High levels of oestrogens in the womb linked to autism | Hacker News Reader

High levels of oestrogens in the womb linked to autism

sciencedaily.com

253 pointsBender174 comments

Maybe so, though equally could just be a small part in a larger puzzle or even a red herring.

However, as somebody who is on the autistic spectrum, I have noted that my index and "ring finger"[edit thanks to comment] are of equal lengths, a trait more common in females than males who tend to have one longer - see https://en.wikipedia.org/wiki/Digit_ratio

Another aspect/theory from personal experience is that my earliest memory was as a baby, equally I used to have a nightmare that abaieted when I was able to tell my mother who informed me of my birth complications and so much of my nightmare correlated, just seemed so related but then, never know for sure beyond once I knew this, my nightmares stopped. In short, maybe (least in my case) autistic people senses and other parts of the brain kick in earlier at a time when we are less able to process them and this becomes another party of the puzzle.

But would I change if I could go back in time and become normal is a question I have asked myself and the answer for me is - no, though the thought of what life would of been like, naturally yields to pondering.

I took a neuroscience course back in the day that discussed findings related to autism. I don't remember everything, but there was a discussion on excess dopamine early in the brain and a later depression of glutamate levels. All in all this would lead to more sparsity of neural activations in the brain. This made sense. Too much dopamine would lead to excess plasticity, causing a normal amount of glutamate to have too great of an effect, so the brain compensates by producing less glutamate, producing the same amount of neural activations but now sparsely spread out in a post-plastic brain. From my naive common sense perspective, it would make sense that an autism prevention would be some mechanism to limit plasticity during development. I'm really stretching argument here, but maybe this has some connection to autism brains "kicking in" early.

The connection to estrogen is an interesting one. Estrogen does have an important effect on neurotransmitter receptors, including dopaminergic, but my speculation is worthless here. Is there anyone here that has a better understanding of this that can provide some clarity?

You're building a theoretical treatment based on a theory you have not validated. (I'm not aware of any reasonable validation in e.g. a model organism at least.)

So, go back, and first check or devise a model. Model organism for autism is a very hard problem.

He said his comment is worthless (in a truly medical way), so I don't see the point in your comment.

Fwiw I found his comment to be interesting conjecture. I too have many dopamine related issues and until we have a better true understanding, all we can do is hypothesize and guess based on the small bits we do know.

I guess this is "how it's done". But why should it be? As long as all the hypotheses he states can be directly measured in humans that should be enough.

Treating humans as black boxes isn't necessary anymore. We have very good measuring tools now. I believe we can make much faster progress if we just look inside and use logic inference.

Couldn't you classify what you described as early trauma - highly stressful situation? I ask because I would have been considered Asperger's as a child, however was never formally diagnosed, and I had I'd call traumatic, a few childhood experiences with severe pain. It was however a series of events in my early 20s lead me to developing a severe hypersensitivity to sound, which then through trying to problem solve, discovered a sound therapy - with a diagnostic method of determining if the therapy would help before doing it - I did it, and it helped me dramatically, including unblocking whatever developmental blocks had occurred at an early age; I had extremely painful ear infections as a child, very stressful for the nervous system - and at a time of rapid brain development - and without going into more detail now, which I have in the past on HN, whatever coping mechanisms lead to autistic characteristics relating to processing feelings, emotion, focusing, which cascade learning, attention, etc. The sound therapy can potentially help the full autism spectrum, of course what the cause is will likely impact who will benefit from it; you also don't lose any of your skills developed, things just flow easier, and you may have gain access to sensory in a more balanced manner, leading to better self-regulation. The therapy I did is called Auditory Integration Training or Berard AIT for short; there is also another method called the Tomatis method which is apparently more effective if the trauma occurred while still in the womb. There are other sound therapies out there claiming to be beneficial, marketing themselves efficiently, however I'm uncertain of their methods - something I someday hope to test adequately with proper research comparing sound therapies.

Hard to clarify, and just earliest memories and maybe trauma solidified those event in memory, really hard to speculate even from personal experience. Also of note I was diagnosed officially in my late 40's, I was tested for autism when I was 5 (remember that vividly) and they deemed me 50/50, which in the 60's - autism was either yes or no with no aspergers or other half-way definitions.

Interesting how you mention sound sensitivity at a later age and I would say puberty saw many senses become more acute. Hearing still today (which is not fun living above a crack-house) in my 50's, it is still impressive.

I, also developed my own coping mechanisms and in many situations, people would have no clue that I was on the spectrum. Equally I'm aware of my kryptonite issues, so avoidance is as with many, whilst not ideal, a good plan B coping mechanism.

But with sound, and many coping mechanisms we develop in out brain, I do find falling asleep hard as those mechanisms take focus and the conflict of sleep and awake fall foul in such situations.

But I just love my bluetooth headphones, listening to music and whilst not drown out the outside world (I don't use noise canceling and play music low), it is enough to dull outside sounds that can prove annoying - which are more annoying the more tired I am, as in unable to focus them out.

But you know what my most favorite things in life still is today - a walk in the snow with nobody around. Kinda my happy place and living in outer London, one in which a good memory has its upsides as not that many opportunities to actually do it.

What you've said overall makes me think you're hypersensitive to sound - and that if you can afford a ~$50 USD hearing test/audiogram to check for imbalances in your hearing then it'd be worthwhile confirming that; it's not a standard audiogram, you'd have to call around to ask and find out if they know what that is - and is meant for use with Berard's Auditory Integration Training) which then can confirm imbalances. Imbalances showing at certain frequencies is actually just a signal that something is blocked function wise, not processing how it should, as your brain and body is a system of homeostasis that wants to find equilibrium at all times - so it should be able to equalize the perception of sound (save actual damage to the hearing); yes, damage is also a possibility, or both. There's a book on it called "Hearing Equals Behaviour: Updated and Expanded" on Amazon - has original book within it.

Do you remember having ear infections as a child, and were they painful at all?

Re: Falling asleep - what you've said regarding sleep is another proof point to me that you likely have a hearing imbalance. I found the comment on HN I made going into more detail on theory of how it works - https://news.ycombinator.com/item?id=13657973 - and in it I explain why your brain may not be able to actually stop paying attention to sound, which of course - a natural cycle of falling asleep - will have your senses slowly diminish until you're asleep and not not getting strong signals from them, or rather not reacting to them - making it difficult to fall asleep.

