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The relationship between serum testosterone level and hoffmann reflex from
the long flexor thumb muscle in right-handed young adults
Üner Tan a
a
Atatürk University, Medical Faculty, Institute of Physiology, Erzurum, Turkey

Online Publication Date: 01 January 1991

To cite this Article Tan, Üner(1991)'The relationship between serum testosterone level and hoffmann reflex from the long flexor thumb
muscle in right-handed young adults',International Journal of Neuroscience,56:1,1 — 11
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THE RELATIONSHIP BETWEEN SERUM

TESTOSTERONE LEVEL AND HOFFMANN REFLEX
FROM THE LONG FLEXOR THUMB MUSCLE IN
RIGHT-HANDED YOUNG ADULTS
UNER TAN
Atatiirk University, Medical Faculty, Institute of Physiology, Erzurum, Turkey

(Received April 20, 1990)

The relationship between serum tetosterone level and Hoffmann (H) reflex from right to left thumb flexors
was studied in right-handed young men and women. The subjects were divided into two subgroups: fast
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and slow in right-hand skill. but no difference in left-hand skill (peg moving). The mean serum testosterone
level was found to be significantly lower in subjects with fast right hand than those with slow right hand.
The mean H reflex from right was significantly smaller in subjects with fast right hand than those with slow
right hand. There was a negative, linear relationship between serum testosterone level and amplitude of
H-reflex from right thumb. This was more pronounced in females than males. The H reflex from left was
not significantly associated with serum testosterone levels. It was concluded that testosterone may affect
the somatomotor system of the left brain during adolescence impairing the right-hand skill especially in
females. These results also appear to be in accord with the testosterone theory of cerebral lateralization.

Kewords: Testosterone, H reflex, handedness, cerebrul laterulizarion, brain

There is evidence indicating that the formation of sexually dimorphic nuclei within the
hypothalamus and other structures is dependent on hormonal influences, especially
on variations in testosterone level during development (Pfaff, 1966; Raisman, 1973;
MacLusky & Naftolin, 1981; McEwen, 1981). It was also proposed that the sex
hormones, especially testosterone, may contribute to the development of an asymme-
tric brain during fetal life (Geschwind & Behan, 1982; Geshwind & Galaburda, 1985).
This hypothesis posits that testosterone slows the growth of parts of the left hemis-
phere so that the corresponding regions of the right hemisphere develop more rapidly.
Rosen et al. (1983) have studied the effects of prenatal testosterone on the tail
posture of the neonatal rats, and found that testosterone injected into pregnant
animals shifted the tail posture bias rightward, especially in female rats tested the day
after birth. This was accounted for by the influence of testosterone on the asymmetric-
ally organized nigrostriatal system in these animals.
There are reports in the literature indicating that sex hormones may be implicated
in the development of brain even at puberty. Waber (1976, 1977), for instance, found
that late maturing adolescents of both sexes were more lateralized for speech percep-
tion and exhibited better spatial skills than earlier maturing adolescents of the same
age. Moreover, Hier and Crowley (1982) suggested that the amount of androgens at
puberty may be a determinant of visual spatial ability, and hypothesized that testos-
terone has transient effects on the central nervous system. Indeed, there are more
examples in the literature about the role of androgens in cognitive brain lateralization
at puberty (Maccoby, 1966; Petersen, 1976; McGee, 1979).
I have recently reported a series of experiments performed three years ago, which
showed that serum testosterone level is associated with hand preference, hand profi-
 2 u. TAN
ciency, nonverbal intelligence and somatosensory evoked potentials in right-handed
young adults (Tan, in press a, b, c. d, and e). Testosterone was found to be related
to these variables depending especially upon sex, familial sinistrality, and hemis-
phericity. These results were in accord with the notion that androgens may be
implicated in the differential development of the brain even at puberty. The present
work presents further evidence that testosterone may be involved in spinocerebral
lateralization. To assess the spinal-motor lateralization, the Hoffmann (H) reflex was
recorded from the long flexors of the right and left thumbs. The size of the H reflex,
especially from the right thumb, was found to be negatively linearly related to serum
testosterone levels in right-handed young men and women.

