Social Cognition in Adolescents with Gender Dysphoria and Congenital Adrenal Hyperplasia: A Preliminary Investigation of Biological vs. Experiential Gender Effects

Objective: To explore hormonal and neurodevelopmental influences on social cognition among individuals with gender dysphoria (GD), congenital adrenal hyperplasia (CAH), and typically developing (TD) controls. Methods: Participants included individuals with GD, CAH, and TD individuals. Social cognition was assessed using the Faces Test (FT), Reading the Mind in the Eyes Test (RMET), and Unexpected Outcomes Test (UOT). Psychiatric comorbidities were evaluated via the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children, depressive symptoms using the Children’s Depression Inventory, autistic traits with the Autism Spectrum Screening Questionnaire, and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms through the ADHD Rating Scale. Results: Participants included 34 GD, 29 CAH, and 35 TD. Psychiatric diagnoses were significantly more prevalent in the GD group, with major depressive disorder (64.7%) and ADHD (50%) being the most common (p<0.001). TD participants showed moderately better performance on RMET (p=0.003) and UOT (p<0.001) compared to GD and CAH, while CAH individuals scored lower on FT (p=0.046). Regression analyses revealed depressive symptoms (B=-0.105, p=0.004) and CAH status (B=-2.221, p=0.003) predicted RMET scores, while GD (B=-3.232, p=0.022) and CAH (B=-7.974, p<0.001) predicted lower UOT performance. FT regressions were nonsignificant. Conclusion: Findings highlight the interplay of hormonal and psychosocial factors in social cognition, reiterating the need for nuanced, contextsensitive approaches to supporting social functioning and well-being in gender-diverse youth.