"Do you remember having ear infections as a child, and were they painful at all" No, though tonsils often a source of discontent, so removed. Though nobody ever warned that they could grow back, though not a troublesome size. As for ear balance, no issue there.

If you haven't had an audiogram specifically to check for imbalances in your hearing, then standard audiograms won't tell you.

When I was in Grade 2 I had trouble focusing in class - they brought in an audiologist to see if I had trouble hearing. They were surprised that no, in fact, I could hear extremely well - however they didn't recognize that as a problem, hypersensitive hearing.

A standard audiogram only checks to see that you can hear well enough in each ear, at different frequencies, say at 15 decibels. Checking for imbalances they check instead for HOW LOW of a decibel you can hear at different frequencies. Say in your right ear the lowest you can hear 1000 Hz frequency is 15 decibels, but in your left ear you hear at 10 decibels - that would show an imbalance by 5 decibels. Very few audiologists do this test, so I'd be very surprised if you found stumbled into one who did check it in this way.

Oh, I love a walk in the snow, ideally when it is falling, nobody around.

So soothing.

I am not autistic, but do have high aural senses. As a kid, I could hear well above 20khz. Today, that has rolled off due to age, but my discrimination is still great.

Sounds can sometimes move me to distraction. ASMR, for example. I trigger easily and it is fairly intense.

There is something about the crisp air, dampening on sound that snow presents to us, and what little is heard otherwise seems to just stand right out, like incongruent, but not in a bad way. Just there, present.

That digit ratio stuff has always weirded me out. There are even some studies that show certain ratios correspond with homosexuality. That wikipedia page even has a huge table with a list of stuff like having a high digit ratio corresponds to reduced financial trading ability, and a low digit ratio corresponds to a longer penis.

That shit is weird.

People tend to forget just how important hormones can be and just assume everything is because of genes.

We are also only equally coming around to the thinking that the makeup of bacteria in the stomach has a bigger impact in area's that we have never invisanged before.

hormones are proteins encoded by genes that affect gene transcription. Many hormones respond to entirely internal signals. So, much of what hormones do have a root cause in genomes (but, there are definitely limits on that statement).

That's an odd comment since hormones are the result of gene expression.

Not necessarily, for example, the very thing in the article title - high levels of oestrogens in the womb - is about hormone levels not caused by expression of your genes but influenced by outside environment.

An outside environment which shares ~50% of your genes, though.

Nothing genetic about lead in the air or in paint, or hormones in your beef. Nothing genetic about alcohol or cigarette exposure in the womb. Or random thugs terrifying your parents, putting your pregnant mom through waves of fight-or-flight hormone spikes.

Yeah, but they are more precisely a function of environment. Diet, stress even sunlight affect hormone levels in a given individual.

They are usually, but you don't get much variation without issues that are not genetic that affect hormones. Like hormone producing tumours.

IMO gene expression is very different than what layman like myself mean when we talk about our genes.

OK, fair point.

In order for genes to have any impact on an organism they need to be expressed. And it's expression that creates the enzymes that create hormones. So it's hard to separate those two.

Environmental exposure can change how genes are expressed and thus hormones.

But hormones are one of the things that affect gene expression in turn. There aren’t really many straightforward causal relationships in biology.

That's true, but the hormones wouldn't changes gene expression unless it was already encoded in the genes.

As with many traits, not always a given, just more likely. Though the last one you mention, as somebody with a low digit ratio is one that escaped me and I'm just fine with that, as happily dispel the relationship myth about shoe size in which I'm size 13UK/14USA.

It’s not that surprising. It’s just a second order effect of an important environmental factor at a critical development stage.

Hormones valances in the womb, as you mentioned, are likely a driver of homosexuality. And having kids changes the hormone balance, making some arrangements of sons and daughters more likely to be gay.

It's essentially a list of stereotypically male/female traits that correlate with testosterone/estrogen.

And of course not a p-value or effect size is sight.

> And of course not a p-value or effect size is sight.

Because... it’s wikipedia and you wouldn’t expect to find those things

While I’m sure nobody thinks there is a casual relationship, you can find statistically significant effects on the digit ratio

> index and forefinger are of equal lengths

Those are two names for the same finger. Did you mean index and ring ringer?

I did, thank you, my bad. Glad I dug up a relevant link to dispel my confusion there.

Same story here: same length of those 2 fingers, complications at birth, damn good memory for things when I was child, and Aspie to the bone.

Don't know about birth complications but otherwise same.

if I could go back in time and become normal

I don't know if this is good news, or bad news but... there is no normal. I know what you meant, what it would be like without ASD. But I'm not sure that would give you any particular insight into anything other than simply being a different person.

> there is no normal.

In a classroom of 30 students, where 1 is viewed by the rest as abnormal, there is normal. Yes, it is only a social construct whose impact is based on our personal experience and the society in which we live, but this is true of many things which I think we would not tolerate being dismissed so readily.

But that's not what happens, despite what people seem to think. On average 1 of those students will be Autistic, but also 3 of those students will have ADHD, 2 or 3 will have "personality disorders", 2 will experience childhood trauma, 1 will be a high-testosterone child assigned the sex "female" at birth, 3 will have specific learning disabilities and 1 or 2 will be considered "gifted".

When half the class isn't neurotypical, being neurotypical isn't any more "normal" than having blue eyes is "normal".

>there is no normal

I mean, yeah there is? There are 7 billion people on this planet. If you could create some score of peoples intelligence, how they react/respond to people, their normal physical movements and put that into a distribution the autistic people would definitely be on the tail end of the curves.

Sure everyone is different in various ways- but a lot of those differences are very small compared to the differences exhibited by autistic people.

I can give you a direct example- my oldest son has.. something. We had him tested for autism when he was younger and were basically told that yeah there is 'something'. He's not technically autistic, or at least not the level where he needs extreme special stuff, but he does exhibit some of the traits of autistic children, just in a more minor way. So for lack of any better term he is "very slightly autistic". At 7 years old he has an insane memory (closest to "photographic" that I've ever encountered) and seems highly intelligent in some areas (but definitely not in others! it's quite incredible actually to see sometimes..). He has some of the physical traits where he can't really sit still, needs weighted blankets, has some of those unique arm movements of autistic people.. but again fairly subtle. A lot of things to him can be more black/white than gray, because he seems to need to fit everything into a very specific bucket in his mind.

Every teacher he has had, including some which work with the more special ed kids, has said "yeah there is... something different about him".