METHODS

Suhjwts iincl Assessmerit of‘ Hciiiileclries.o

Subjects were male and female right-handed students ranging in age from 17 to 19
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years. They participated in the study voluntarily, and were healthy, and devoid of
neurological and psychiatric signs and symptoms.
Hand preference was assessed by the Edinburgh Handedness Inventory (Oldfeld,
1971). A laterality score was obtained from this questionaire, which was called the
Geschwind score (GS,see Tan, 1988).This study comprised the right-handers without
familial sinistrality.
Hand skill was assessed by a peg moving task (Kilshaw & Annett, 1983; see also
Tan, 1985). The peg board consisted of two parallel rows of 25 holes with 25
loose-fitting dowelling pegs in one row. The subjects were required to insert 25 pegs
into the corresponding opposite holes as fast a s possihlc. Pegs were moved from right
to left with the right hand and then from left to right with the left hand. The time
elapsed for the right and left hand was accurately measured by an electronic device.
One trial consisted of the time elapsed to move 25 pegs with one hand. Ten trials were
given to each hand, and the mean peg moving lime was calculated for each hand.

Hornion AS.SLIJ’
Venous blood was taken into a lithium test tube, and plasma separated. Serum
testostrone level was dctermined by using tritium-marked radio-imniunoassays
(Nieschlag & Loriaux, 1972).

IIoffrmni Rcfk.u
The method used to record H reilex from long flexor muscle of the thumb was
described elsewhere (Tan, I989a). The recording electrode (active) was placed over the
belly of the flexor pollicis longus muscle and the reference electrode over the proximal
phalanx of the thumb. Square pulses of 0.2 ms duration were applied to the median
ncrve at the wrist at l/s frequency. The cathode was proximal to anode. The stimulus
intensity was just at the threshold for motor fibers of the median nerve, to create the
same stimulus conditions for both hands.
To elicit the H reflex, the subject was instructed to press the ball of the thumb
against a flat circular brass disk attached to an isometric force transducer. The force
exerted by the subject’s thumb was made visible on a digital voltmeter connected to
 TESTOSTERONE AND H REFLEX 3

the force transducer. A minimal force usually eliciting a threshold H reflex (1 .OT) was
kept constant for all subjects and for both hands.
EMG signals were averaged over 8 trials, while the subject exerted a constant force
on the strain gauge at I.OT (3mA). Following a resting period of one minute, the
subject was asked to increase this force to double (6 mA), and the asme procedure was
repeated under the same stimulus conditions. The H responses were also recorded at
3.OT and 4.OT forces. The latency of the H reflex was measured by the cursor of the
oscilloscope. The reflex responses were plotted by a plotter connected to the oscil-
loscope. The peak-to-peak amplitudes of the H reflexes were measured by calipers on
the paper; the metric values were converted to valtages (mV).

RESULTS

Testosterone, Hand Skill, and H Reflex

The subjects were divided into two subgroups as fast and slow right-handers accord-
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ing to their peg moving times. In the males subjects with a fast right hand, the mean
peg moving times for the right and left hands were found to be 29.1 s (SD = 2.2) and
32.3 s (SD = 2.4), respectively. In the male subjects with a slow right hand, the mean
peg moving times for the right and left hands were found to be 31 .O s (SD = 2.6) and
32.9 s (SD = 2.5). respectively.
Figure la shows the mean testosterone, and reflex amplitudes in these two sub-
groups of the male subjects. The mean serum testosterone levels of these two sub-
groups were significantly different from each other. The mean serum testosterone level
was found to be 522.9ng/dL (SD = 92.8) and 984.0ng/dL (SD = 202.4) for the
subgroups with fast and slow right hands, respectively. The mean reflex amplitudes
from the right side were found to be I .7 mV (SD = 0.9) and 4.6 mV (SD = 1.8) for
the subjects with fast and slow right hands, respectively. The mean reflex amplitude
from the left side was also higher in the subjects with slow right hand (3.9mV,
SD = 2.4) than the subjects with fast right hand (2.4mV, SD = 1.8), but the differ-
ence did not reach the 5 % significance level.
The female subjects were found to be faster in hand skill than the male subjects. The
mean peg moving times for the right and left hands were found to be 26.5s
(SD = 0.9) and 30.3 s (SD = 1.2) for women with fast right hand. The mean peg
moving times for the right and left hands were found to be 28.1 s (SD = 1.8) and
30.9s (SD = 1.7) for women with slow right hand.
Figure IB shows the mean testosterone and reflex amplitudes in these two sub-
groups of the female subjects. The mean serum testosterone levels were found to be
23.6ng/dL (SD = 9.3) and 72.6ng/dL (sD = 12.1) for the subjects with fast and
slow right hands, respectively. The mean reflex amplitudes from the right side were
found to be 3.6 mV (SD = 2.2) and 6.0 mV (SD = 3.1) in the subjects with fast and
slow right hands, respectively. The mean reflex amplitudes form the left side were
2.9 mV (SD = 1.2) and 4.2 mV (SD = 2.6) for the subjects with fast and slow right
hands, respectively.

