Autism and Testosterone

Autism and Testosterone
Letter to the Editor (Guardian)- sent 12th Jan 08

Dear Sir,
It is with interest that I read your article entitled “New research brings autism screening closer to reality” (12/1/09) calling for a debate on pre-natal screening for autism.

Several important aspects need to be taken into account in this important discussion. Is the issue of elevated testosterone in autism valid? Is elevated testosterone specific to autism? What are the consequences for individuals with autism and future parents contemplating pregnancy, particularly in light of recent media coverage depicting autism as a serious debilitating condition? What other issues in autism are being overlooked by focusing on this particular hypothesis?

First of all, it is by no mean proven that an excess of testosterone is implicated in autism. Whilst the recent study from Auyeung et al. conducted on 235 children suggests that there is a relationship between higher levels of testosterone and higher autism trait quotients, it should be highlighted that what was measured relied on the use of two parental questionnaires and not gold standard psychometric measurements of autism, which are based on observations made by trained psychologists and paediatricians. The study seemed to rely on earlier supportive research that suggested a link between autism and high levels of testosterone, but these studies are equally controversial, and have not been replicated other than by the same authors. More importantly, whilst some individuals with autism may have abnormal steroid metabolism, and present with excessive androgen levels, as measured in blood and urine samples, these abnormal findings appear to be by no means representative of the autistic children seen today, especially children who have experienced regressive autism, characterised by loss of already acquired skills in the areas of communication, socialisation and behaviour. These children on the whole present with a failure to thrive physically, and are often under weight and have delayed maturation, which is hardly compatible with excess testosterone.

It should also be noted that testosterone is implicated in a wide variety of biological and behavioural processes. It is required for normal development, sexual maturation and sexual activity, and in many aspects of human behaviour, in addition to being potentially neuro-protective. It therefore seems that testosterone in itself is insufficiently specific and sensitive as a means of predicting the likelihood of developing autism.
It is of great concern that a debate on pre-natal screening with a view to potential pregnancy termination is even being embarked upon in light of the lack of hard scientific fact on this subject.
The issues of autism that need addressing concern the urgently needed explanation for the 7-10 fold rise in the autism rate seen in the last 10-15 years and an understanding of novel gut and immune pathologies implicated in regressive autism. It is also essential that more emphasis is placed on providing better education services and improved support for families.

Lorene Amet, D.Phil.
Autism Treatment Trust