Now conversely, my younger child I would classify as "normal". Why do I say that? Well.. I worked at co-op preschools with both of my boys for years. I saw lots of kids. And when you see a ton of kids and play/interact with them... I mean yeah there is a normal. Normal is how you would expect someone to behave and interact with. There is a relatively normal way you would expect a 7 year old to respond in various situations, etc.

Anyway- sorry for writing a book. I guess I'm putting off work.. I just found it a bit strange to not accept that, well, most people are actually pretty darn similar while a minority of people are very different. I see it every day in my house!

It’s just semantics. There are negative connotations associated with calling someone “normal” versus “abnormal”. I’m sure you’re polite enough to not describe people in wheel chairs as “abnormal”.

The non-controversial terms that people use related to issues like autism are “neurotypical” and “neurodivergent”.

>It’s just semantics

No it's not... I was responding to someone who said there is no "normal". Yeah, there is. Most people behave in a way you would expect. Most people exhibit motor controls the way you would expect. A minority of people, and specifically people with autism, really do think in a "different" way and exhibit strange motor functions at times that most people do not.

I don't think we have to dance around politically correct terms here. I'm using normal in the statistical sense. Statistically, most people are very neurologically similar and then some people are (relatively) wildly different.

> I’m using normal in the statistical sense

Which is semantics. You’re using a different meaning of the word to fit your point just like the person did in the grandfather comment. You even put the word normal in quotes yourself indicating that you understand how words can be interpreted differently. I wasn’t disagreeing with your interpretation of the term.

>Most people behave in a way you would expect.

This is absurd. How do you have any idea what "you would expect"?

>I'm using normal in the statistical sense. Statistically, most people are very neurologically similar and then some people are (relatively) wildly different.

First, define "very neurologically similar". Second, "most people are similar" in a normal distribution because that's the way the distribution is defined. It's not some biological coincidence.

Even without being able to consciously explain their expectations, humans are often consciously aware when their expectations have been violated. Experimentally, there are lots of responses that can be tracked. Unexpected stimuli causes slower reactions, longer focus times, and stronger memories. https://onlinelibrary.wiley.com/doi/full/10.1111/tops.12292

I don't see the part of that paper that explains that people "expect" the same things; that there's some "normal expectations" in the population, which is what the OP is arguing.

There's a funny thing that happens every time an article on autism comes up on this site where a bunch of commenters state they have some degree of autism. This aligns perfect with the OP's argument: everyone is "normal", but I'm not. I'm special.

It's why "normies" is a thing. Everyone sees everyone else as "normal", but they're different. I wonder why that is?

Ah, when you said > how would you know what "you would expect" I thought you were challenging the idea that people know what they expect from others. It sounds like you were actually challenging the idea that people can know what others expect?

Blond hair is less common in the US than autism, but it would be considered very strange to call brown-haired people "normal" and blond-haired people "abnormal".

> Blond hair is less common in the US than autism

The stats I can find quickly suggest blond hair in the US is around 3%, and autism in the US is around 1.7%.

> If you could create some score of peoples intelligence, how they react/respond to people, their normal physical movements and put that into a distribution the autistic people would definitely be on the tail end of the curves.

Some measurable aspects of human physiology and behavior would fall into a normal distribution (i.e. "bell curve") if you graph it, yes. Bell curves are common enough that there is a lay assumption that all distributions look like that, but it isn't the case, at all. Certain forces are required to lead to that flavor of distribution and in the absence of those, you can get graphs of all sorts of shapes.

For example, if you were to graph "how feminine" a set of people are, you're unlikely to get a bell curve where most people are androgynous. Instead, you get a bimodal distribution where there's a hump on one side for dudes and one on the right for ladies. In fact, graphs of height show a similar distribution.

If you graph how many fingers someone has, you'll probably get something closer to a power law where almost everyone is on the left at "10", a few misfortunate at "9", even few very unlucky at "8", and so on. (Plus a couple of odd points for polydactyly, etc.) This is the famous "long tail" you hear about in economics.

So there is certainly variation in all attributes, but that does not imply that the center of that range is the most populated. And thus, there may not be a "normal" in the typical "average and most common" sense of the word.

What does a normal set of genitals look like?

Normal means conformance to e.g. a standard. Let's assume the reasonable communal standard of 'factuality', i.e. 'what exists in facts'. Individuals may not be able to tell with 100% precision about the entirety of a fact. But if we take some math problems like 1+3, 2+2, 5+5, etc., and have a person going around believing, teaching, and attempting to apply a different principle (equation, i.e. meaning/relationship of the numbers) then they're going to get different answers. It's wrong to say that 1+1=3 as if it's mathematics. Therefore, it's natural and consistent to conclude that a person who has the wrong answer or wrong view of questions cannot behave normally to those questions nor to the standard of 'what is' in the questions. Have you ever heard that angle on the matter?

Agreed and yes, normal is a perception based upon a mode average. After all, if the majority of people were psychopaths, normal would take on a whole new meaning.

Equally it is hard to evaluate such a different timeline as you are evaluating from a different perspective/timeline.

Yes, you end up very quickly in Thomas Nagel's "What is it like to be a bat?" scenario. You can't ever know what it is like to be another person (or animal) because as soon as you are that other thing, you are no longer you. If you were still you, you wouldn't be that other thing so you still wouldn't have that knowledge.

> But would I change if I could go back in time and become normal is a question I have asked myself and the answer for me is - no

Just as long as people remember that this is a personal decision, and not one you can make for others. I wonder what I would do for my children, both of whom have autism and who I love. But my older child is non-verbal, still wears diapers, and is a flight risk. He cannot take care of himself. I worry what will happen when my wife and I can no longer take care of him adequately. Adult autistic support is not great.

But what will he lose if I "cure" him. Both boys are happy, affectionate, and they are the lights of my life. They are far happier than those who are far more "successful" in life.

It's not easy.

Interesting about the digit ratio. As a counter example my ring and index are approximately the same length on both hands, left hand index is only slightly smaller. I've never been diagnosed with autism though (my friend who used to work very closely with autistic kids has suggested that I might be slightly in the spectrum because some characteristics but that's about it).

Could be a pattern. Could be a pattern that doesn't actually exist. I think we need more samples (I'd imagine some selection bias on HN)

ok..now I am confused which hand do you look at?.. On my left hand..index and ring finger are about the same.... on my right hand the ring finger is longer

For me it varies widely depending on how I hold my hand. If I place them flat on a surface, palm down, fingers together, my ring fingers look longer. If I look at them palm towards me, fingers separated, extended, but relaxed, it's clear the index fingers are longer on both hands.