Relation of Testosterone to H Reflex

Figure 2 shows the relationship between serum testosterone levels and H-reflex
amplitude in male and female subjects with a moderate reflex facilitation induced by
a rather slight force (9mA) applied to the transducer (see methods). Figure 2A
 4 U. TAN

A. MALE SUBJECTS
12
I3 Fm

?
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R-=EX L-RENX

B. FEMALE SUBJECTS
10
FAST

FIGURE I Mean tcstosterone and H reflex amplitudes in male and females subjects with fast and slow
right hand in pcg moving

presents the data from male subjects ( N = 12). In males with fast right hand ( N = 7),
there was no significant correlation ( r = - .04) between testosterone and reflex
amplitude from right side (squares, dashed line). In males with slow right hand
( N = 3,there was a negative linear correlation between testosterone and H reflex
from the right side (crosses, straight line), but the correlation did not reach the 5%
significance level (Y = - .65, df = 3, p > .05). However, 42% of variations in Y
 TESTOSTERONE A N D H REFLEX 5

A. MALE SUBJECTS
16

a
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SERUM TESTOSTERONE L M L (ng/dL)

8. FEMALE SUBJECTS
16

T
W
E
x l2
w
?i
w
U
I
LLa
0
W

;
3
n 4
a
0
0 m 4.0 Bo CID loo
SERUM TESTOSTERONE LEVEL (ng/dL)
FIGURE 2 The relationship between H reflex and serum testosterone level in right-handed men and
women who applied a slight force (9mA) to the transducer Abscissa: serum testosterone level (ng/dL)
Ordinate: amplitude of H reflex (mV). A. Men; squares, dashed line: subjects with fast right hand
(Y = 1.66); crosses, straight line: subjects with slow right hand (Y = 1.66); crosses, straight line: subjects
with slow right hand (Y = 14.4 - 0.01X); triangles, dotted line: subjects with fast left hand (Y = 2.4);
# , interrupted line: subjects with slow left hand ( Y = 3.9). B. Women; squares, dashed line: subjects with
fast right hand (Y = 7.9 - .2X); crosses, straight line: subjects with slow right hand (Y = 20.5 - 0.2X);
triangles, dotted line: subjects with f i a t left hand (Y = 4.6 - 0.1X); #,interrupted line: subjects with slow
lzft hand (Y = 7.1 - 0.04X).
 6 u. TAN
could be explained by x (CD% = 42). There was also no correlation between H reflex
from thc left side and testosterone in men with fast (triangles, dotted line) and slow
( # , interrupted line) right hand.
Figure 2B shows the relationship between serum testosterone and H-reflex am-
plitude in female subjects ( N = 14). In females with fast right hand, the H-reflex
amplitude from right side was found to be negatively linearly related to serum
testosterone (squares, dashed line). The correlation was found to be significant
(r = - .86, df = 3, p < .05, C D % = 73.2). In females with slow right hand, the
H-reflex size was also found to be negatively linearly related to serum testosterone
(crosses, straight line); the correlation was highly significant r = - .83, 4f’ = 7,
p < .01, C D % = 69.1).
In females with fast right hand, the H-reflex amplitude from the left side was found
to be negatively linearly related to serum testosterone (triangles, dotted line), but the
correlation did not reach 5% significance level ( r = - .63, df = 3, p > .05,
CD% = 39.4). In females with slow right hand, there was no significant correlation
between serum testosterone and the amplitude of the H reflex from left side ( # ,
interrupted line; r = - .20, df = 7, p > .05, C D % = 4. I).
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Figure 3 shows the relationship between testosterone and H reflex in male (A) and
female (B) subjects as above, but the force (12mA) applied to the transducer was
higher than that in Figure 2, so that larger reflex responses could be produced. In
males with fast right hand, the amplitude of the H reflex from the right thumb was
found to be negatively linearly related to testosterone (squares, dashed line), but the
correlation was only marginally significant, probably because of small sample size
( r = - -75, 4f’ = 5 , p = .05, CDYO = 56.1). In males with slow right hand, there
was also a negative linear correlation between testosterone and H reflex from the right
thumb (crosses, straight line), but the correlation did not reach the 5% significance
level ( r = - .8 I , Itf = 3, p > .05, CD% = 66.1). There was no correlation between
the H reflex from the left side and testosterone in males with fast (triangles, dotted
line; r = .05) and slow ( # . interrupted line; r = .01) right hand.
In females (Figure 3B) with fast right hand; there was a negative linear correlation
between the H reflex from right and testosterone (squares, dashed line), but the
correlation did not reach the 5% significance level ( r = - 85, 4f’ = 3,
.I0 > p > .05, CD% = 72.6). In females with slow right hand, the H reflex from
right was found to be negatively linearly related to testosterone (crosses, straight line);
the correlation was significant ( r = - .86, 4f = 7, p < .01, C D % = 74.2). In sub-
jects with fast right hand, there was no significant correlation between testosterone
and H reflex from left side (triangles, dotted line; r = - .75, df = 3, p > .05,
CD% = 56.2). In subjects with slow right hand, there was no significant correlation
between testosterone and H reflex from left ( # , interrupted line; r = - .54, 4f’ = 7,
p > .05, CD% = 29.5).

