Which of the following statements regarding androgens and estrogens in the fetus are true?

b. A female with congenital adrenal hyperplasia is likely to be masculinized in appearance

c. The development of normal male external genitalia requires adrenal androgen production

Adrenal androgens in the fetus stimulate wolffian duct development and elongate the genital tubercle. They promote midline migration of the labial folds and fusion of these folds to form the scrotum. To complete the male transformation, the urethral opening migrates to the tip of the phallus. All of these events are androgen-dependent. Since the normal female fetus does not secrete androgens, the genital tubercle, labial folds, and urethral opening all remain in the female position in this circumstance. Thus the female phenotype is associated with the absence of fetal sex hormone production. Excess androgen in the female fetus causes neonatal virilization, as is seen with congenital adrenal hyperplasia. The male infant with congenital adrenal hyperplasia is likely to have a normal appearance of the external genitalia as a neonate. Precocious puberty will develop over a period of years in this latter circumstance.