The other way around for me. I am left handed. This finger ratio thing is weird.

Maybe I’m misreading but the article says the opposite that it’s a short ratio (short index) that is associated with asperger and autistic traits.

Autism in males is supposed correlated to high testosterone and long ring fingers, opposite of this article.

https://www.newscientist.com/article/dn509-pointer-for-autis...

in regard to the digit ratio:

I notice my fingers are similar in length if I look at the top of my hand.

But looking at the palm of my hand, as shown in the picture on the wikipedia page, they look very different in length.

Would like to see the original study for this, because it seems like something is getting lost in translation. The article mentions 4 major prenatal steroid hormones involved, "two known as androgens", but the headline says that estrogen is linked. Colloquially, estrogen is the female sex hormone and androgens (including testosterone) are the male sex hormones. Molecularly, "estrogens" are a family of different steroid hormones (not a single molecule), and androgens are a family of other hormones, and both of them occur in both males & females but in different quantities. And to muddy the waters further, many androgens are metabolic precursors of estrogens, eg. testosterone is synthesized into estradiol. And to muddy them even further, some molecules (eg. DHEA) are both depending upon which biological receptors they bind to.

The title as written contradicts the article, using the colloquial meaning of the words involved. There's probably a more precise technical meaning where everything makes sense, but the article doesn't really explain it.

The discussion of androgens is of previous work completed in 2015 that the new estrogen work builds upon. The second paragraph explains the former and the third paragraph explains the latter.

https://www.nature.com/articles/s41380-019-0454-9

One complicating factor that I put into every thread about random things being associated with autism: the diagnostic criteria for autism doesn't just measure how autistic someone is, but also how well they've learned to cope with being autistic. It measures things like frequency of meltdowns, ability to handle their everyday life without assistance, ability to "mask" by doing things like holding eye contact or memorizing social scripts, etc.

Better brain function in general means that someone on the autism spectrum is less likely to have general life issues that lead to an official diagnosis. Anything that could reasonably be linked to a decrease in IQ can also reasonably be linked to autism. IQ is positively correlated with general life outcomes, and negative life outcomes are part of the diagnostic criteria for autism.

> the diagnostic criteria for autism doesn't just measure how autistic someone is, but also how well they've learned to cope with being autistic.

I'm not medically qualified at all, but that sounds a bit like saying Typhoid Mary didn't have typhoid because she was asymptomatic. That someone is able to effectively cope with a condition doesn't mean they don't have the condition. Am I missing something?

Medical practitioners aren't on a platonic quest for truth when they make diagnoses. They're generally trying to separate out those who would benefit from treatment. Physical tests aren't often that useful for mental conditions, so official diagnostic criteria often has a section about how the observed traits and behaviors cause problems for the patient at home, in school, or at work.

Furthermore, people simply don't seek diagnosis and care unless they're having problems that are severe enough. One example is Bill Gross, the "bond king", who figured out that he had Aspergers in his 70s. If someone is adjusted enough to their social niche, why would they seek a mental health diagnosis?

Thank you for that clarification, that is my rough understanding of mental health having been sent to a whole mess of shrinks.

I guess what my ultimate misunderstanding is:

> One complicating factor that I put into every thread about random things being associated with autism

How is that a complicating factor in discovering causes themselves? If someone has the Foo and Bar factors that cause autism, but has otherwise been able to work around it they are still "autistic" but just at a subclinical (is that the right phrase?) level. I guess I'm having some (pedantic?) misunderstanding around autism as a diagnosis vs. a disease you have.

Subclinical is the right word for that, yeah.

>How is that a complicating factor in discovering causes themselves?

The study links the factor under study to autism diagnosis, rather than some hypothetical "true" rate of autism that includes undiagnosed and subclinical cases. Ten IQ points can be the difference between otherwise-identical autistics barely passing a class versus failing it and getting referred to a psychologist. Or after getting referred, the difference between qualifying for a diagnosis or not.

The latter actually happened to me personally in elementary school: I had held my pen funny in a way that made my hand hurt after a while, and my teacher referred me for refusing to complete a handwritten class assignment. They did a test on various types of school subjects, and I ranked a bit above grade level in some and far above grade level on others. If I was a grade lower in each subject and thus had below grade level scores, I'd've gotten an official diagnosis of some kind of subject-specific learning disability. But instead, there wasn't enough of a problem to need to do stuff, and doing stuff costs money, so they basically shrugged their shoulders and sent me on my way.

In the case of something like autism, the presentation of symptoms is massively complicated by the amount of support and therapy/'training' a person has had. In a population where everyone had equal levels of Foo and Bar, but a widely varying level of therapy, they would show widely varying levels of 'autism' in their diagnosis - and this would complicate any attempt to study the relationship of Foo+Bar<->autism.

Should have said: that is in an imaginary scenario where foo+bar really does cause autism

We don't know what autism really is, beyond it's symptomatic effects and correlations like that of TFA. It's not clear that there is a meaningful notion of being autistic but asymptomatic. Typhoid, on the other hand, is a bacteria that exists independent of its symptoms.

"Asymptomatic" just means poor or absent testing, not an inherent property. Better diagnostic tests can detect low visibility symptoms.

It's like saying that someone with nearsightedness is asymptomatic and therefore not nearsighted because someone is good at squinting. There are still symptoms if you know what to check for.

Typhoid Mary, the example the parent used, was asymptomatic in an inherent way, not just due to poor or absent testing.

> There are still symptoms if you know what to check for.

What are these in autism? Are you sure they exist? It may be that "inability to mask" is just what autism _is_.

I'm a medical practitioner and that sounds a little silly to me too. I don't diagnose autism, though. I leave that to the paediatricians. The main reason that diagnosis is a big deal here is it's related to funding packages. I suspect that's also why ability comes into it.

The other thing is that autism is somewhat nebulous and it's in part a condition of not being able to cope socially in this world. So because of this, it makes sense what GP was saying.

I'm glad I don't need to diagnose autism. Severe is easy to see from 100m away. Borderline would be a coin toss.

Adults can be autistic and can have great quality of life improvements from diagnosis and treatment.

What could a high-functioning autistic adult gain from diagnosis and treatment, one who has managed to blend in well enough to go undiagnosed.

A diagnosis allows life to finally make sense. Even for those that are able to blend in, it's really great to have a framework to understand things, and that there's a community that actually understands you because they have first-hand experience of eg, the rage and meltdowns that plague individuals with autism.

