It has been proposed that 2D:4D ratio is affected by
fetal exposure to
sex hormones, in particular to
testosterone and other
androgens. Lower 2D:4D is found to correlate with higher prenatal androgen exposure. Therefore digit ratio could be considered a
proxy variable (indirect measure) for prenatal androgen exposure. Various studies suggest that 2D:4D is also influenced by prenatal
estrogen exposure, and that it correlates negatively, not with prenatal testosterone alone, but with the testosterone-to-estrogen ratio. Prenatal hormone exposure can be measured via
amniocentesis (usually performed between 14th and 20th weeks of pregnancy), maternal
serum sampling and
umbilical cord sampling at birth, the latter being a measure of exposure in late
gestation. A 2024
meta-analysis has suggested that digit ratio may be related to
amniotic fluid testosterone levels, but not umbilical cord levels, requiring further validation. A 2011 paper by Zhengui Zheng and Martin J. Cohn reports that "the 2D:4D ratio in mice is controlled by the balance of androgen to estrogen signaling during a narrow window of digit development". If, during this period, the fetus is exposed to androgens (levels of which are usually far higher in male than female fetuses) the growth rate of the 4th digit is increased. In a 2006 study, digit ratio analysis of opposite-sex
dizygotic twins found that the females in these pairings were born with significantly lower 2D:4D ratio, postulated to occur from exposure to excess androgens from their brothers in utero (the hormone-transfer theory). However, an attempt to replicate these findings with a larger sample of dizygotic twins (867 individuals) found no differences in the
variance or
co-variance of same-sex and opposite-sex pairings to support the theory, though it did confirm female 2D:4D to be significantly higher than male as expected. Researchers have raised concerns that, although the general trend points towards a correlation between digit ratio and early androgen exposure, many results have not been statistically significant. Various findings have also challenged the general trend. One study of 66 children that attempted to replicate the findings of a frequently cited paper on the topic Another paper also found no relationship between 2D:4D ratios and umbilical cord androgen and estrogen levels. A large meta-analysis studying genomic correlations was unable to find evidence for 2D:4D being a marker for prenatal androgen exposure, but did not exclude the possibility given constraints in genomic knowledge (with 3.8% of the variance in 2D:4D ratio accounted for genetically).
Developmental disorders Women with
congenital adrenal hyperplasia (CAH), who have elevated androgen levels before birth, have lower (more masculine) 2D:4D on average along with other possible physiological effects such as an enlarged
clitoris and shallow
vagina. Males with CAH also express lower digit ratios than
controls. indicating that males with CAH are exposed to greater prenatal concentrations of total androgens. A greater (more feminine) digit ratio occurs for men with
Klinefelter's syndrome, who have reduced testosterone secretion throughout life compared to their fathers or to controls. Men with genes that produce androgen receptors that are less sensitive to testosterone (because they have more
CAG repeats) have greater digit ratios, though there have also been reports of failure in replicating this finding. Men with less sensitive androgen receptors may compensate for this by secreting more testosterone via reduced inhibitory feedback on
gonadotropins. Thus, it is not clear that 2D:4D would be expected to correlate with CAG repeats, even if it accurately reflects prenatal androgen. XY individuals with
androgen insensitivity syndrome due to a dysfunctional gene for the androgen receptor present as women and have greater digit ratios on average, as would be predicted if androgenic hormones affect digit ratios. This finding suggests that the sex difference in digit ratios may be unrelated to the
Y chromosome per se. ==Geographic and ethnic variation==