The differences in the number of individuals with MS vs those without MS agreeing to participate likely reflected differences in the groups' schedules (participants with MS were awaiting medical appointments, while participants without MS were often just passing by the clinic). Based on their medical history obtained after enrollment, a further 8 were excluded because of diagnoses of autoimmune or endocrine diseases. Among 209 individuals without MS approached, 26 refused, 22 were ineligible based on general screening criteria (age, handedness, or prior hand trauma), and 161 were enrolled. Inclusion criteria for all men were ages 18 to 65 years, right-handedness (to reduce potential variability in the 2D:4D ratio introduced by handedness 4), and no history of trauma to the right hand.Īmong 171 patients with MS approached, 9 refused, 3 were ineligible, and 159 were enrolled. Screening procedures excluded men with MS or other autoimmune (e.g., asthma) or endocrine (e.g., Addison disease) diseases. Of all participants without MS, >95% were known to be unrelated to MS Center patients. Participants included individuals presenting to a number of medical offices or the phlebotomy laboratory in the building, postal and construction workers, janitorial and medical staff, as well as individuals (spouses, partners, friends) accompanying MS Center patients to their visits. Secondarily, in recognition that some MS risk factors may influence not only MS risk but also disease course (e.g., smoking 5, 6 and vitamin D levels 7), we explored a possible association between the 2D:4D ratio and clinical features of a more aggressive MS course.Ĭoncurrently with our recruitment of patients with MS, we recruited men from a large medical office building, which houses the MS Center. In this study, we hypothesized that the 2D:4D ratio may be increased in men with MS relative to men without MS. 4 We are not aware of published data for its association with autoimmune diseases. On the balance, this association is more clearly manifest in men. 4 This sexually dimorphic ratio can be considered as a lifelong signature of prenatal hormonal levels: a higher ratio has been shown to be associated with a lower in utero balance of androgens to estrogen. 3 The ratio of an individual's second and fourth digit lengths (2D:4D ratio) reflects digit growth, which is highly influenced by the ratio of prenatal androgen to estrogen levels. The prenatal period is increasingly understood as a period of vulnerability to subsequent inflammatory and neurologic diseases including MS. In fact, some studies have found decreased levels of testosterone in men with MS relative to healthy controls (reviewed in reference 1), as well as an association between hypogonadism and subsequent MS diagnosis. 1 In addition to chromosomal and epigenetic factors, gonadal hormones may contribute to sex-related differences in inflammation and neurodegeneration in MS. Men are less likely to develop multiple sclerosis (MS) than women, but they are more likely to display progressive forms of the disease and to develop more rapid brain atrophy.
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