Post diagnosis, there's even treatment for some of the things that high-end functioning adults with autism simply can't do without medication, and are negatively judged for by society.

In that case I leave it to the psychiatrists. In practice, very few adults are diagnosed with autism where I'm from.

I would be interested in references here, as I'm not aware of treatments specific to autism in adults.

Something like 1 in 4 transgender women are also autistic. If this study holds any water that might be an interesting investigation.

Interesting, I had no idea the rate was so high. I’ve seen one study[1] that sampled for ~7%, but not 25%. Do you have a link I could read?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904453/

Not parent, but closest thing I can find is the Kaltiala-Heino et al. study [1], found from p7 in this literature review [2]. There it's summarized as "26% of those who had experienced gender dysphoria had previous diagnosis of ASD". But that study has only 47 people (none adults), all drawn from a pair of Finnish hospitals. It looks like an outlier among the others, which suggest something more like 5%.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396787/#!po=0.... [2] https://www.smr.jsexmed.org/article/S2050-0521(15)00004-9/pd...

Thanks for posting the studies. This might be considered bad faith but the parent comment struck me as anecdotal and I wanted to press where those sources were coming from.

I didn't take your question as bad faith, I appreciate it actually, but I didn't have time during the work day to cite sources. The one posted is the most scientific one I know of. I have seen self reported surveys of transgender communities that hit numbers that high, but that's obviously not scientifically rigorous. Food for thought tho.

I keep myself informed on transgender issues because I have transgender people near and dear to me and I have transgender colleagues at work. In my personal life many of the transgender women I know identify as on the spectrum, some more intensely than others. 1 in 4 sounds right anecdotally as well.

Anecdotally, I think it might be true that younger people in general are more receptive to identifying as autistic while people my age or older might be averse to it even with the same experiences.

Thank you for this. My fiancée is the only woman with diagnosed autism I've met in real life. She has gender dysphoria and when she joined a few online chats for advice the few people she's befriended that are also either women or trans men are all diagnosed with ASD.

Interesting, even at 7%, this autistic population could be creating the unfavorable perceptions of trans women and confirming people’s pre-existing beliefs of mental health issues because enough of their quirky or negative experiences with trans women are “just” with autistic people

As in, one circumstance is being conflated with another circumstance and this is counterproductive for everyone

> because enough of their quirky or negative experiences with trans women are “just” with autistic people

While I hate to agree with this, it is also my opinion as a transgender woman myself.

I also believe that the percentage of trans people who are also part of the spectrum and who are in online support groups is even higher than 7%.

Often, they are quirky people who have difficulty expressing their opinions, points of view and identity. They often seem rude and frustrated. They are very passionate about the subject of gender identity and will make far-fetched statements and present them as facts. This results in very embarrassing interactions.

Personally, I can't stand their quirks and I often have negative experiences with them. These users will take up all the space and drive other users away.

My favorite Facebook support group is the result of two of these "migrations". The first group was huge and became "unstable", so a few people created a second one. After a while, some of the users from the first group found the second one so a third group was created. This group is set to invitation only and has around twenty users.

Many people approach me as if I was autistic, which I am not and it is frustrating at best.

This is very taboo and most people will not talk about it. You cannot deny support to people on the spectrum, but I wish they had their own spaces.

I would bet that most of the socially awkward encounters people have with trans individuals is just that. It's people interacting with people with autism. Being transgender is about finding and expressing your gender identity. Puberty is always awkward for anyone involved at first but most people grow out of it and become adults and this is no different for a second puberty.

Being stuck in-between, unable to express one's identity in a socially acceptable way is not a symptom of gender dysphoria, it is a symptom of the autistic spectrum disorder.

If people were more aware of this, they could act accordingly. Just because someone is on the spectrum doesn't mean that they are invalid in their trans identity. It simply means that they have their own needs and require a different mindset.

I understand that this is going to come across as very controversial. It is not my goal to belittle anyone and this is merely my anecdotal point of view as someone from within those communities.

On the other hand what if it's not just conflated circumstances and there is some kind of interaction there. When there is an unusually large correlation between two unexpected things it normally merits further investigation.

Not inaccurate. People should research this further.

Good luck finding a way to say it.

I read an article somewhere claiming that estrogen via Hormone Replacement Therapy actually reduces the symptoms of autism. It wasn't a scientific study, but it was written by someone who claimed to personally know several people who had observed this effect.

As a trans woman, I agree this needs more study, and I have experienced something similar.

And I'd like to have a word with whoever downvoted this.

>And I'd like to have a word with whoever downvoted this.

Why?

The comment is essentially: "I read someone claiming something one time." It has no sources, no links to anything to explore or understand, nothing. There's not even a link to the article or story. Just someone making a wild statement on the internet.

While anecdotes aren't evidence themselves, they're extremely useful (1) when there aren't scientific studies available and (2) for generating theories that can later be tested. Whether they're interpreted as an invitation for further discussion or unjustified proof depends on how responsible the audience is.

I'd argue that anecdotes are evidence. Albeit much weaker evidence than a scientific study. In the absense of better evidence, it would be foolish to disregard them entirely.

Evidence from someone who has experience with particular medical condition, who has been living with it for years, is not 'ancedotal', it is local knowledge. It might not be accurate, but it's often a good place to begin actual scientific investigation. This isn't a wild statement; it's something I've personally suspected for years, and I'd like to see research around.

But just pointing this out cost me -2 karma, which is -- again, anecdotally -- an example of how Hacker News is a toxic environment for marginalized folks.

I'd love to see some studies on that too.

What experiences did you have while on HRT that lead to you to believe this?

In general, I'm specifically skeptic of claims of behavioral changes associated with HRT, as I feel as if a lot of those claims have roots in gendered preconceptions of women that have nothing to do with biological differences. People going through HRT will associate personal, unrelated, experiences with the medical transition, but cannot be corroborated through any studies or research.

Speaking for myself...

The most obvious example was my response to emotional situations in fiction. Going from only being able to empathize with characters only on an intellectual level to also being able to empathize on an instinctual/emotional level was was so incredibly obvious it was like going from black and white to color.

One the one hand, you could dismiss "I cry at movies now" as just an intellectually-driven conformity with gender stereotypes. You could dismiss my self-report as rationalization--even a dishonest one. On the other hand, what we're fundamentally talking about here is my own mental states--something about which I have first hand observation and you can have only assumptions.