Forcc-Rqfii.x Relatioriships in Right-Handers with Fast and Slow Right-Hund

Figure 4 shows the relationship between force applied to the transducer by the thumb
and H-reflex amplitude in male (A) and female (B) subjects. There was always an
exact positive-linear correlation between force and the amplitude of the H reflex. In
males, the regression lines for the fast (squares, dashed line) and slow (triangles,
dotted line) right hands had about the same slopes, but there was a large difference
between their intercepts. This indicates that supraspinal facilitation for the subjects
with fast and slow right hands are the same, but the subjects with slow right hand have
larger reflexes than those with fast right hand in peg moving. The slopes of the
 TESTOSTERONE A N D H REFLEX 7

A. MALE SUBJECTS
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SERUM TESTOSTERONE L M L {ng/dL)

8. FEMALE SUBJECTS

0 m 40 80 80 100
SERUM TESTOSTERONE L M L (ng/dL)

FIGURE 3 Relation of serum teslosterone to H reflex in right-handed men and women who applied a
strong force (12 mA) to the transducer Abscissa: serum testosterone level (ng/dL) Ordinate: amplitude of
€1 reflex (niv). A. men; squares. dashed line: subjects with fast right hand ( Y = 14.3 ~ 0.02X); crosses,
straight line: subjects with slow right hand (Y = 15.0 - 0.01X); triangles, dotted line: subjects with fast
left hand (Y = 4.6); # , interrupted line: subjects with slow left hand (Y = 5.6). B. Women: squares.
dashed line: subjects with fast right hand (Y = 12.6 - 0.3X):crosses. straight line: subjects with slow right
hand (Y = 29.4 - 0.3X); triangles, dotted line: subjects with fast left hand (Y = 7.1 - 0.IX); # ,
interrupted line: subjects with slow left hand (Y = 17.1 - 0.2X).
 8 a. TAN
regression lines for the left hands of the subjects with fast (crosses, straight line) and
slow ( # , interrupted line) right hand in skill were found to be about the same. Their
slopes were also not significantly different from each other.
In female subjects (B), there was also a nearly perfect positive linear correlation
between force and reflex size. The supraspinal facilitation of the H reflex from right
was found to be slightly higher in subjects with slow right hand (squares, dashed line)
than those with fast right hand (triangles, dotted line). The main difference was,
however, that the reflexes from right was significantly larger in subjects with slow right
hand than those with fast right hand. The reflexes from left were about the same size

A. MALE SUBJECTS
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6 9 12 15
Force (mA)

B. FEMALE SUBJECTS
 TESTOSTERONE A N D H REFLEX 9

in subjects with fast (crosses, straight line) and slow ( # , interrupted line) right hand.
Interestingly, only the reflexes from right made the difference between subjects with
fast and slow right hands in peg moving.

DISCUSSION

Testosterone, Hand Skill, and H Reflex

The male and female subjects were studied in two groups in this work. The subjects
in the first group had fast right hands, and the second group had a slow right hand
in peg moving. The left hands of these subjects did not differ in skill. This indicates
that the subjects with fast right hand had larger left minus right times than the subjects
with slow right hand in peg moving. Interestingly, the mean serum testosterone level
was found to be higher in subjects with slow right hand than those with fast right
hand. These results suggest that testosterone is associated with right-hand (left
hemisphere) skill, decreasing the left hemispheric motor performance toward the right
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hemispheric motor performance, and creating a more symmetrical brain as compared

