estrogens during the early postnatal period.

Adult↗

Androgenic effects on hypothalamic asymmetry in a sexually differentiated nucleus related to vocal behavior in Mongolian gerbils.

The relationship between courtship ultrasound emission rates and the volume of a discrete, sex-related, hypothalamic nucleus, the sexually dimorphic area, pars compacta (SDApc), in male and neonatally androgenized female gerbils is lateralized. Unbiased stereological estimates of neuron number and nuclear and neuropil volume are also laterally asymmetric in male SDApcs. In this study sexual differentiation and lateral asymmetry of stereologically assessed cytoarchitectural SDApc components, and their relationship to male-typical behaviors, including vocal emission, were examined in masculinized females. Female neonates received a single injection of testosterone propionate (TP) or control vehicle (Control) and were then implanted with silastic cannulae of testosterone at 65 days of age. Total SDApc volume, neuron number, nuclear volume, and neuropil volume had significantly greater values in TP compared to Control females. Neuron number was laterally asymmetric in TP females, since the left SDApc contained a greater number of smaller neurons, possibly interneurons, than the right. Courtship vocal emission and two other behaviors were masculinized in TP females. Left SDApc total volume and, most significantly, left neuron number, were correlated with vocal rates. No other lateralized correlations between behaviors and stereological estimates were found. It was concluded that various stereological parameters and the lateralization of vocal behavior and brain asymmetry depend on the early sexually differentiating effects of androgens. It is suggested that in gerbils, androgens have a role in the survival of interneurons in a laterally asymmetric hypothalamic nucleus which is an index of vocal control.

Androgens↗