Go through the thought exercise of what kind of information you'd need to evaluate this kind of claim scientifically. You'll quickly realize how incredibly implausible it would be that anyone would perform (or fund!) a study like this.

Seeing as that's never going to happen, You're left with the choice of either (1) believing people's self-report as the best available evidence, or (2) requiring trans people to solve something like the "Chinese Room Argument" just to justify that their own mental states are, in fact, real. It's like asking someone to prove they actually love their spouse, and aren't just simulating that behavior. Who else is subjected to this level of burden of proof? It's totally unreasonable.

I only question it because of the risk of attributing these changes towards predispositions to specific gender stereotypes. I'm not trying to place scrutiny on the subject because I unilaterally disbelieve trans people, but rather I believe these claims are dangerous. They can give trans people misconceptions on what medically transitioning will do for them, present medical transition as a method to become a "real" trans person, or give ammunition to opponents who use the hormone topic to dismiss women as a whole.

I do understand that these things are different for everyone and it's basically impossible to prove, but you can understand my skepticism. I definitely experienced some of the emotional elements you mention, but they aren't new to me. I don't cry or get upset now where I wouldn't have before. It does feel different though. I do not think this is the same as some of the behavioral changes that the parent is describing. My behavior hasn't changed. I'm still just as much of a nice/mean/thoughtful/forgetful/etc person that I was before. I had ADD before, I have ADD now. My political views haven't changed, I don't treat my friends differently, my hobbies haven't changed. I can't think of anything special about autism that would allow for those symptoms to change because of HRT.

Personally, the experience I have now at crying at literally anything can be explained quite well (by myself) by the impact of early childhood trauma, and the eventual intense psychotherapy I've undergone in relation to my transition.

That is, I eventually learned how to process emotions 'correctly', something I was never taught as a child. This is coincident with my transition. I am unclear if it has been directly caused by HRT, but I haven't ruled it out.

However. I absolutely disagree that this is a change caused by "intellectually-driven conformity with gender stereotypes".

Can you elaborate on "experienced something similar"?

Found the article https://slatestarcodex.com/2017/06/28/why-are-transgender-pe...

I find that difficult to believe. Estrogen isn't known to cause large behavioral changes like you've described. The changes in hormones can result in some emotional changes, but I cannot see how they would reduce symptoms of autism.

Symptoms of being a high-functioning autistic—as perceived by others—include an inability to empathize with peers or with hypotheticals of “natural” human responses. But one obvious confounder for this symptom is that you’re comparing with the wrong peers. Being a woman but not liking the things women like or having the same emotional responses that women tend to have (because, instead, you like the things men like and have the same emotional responses that men have), could get you (incorrectly) labelled as autistic, when all you’re actually experiencing is gender dysphasia.

So now men and women have inherently different interests and emotional responses that should result in not only misdiagnosis of autism, but actual diagnosis of gender dysphoria?

I think that my fiancée with ASD and constantly elevated testosterone levels and gender dysphoria would say yes to the inherented differences in an instant.

But there are plenty of symptoms of ASD that have nothing to do with stereotypical gendered behavior. And they are a requirement for diagnosis.

Personally I don't know.

So these aren't symptoms that the individual is exhibiting but symptoms that are perceived differently by others? I could definitely see that being the case but I also feel as if that's moved the goalpost on what the parent said.

1-2% of males are autistic. A female with stereotypically male traits isn't autistic on that basis.

One of the key things to know about high-functioning ASD is that it's underdiagnosed; which means that many people who have high-functioning ASD only figure out they're on the spectrum if someone points out to them (or their parents) that they "seem autistic"—and they then take that assertion seriously and ask a doctor.

People who are gender-nonconforming and/or trans, are more likely to have the main trigger event for being diagnosed with autism: being told that they seem autistic. Which will lead to more of them "being" autistic (in the medical-statistics sense, under which people who have ASD but are never diagnosed, get categorized as "neurotypical.")

Found the original article if you're interested: https://slatestarcodex.com/2017/06/28/why-are-transgender-pe...

I'm not saying I necessarily believe it, but it's one of the most interesting articles I've read recently.

ASD diagnosis of a reasonably functional person is basically whether they're weird or not. For example, I picked one up almost by accident when I nit-picked a psychologist's choice of wording and then explained my reasoning when questioned about it.

If someone publicly asserts they're trapped in the body of the wrong sex, and does not back down when challenged, might this be sufficiently weird to be ASD by definition? Especially given the awkwardness of violating gender norms.

A comparison between ASD diagnosis rates in places where trans identity is culturally normalized might shed some light on it, but as ASD diagnosis is also pretty cultural it might be tricky.

A psychologist tried to put an Autism diagnosis on me as well, yet I am extremely good at reading people. So I believe that Autism as diagnosed is not just a spectrum, but a normal distribution where both tail ends are bad. A person who can't read others feelings will obviously not be good at dealing with others. However a person who has too much empathy won't be able to properly cope with the pain from social situations and will therefore spend most of their energy trying to keep the empathy in check. This results in similar problems and even "Meltdowns" when they fail to cope.

Both sides get the same autism diagnosis since both of them are better at dealing with things than people, but they are completely different. For me I felt the diagnosis would hurt more than help since it didn't properly describe me, so I asked for a proper test and alternatives. I got ADD and social phobia, there were no signs of proper autism but I could have gotten a diagnosis from the original psychologists hunch.

Two of the three openly trans women I know have ASD siblings; I hadn't ever thought about the connection before.

A lot of people with autism also have sensory issues, maybe that is a factor in dysphoria?

Further reading: https://www.theatlantic.com/health/archive/2016/11/the-link-...

I've had a sneaking feeling that a lot of the phyto-estrogen compounds out their were eventually going to be linked to autism. Expect to see a massive consumer wave against anything containing these compounds: fragrances and any items that contain fragrance, dyes, receipt paper, soy, both BPA and BPS in soft plastics, etc.

Is there any reason to believe that phytoestrogens would act in a similar way to estrogen, to a significant level, in humans? People throw around this concern a lot, but I have never seen evidence of that.

Edit: Elsewhere in this comment thread, the argument appears to be that the opposite may in fact be true: https://news.ycombinator.com/item?id=20588240

Do you know any off the top of your head?

As far as compounds with phyto-estrogens. Plenty. A great book on the topic:

The Case Against Fragrance - Kate Grenville

Also, I think this story from 2014 about BPS is the biggest bombshell to consumers that just hasn't hit critical awareness yet:

https://www.scientificamerican.com/article/bpa-free-plastic-...