to the subjects with fast right hand. These results and this interpretation are in
accordance with the testosterone theory of cerebral lateralization (Geschwind &
Behan, 1982; Geschwind & Galaburda, 1985). This theory posits that testosterone in
fetal life slows the growth of parts of the left hemisphere so that the corresponding
regions on the right side develop relatively more rapidly, creating nonright-handed-
ness especially in men. The results of the present work suggest that testostrone may
affect brain development even at puberty; the main program would be created during
fetal life. There are reports in the literature (see introduction) supporting the notion
that testosterone may play a role in the late development of the brain during puberty
at least with regard to cognitive systems.
It was also shown in the present work that the mean H reflex especially from right
was significantly larger in subjects with slow right hand than those with fast right
hand. That is, high testosterone levels in subjects with slow right hand are associated
with large H reflexes. This also indicates that there would be a negative correlation
between hand skill and H-reflex size under testosterone. In accordance with this
conclusion, I have recently reported that there is a negative linear correlation between
hand skill and the amplitude of the H reflex from wrist and thumb flexors (Tan, 1989a,
b).

FIGURE 4 Force-reflex curves for the male and female subjects with fast and slow right hand in peg
moving Abscissa: force applied to the transducer to facilitate H reflex Ordinate: amplitude of H reflex (mV).
A. male subjects; squares, dashed line: the mean amplitude of the H reflex form right in subjects with fast
right hand (Y = 1.4 + 0.4X, r = .99, cif = 3, p < ,001, C D % = 97.9); Crosses, straight line: H reflex
from left in subjects with fast right hand (Y = - I .4 + 0.5X, r = .99, Ir/ = 3 , p < ,001, C D % = 97.7);
triangles, dotted line: H reflex from right in subjects with slow right hand (Y = 0.4 + .4X, r = 1.0,
d/ = 3, p < ,001, C D % = 99.1); #, interrupted line: H reflex from left in subjects with slow left hand
(Y = -0.5 + 0.5X, r = .99, d/ = 3, p < ,001, CDYO = 98.4). B. Females; squares, dashed line: H
reflex from right in subjects with fast right hand (Y = -2.2 = 0.7X, r = .99, df = 2, p < . O l ,
CD% = 98.6); crosses, straight line: H reflex from left in subjects with fast right hand
(Y = -0.8 + 0.5X, r = .99, df' = 2, p < .01, CD0h = 97.8); triangles, dotted line: H reflex from right
in subjects with slow right hand (Y = -0.1 + 0.7X, r = .99, df = 2, p < .01, C D % = 98.8); # ,
interrupted line: H reflex from left in subjects with slow right hand (Y = - 0.9 + 0.6X, r = I .OO, df = 2,
p < .01, C D % = 99.3).
 10 ti. TAN
Association Bt>twrm Testosterone and H Reflex
The H reflex-size from right side was found to be negatively linearly related to serum
testosterone levels especially in subjects with slow right hand (small difference bet-
ween left minus right hand skill). The H reflex from left side did not show any
significant correlation with testosterone. Moreover, there was a sex-related difference
in association of testosterone to H reflex. The amplitude of the H reflex from right side
was found to be significantly correlated with serum testosterone levels only in female
subjects especially with slow right hand. The negative linear correlation between
testosterone and H reflex from the right appears to be in accord with the testosterone-
theory of cerebral lateralization (Geschwind & Behan, 1982), since the H reflex
recorded from the right thumb by supraspinal facilitation from left hemisphere is
predominantly under left hemispheric control which is proposed to be affected by
testosterone.
Geschwind and Behan (1982) argued that, during fetal life, males would be especi-
ally vulnerable to testosterone effects because males have more testosterone than
remales, which would be the cause of a higher incidence of left-handedness among
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males. The present work, however, showed that the negative correlation between
testosterone and H reflex from the right hand was much more pronounced in females
than males. In accordance with this result, Rosen et ul. (1983) have reported that
testosterone injected into pregnant animals shifted the tail posture bias rightward,
especially in female rats tested the day after birth. I have previously reported that the
degree of the right-hand preference is negatively linearly related to serum testosterone
levels especially in right-handed young women, not in men, except those with familial
sinistrality (Tan, in press a). This also supports the results of the present work.

Force-Reflex Relationship
There was almost a pcrfect positive correlation between the degree of supraspinal
facilitation and the amplitude of the H reflex (see Figure 4), which was about the same
in subjects with fast and slow right hands. However, the H reflex from right side was
found to be especially significantly larger in subjects with slow right hand than those
with fast right hand. The H reflex from left hand did not make any difference in
subjects with fast and slow right hands. These results were also more pronounced in
females than males exerting less asymmetry than females. Here again, the large H
reflex from the right hand seems to be associated with impaired right-hand skill and
high testosterone.

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