Salivary testosterone in male and female youth with and without autism spectrum disorder: considerations of development, sex, and diagnosis.

Researchers studied hormone levels in 244 young people aged 10-13, including those with and without autism. They found that children with autism had higher testosterone levels than other children the same age. The study also showed that hormone changes happen differently for boys and girls during puberty - girls' levels rise earlier but plateau around age 11.5, while boys' levels continue rising rapidly. These findings suggest hormones may play a role in autism, especially during puberty.

This longitudinal study examined morning salivary testosterone levels in 140 youth with ASD and 104 typically developing youth aged 10-13 years. Researchers measured testosterone concentrations across three days and assessed pubertal development through physical examination. Youth with ASD demonstrated significantly elevated testosterone levels compared to typically developing peers. The study revealed distinct developmental patterns by sex: females showed higher testosterone at younger ages until approximately 11.5 years when levels plateaued, while males exhibited continued rapid increases surpassing females.

More advanced pubertal development correlated with elevated testosterone across both groups. No association was found between parent-reported social communication symptoms and testosterone levels.

Findings suggest testosterone may uniquely influence ASD presentation during puberty. Clinicians should consider hormonal factors when supporting autistic youth through pubertal transitions. Sex-specific developmental patterns indicate need for individualized approaches to understanding pubertal changes in autism.

Unequal sex distribution in sample, non-representative population regarding cognition and race/ethnicity, inability to examine afternoon/evening testosterone due to detection limits, and cross-sectional nature limiting causal inferences about hormonal changes over time.

Puberty is characterized by significant physical, hormonal, and psychological changes, which may be especially challenging for individuals with autism spectrum disorder (ASD). Although the etiology of ASD remains uncertain, studies suggest imbalances in hormones, such as testosterone, may modulate the autism phenotype. While differences in fetal and postnatal testosterone have been reported, there is limited literature regarding testosterone variations during adolescence in ASD. We investigated morning salivary testosterone levels in youth with ASD and typical development (TD) to explore hypothesized differences, expecting elevated hormonal levels in ASD compared to TD.

Youth with ASD (n = 140) and TD (n = 104), ages 10 to 13 years, were enrolled as part of a longitudinal study on pubertal development. Pubertal stage was determined by gold standard physical examination, and salivary testosterone was collected in the morning immediately upon waking and 30 min after waking and averaged across 3 days. Diagnostic (ASD/TD) and sex (male/female) differences, as well as interactions with age and puberty, were examined using robust linear mixed effect models. Youth with ASD showed significantly elevated testosterone concentrations compared to same-age TD peers.

After the inclusion of natural cubic splines to account for nonlinearity in age, a significant age-by-sex interaction emerged with distinct developmental slopes for males and females. At younger ages, females had higher testosterone, until about 11.5 years of age, when levels began to plateau, while male testosterone concentrations continued to rapidly increase and surpass females. As expected, more advanced pubertal development was associated with elevated testosterone. In contrast, no significant effect of parent-reported social communication symptoms was observed.

Limitations include an unequal sex distribution, non-representative sample (e.g., cognition and race/ethnicity), and inability to examine afternoon/evening testosterone due to detection limits. Testosterone may play a unique role in the presentation of ASD, especially during periods of dynamic hormonal changes including puberty. Inherent developmental (age, puberty) and sex-based (male, female) factors play a more prominent role in changes in testosterone levels during adolescence. Even so, future research is warranted to determine the differential expression and impact of exposure to excess testosterone during the pubertal transition for youth with ASD.