All my kids drink from stainless steel or glass now. It's made me a bit of a plasti-phobe.

I'd take this with... not quite a grain of salt, but maybe a small dose of healthy skepticism. Simon Baron-Cohen is a legitimate and respected researcher, but he's well known in autism research circles as pushing very hard a theory that autism is a manifestation of an "extreme male brain", which is a theory that almost every other significant researcher in the field disagrees with. I'd suggest taking a critical view of any research coming out of his lab that bolsters his pet theory, like this does - there's a lot of context here that's lacking.

It sounds like this is evidence for that view then. Why is the researcher's theory relevant to results that support that theory?

The scientific method is not generally served well by people seeking to find a particular answer, as opposed to the truth.

Not saying that is the case here, but I agree with the parent-it inspires some scepticism from me.

You gererate a hypothesis and then experimentally test that hypothesis, I don't see anything wrong there. How else would you evaluate new theories that go against convention? Maybe you are suggesting that he fudged the data or otherwise manipulated the experiment to get a desired result?

Of course, but there is a difference between having a hypothesis to test, and believing something and setting out to find evidence for it. Those are some extreme examples of that being an issue, but also things like not publishing negative results can also be a result, less obviously.

I very specifically said that I was not saying that was what happened in this case, just that I agreed that there was something of a red flag.

One way that you can get bad results is to start with too broad a hypothesis, like 'autism is related to maleness', conduct your experiment and then engage in p-hacking, or analysing all the relationships in the data that would support your hypothesis until you find one that looks significant. [https://bitesizebio.com/31497/guilty-p-hacking/]

Summary of study from Nature link, italics mine to prevent likely misunderstandings of their work:

> Here we test whether levels of prenatal oestriol, oestradiol, oestrone and oestrone sulphate in amniotic fluid are associated with autism, in the same Danish Historic Birth Cohort, in which prenatal androgens were measured, using univariate logistic regression (n = 98 cases, n = 177 controls). We also make a like-to-like comparison between the prenatal oestrogens and androgens. Oestradiol, oestrone, oestriol and progesterone each related to autism in univariate analyses after correction with false discovery rate. A comparison of standardised odds ratios showed that oestradiol, oestrone and progesterone had the largest effects on autism likelihood.

After reading the article I had a brief hypothesis that higher estrogen levels would also be associated with non-heterosexuality. This study seems to strongly concur: https://www.ncbi.nlm.nih.gov/m/pubmed/29159906/

> In the group with ASD, 69.7% of the sample reported being non-heterosexual, while in the TD group, 30.3% reported being non-heterosexual. The group with ASD reported higher rates of homosexuality, bisexuality and asexuality, but lower rates of heterosexuality

There are also other features. For instance, measuring the anogenital distance in neonatal humans has been suggested as a noninvasive method to determine male feminisation and thereby predict neonatal and adult reproductive disorders.

https://en.m.wikipedia.org/wiki/Anogenital_distance

BPA mimics estrogen, so does that mean that plastics are causing autism?

https://www.medpagetoday.com/infectiousdisease/publichealth/...

There's also the soy-estrogen link, and soy is in everything. I don't know what the truth is regarding soy estrogens, because it's one of those things where searching brings up reams of pseudo-scientific garbage.

There is no soy estrogen link. If there were we'd be seeing an epidemic of hormone based pathologies nearly everywhere. Soy is a staple and has been for centuries and centuries.

I wonder if birth control (which spikes estrogen) has a lasting impact on levels after a mom goes off to have a child.

I'm wondering that as well, could be an unintended side effect of some forms of hormonal birth control.

There is some precedent for the opposite in biological males one hazard of androgen doping is a drop off in natural production. While a similar feedback mechanism may exist there is no guarantee.

I am uncertain what influence multiple pregnancies has on estrogen levels - let alone how comparable birth control is but that could offer a hint.

What forms of birth control spike estrogen? My understanding was that it worked by suppressing the natural estrogen spike that triggers ovulation.

Not just bpa, all plastics emit equally harmful estrogen producing chemicals as bpa per recent studies. Plastics in sun and hot water are a big no.

I’m interested in the studies. Happen to have links to them?

> However, the team cautioned that these findings cannot and should not be used to screen for autism. "We are interested in understanding autism, not preventing it," added Professor Baron-Cohen.

I don't understand why not?

One shall not see a difference as something bad.

Many autistic people have tremendously contributed to our society. The goal in this case is to develop the knowledge and tools that will help everyone use this as a strength.

Autism is a disorder that can require medical treatment. If a doctor could screen for risk factors and provide medication to pregnant women that reduced the chances of autism developing in the child, it would be their duty.

It depends on the acuity of the test imo. Autism is a spectrum. High functioning and low functioning autism are two different beasts. If they can't differentiate between high and low functioning, I agree that they should do what they can to try to prevent it. If they can predict high functioning, I think there's a real debate to be had. Especially if there are any potential risk factors with the treatment.

Absolutely not. If it were anyone's decision it should be the mother's, and I even find that questionable.

Autism isn't inherently bad, it's just different. There's no duty beyond screenings and providing the knowledge.

> Autism isn't inherently bad, it's just different.

Not true for all manifestations of it.

There are certainly forms or degrees of autism which are totally disabling.

> One shall not see a difference as something bad.

What's a "difference"? You're begging the question by implicitly redefining what would fairly be described as a challenge or handicap, depending on severity, as simply being a "difference" instead.

Inability to properly simulate the mental state of others is, by and large, a deficiency. Mental abilities that you cultivate in the place of that can be interesting, but it's not just a "difference".

If we're going to give people the right to abort, and the right to abort based on screening processes - both of which are huge moral questions in and of themselves - then it only stands to reason that we continue to give parents more power in this situation based on the information we can give them.

Since in many places you can simply abort because you just don't want the kid, which is a pretty simple reason, it stands to reason that more complicated / more concretely justified reasons would be fine also.

It's unclear which "not" you're addressing —

"should not be used to screen for autism" — They have identified a statistically-valid link between estrogen levels and autism, and are worried that parents will say "I have high estrogen levels, I'd better terminate my pregnancy and try again". Sadly, some parents will.

"not preventing [autism]" — Imagine that autism is what makes hermits (such as Merlin the Wizard) valuable to nearby towns. The towns bring the hermit food and build a house to keep them all far apart, because the hermit is incredibly strange and doesn't care about people's feelings — but also can solve any problem and always seems to be coming up with ways to make everyone's life better.

maybe because we could have a lot of bad side effects if we try to prevent something we don't understand

From the study:

> This finding appears to contradict an earlier report by Windham et al. [32] that showed that lower levels of oestriol in second trimester were modestly associated with a later diagnosis of autism in the offspring. However, our samples correspond to a slightly earlier time point in pregnancy compared to Windham et al. (mean gestational week = 14.9 vs. 17.2 respectively) (see Table 1) [32], which could potentially better capture the steroid surge during the PMW [14]. Furthermore, our samples are of different origin, as Windham et al. assayed maternal serum, rather than foetal amniotic fluid. Steroid hormone levels in maternal serum do not differ relative to the baby’s sex and do not correlate to amniotic levels during the PMW [42].

So, high levels in blood reduce the autism risk and in amniotic fluid it's the other way around? I'll wait for a replication, I think

As always, a reminder that correlation != causation. This shows an association between hormone levels and autism, which is suggestive. But keep in mind that there may be a confounding factor or factors (e.g. the same genes that control synapses that are dysfunctional in autism may be involved in hormonal regulation).

Biology is decidedly unlike good code - no modularity, many pleiotropic effects. Something more definitive would be examining pregnancies where oestrogens were artificially elevated, maybe by looking at women who were unknowingly pregnant but continued to take oestrogenic contraceptives.

We already have a lot of progress in artificial womb technology. I wonder if studies like this will push towards more research in that direction.

> High levels of oestrogens in the womb linked to autism

I wonder how this fits with the "extreme male brain theory of autism".

This makes me wonder if reducing estrogen levels in the child would make a difference in cognitive function.

So am I to understand that birth control could be responsible for autism?

I'm sure the anti-vaxxers will be happy to update their views.

There's a well established link between obese mothers and autism.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006442/

and obesity leads to higher than normal estrogen levels:

https://www.ncbi.nlm.nih.gov/pubmed/7083189/

So this may be the connection.

Your study doesn't support your summary:

> Maternal obesity (BMI ≥30) was only weakly associated with ASD risk, whereas paternal obesity was associated with an increased risk of autistic disorder and Asperger disorder.

Paternal obesity couldn't impact womb estrogen levels. There's a weak connection between maternal obesity and ASD risk in the study you linked.

What? It wasn't video games?

I thought it was vaccines.

Would be interesting to see what causes high estrogen in the studied women. My guess would be obesity, and potentially plant-based diet high in soy products.

I think the soy idea has been debunked for some time now. The main external estrogen source is milk and to some extend meat products.

Fake news! Soy has orders of magnitude more estrogen than animal products, even the hormone-implanted ones.

> The 1.9 nanograms of estrogen in implanted beef is also minuscule compared to 225 nanograms of estrogen in potatoes, 340 nanograms of estrogen in peas, 520 nanograms of estrogen in ice cream, 2,000 nanograms of estrogen in cabbage, 11,250 nanograms of estrogen in soy milk, and 170,000 nanograms of estrogen in soybean oil… all based on a 3 ounce serving size. One birth control pill contains 35,000 nanograms of estrogen.

https://newsroom.unl.edu/announce/beef/2846/15997

Not quite, because while you are talking about estrogen in beef and birth control pills (Diane 35, presumably), you are talking about phytoestrogens in soy milk & co, and specifically isoflavones.

Phytoestrogens have a similar structure to estrogen, and can thus bind to the estrogen receptors, but they have only a weak estrogenic effect (the opposite might actually happen). The effect of isoflavones, at least, has been studied [1], finding "no significant effect" on "T, SHBG, free T, or FAI" - this despite the trials featuring subjects whose "soy protein and isoflavone intake greatly exceeded typical dietary Japanese intake", which was said to range from "25 to 50 mg" in Japanese adults.

What effect isoflavones have might be debated, but that comparison remains apples to oranges. A daily dose of estrogen greater than 25 to 50 mg would definitely have an effect. Even a tenth of that would have a very noticeable effect. It doesn't, so just saying "170'000 ng per serving" tells us nothing, not when the comparison includes birth control pills.

Hell, that comparison would even remain apples to orange if you just compared animal estrogens, or those estrogens that can be found in pill form. Diane 35 contains ethinylestradiol, which is much more potent than conjugated estrogens (Premarin & co) or micronized estradiol (Estrace): while 95% of the estrogen you ingest is going to be inactivated, ethinylestradiol bypasses most of that.

Isoflavones do not, they also undergo first-pass metabolism, so the comparison is doubly flawed.

[1] https://doi.org/10.1016%2Fj.fertnstert.2009.04.038

phytoestrogen != estrogen

If this were true, all the pre-transition trans women I know would be eating a LOT more soy. Unfortunately, it's not, and can even have the opposite effect, by binding to receptors that estrogen would, preventing it from acting normally.

The idea of consuming phytoestrogen in pre-HRT transwomen is pretty widespread, in my experience. Unsure where the idea came from, but it is definitely "in the air".

> and can even have the opposite effect

This part gets omitted a distressing amount of the time, unfortunately.

Just like breast cancer

Word of warning: There's about on study per month finding the cause of autism. Unfortunately each study finds another one.

I have hemophilia, a genetically inherited X-chromosome linked disorder, inherited from the mother. Due to the fact males have an XY chromosome and mothers have two X’s, with one of the X’s containing the faulty gene, it’s possible for a mother to have children with and without the disease. In fact, there is a 50% chance each of her males will have the disorder.

Why am I telling you this? Because there is a test that can tell if the fetus has hemophilia or not by sampling blood via amniocentesis. When my mom was pregnant with my brother, she had this procedure done.

However, there were complications during pregnancy and my brother, although he was in fact born without hemophilia, has severe birth defects in his lower extremities. It was later found to be directly caused by the test itself.

Just goes to show what happens when you try to play god.

Playing god is fine if you've got the technology to back the check you're writing.

We aren't there yet, but I hope we end up surviving and maturing to the point where we can "play god" and do so ethically.

Let's get some things straight.. Did they use CVS to get the DNA sample? CVS has birth defect risks. This is not playing God, this is taking a calculated risk because you know of a 50% chance of a birth defect. It is horrible that your brother suffered unnecessarily. I am pretty sure that they can sample the mother's blood to get the DNA needed in 2019 (so no risk of birth defects).

[https://www.webmd.com/baby/chorionic-villus-sampling]

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