PerceptuaZand~UotovSkzlls,2008, 107,3-13.

O Perceptual and Motor Skills 2008

RATIO O F FOURTH T O SECOND FINGERTIP EXTENSIONS

IN RELATION T O SERUM ESTRADIOL AND
TESTOSTERONE LEVELS IN ApIEN AND \7CTOhIEN1

UNEK TAN

Sz~7rzmal-;.-Sex differences in second (2D) and fourth (4D) fingertip extensions

relative to the iniddle fingertip and 4D:2D fingertip extension ratios were studied in
men and women. Body height positively corrclatcd with index fingertip extensions, not
with ring fingertip extensions; nor with their ratio. Mean 2D extension (both hands)
was smaller in women than men: mean 4D extension (right hand) was smaller in mcn
than women: 4D:2D fingertip extension ratios from both hands were larger in women
than men. Serum estradiol concentration negatively correlated with 2D extensions for
both hands (no significant correlation with 4D extensions), but positively correlated
with 4D:2D extensioll ratios for both hands. Serum testosterone concentration posi-
tively correlated with 2D extensions of both hands (no significant correlation with 3D
extension); but negatively correlated with 4D:2I) extension ratios for both hands.
These relations were also studied in men and women separately. It was concluded that
the 4D:2D extension ratio was greattr in women than in men; 2D and 4D extensions
and 4D:2D extension ratios nyay be determined prenatally by sex hormones; finpertip
extensions may be predictive of adult and prenatal sex hormone le\:els.

Research on linger-length patterns, i.e., ratio of the index to the ring

finger length (2D:4D), essentially started with a leading article from Man-
ning, Scutt, Wilson, and Lewis-Jones (1998) and is acculnulating nearly in
every aspect of life sciences. There are reports suggesting associations of
2D:4D ratios to sex, prenatal sex hormone lelels, ethnicity, psychological
traits (cognition and personality), fertility, heart disease, obesity, psychologi-
cal disorders (autism, depression, schizophrenia), sports, physical abilities,
sexual orientation (heterosexual men and women, lesbians, gays, transsexu-
als), immunitl, human development, and growth (see hIannlng, 2002). Be-
fore being attributed a universal indicator, the finger-length patterns were
reported much earlier by Baker (1888), George (1930), hlinami (1952), and
Legay and Heizmann (1967). However, the historically earliest reports (e.g.,
Ecker, 1875: Baker, 1888) were on the distal extents of fingertips relatire to
the middle fingertip, contrary to the now commonly used Manning method
of measuring the finger lengths from the most proximal to the most distal
ends of the fingers.
Peters, Tan, Kang, Teixeira, and Mandal (2002) used the original meth-

-Address correspondence to Prof. Dr. Uner Tan, Cukurova University, Faculty of Arts and
Sciences, 01330 Adana, Turkey or e-mail (unertan37@yahoo.con1).
od, measuring the fingertip extensions, to study the sex-specific finger-
length patterns in various human populations. The results seemed to be con-
sistent with expected sexual dimorphism in the 2D:4D digit ratio reported
by many authors studying finger-length patterns (e.g., hIanning, et nl., 1998;
Tester & Campbell, 2007: Voracek, Reimer, Ertl, & Dressler, 2006; Voracek
& Dressler. 2007). The diflerence in the lengths of the distal extents be-
tween index and ring fingers, relative to the middle fingertip, is smaller in fe-
males than in males, suggesting nearl) equal-length index and ring fingers in
females as compared to males with longer ring than index fingers.
The importance of the theory of sexually dimorphic 2D:4D digit ratio is
the supposed prenatal origin of this trait: high prenatal testosterone and lo^
estrogen (lour 2D:4D ratio) may be responsible for the male pattern, while
low prenatal testosterone and high estrogen may be responsible for the fe-
male pattern. Accordingly, Manning. et al. (1998) have shoxrn in adults that
the 2D:4D ratio is negatively correlated with serum testosterone concentra-
tions and positively correlated with serum estrogen concentrations, suggest-
ing that men with lour 2D:4D ratios would ha\e had more testosterone and
less estrogen prenatally than men with high ratios. These authors did not
clarify if they measured the free or total testosterone concentrations. On the
other hand, the 2D:3D ratio was positively correlated with serum estrogen
levels in \\-omen, suggesting that women with high digit ratios u~ouldhave
had more estrogen prenatal13 than women with low digit ratios.
It was argued that the above results in adults would reflect prenatal hor-
mone levels, since digit ratios are determined prenatally by about the 13th
week (Phelps, 1952; Garn, Burdi, Babler, & Stinson. 1975). If adult sex hor-
mone levels are correlated with phjsical traits such as digit ratios, then
another sex hormone-dependent trait, body height, should also be related to
digit ratios in adults. However, there are inconsistent reports on this rarely
studied subject. For instance. Manning, et nl. (1998) could not find any sig-
nificant relationship between height and digit ratios, similar to Fink, Neave,
and Manning (2003) and Neave, Laing, Fink, and Manning (2003). How-
ever, Tester and Campbell (2007) reported a significant negatir-e correlation
between height and digit ratio ( r = -.25, p < .05).
Distal fingertip extensions relative to the middle finger were measured
in the present study instead of the whole finger lengths, since there is a tiny
sex difference in the digit length ratio (usually 0.98 mm in males and 0.99
mm in females), about .25 standard deviations (see Honekopp. Bartholdt,
Beier, & Liebert, 2007). Such a small difference uould be vulnerable to
many factors and easily disappear from sample to sample depending upon
too many factors. For instance, there was no significant sex difference in
2D:dD digit ratios in 300 English adults (Manning, Barley, KTalton, Lewis-
Jones, Trivers, Singh, et nl., 2000). Similarly, there are indeed a number of
 FINGERTIP EXTEKSIONS AND HORTTIONE LEVELS 5

other null findings in the scientific literature (see Putz, Gaulin, Sporter, &
hlcBurnley, 2004). Therefore, replication is desirable. Null results are gener-
ally not published, for example, an earlier attempt to study the sexual di-
morphism in 2D:4D ratios of some Turkish samples (Tan & Okuyan, un-
published observations). In contrast, Peters, et al. (2002), measuring distal
fingertip-extension patterns, found larger sex differences than had been
observed for digit ratios. For these reasons, the method of measuring the
finger extensions relative to middle fingertip was used in the present study.
Body height, another hormonally influenced and sexually dinlorphic physical
trait, as well as serum estradiol and free testosterone concentrations, were
studied in relation to fingertip extensions, to study the proposed hormonal
correlates of sexuallj7 dimorphic finger-length patterns considering the rela-
tion of adult sex hormone concentrations to prenatal sex hormone levels (see
Jamison, hleier, & Campbell, 1993). Folloxving these considerations, it was
expected that: ( I ) a greater sex difference urould be found using measure-
ments of fingertip extensions relathe to middle fingertip than has been
previously reported; ( 2 ) body height would be a significant predictor of fin-
gertip extensions; (3) lengths of fingertip extensions and 4D:2D extension
ratios would be significant predictors of adult sex hormone concentrations.
~~ETHOD
The participants (264 women, 214 men) were Turkish university stu-
dents urho voluntarily participated in the study. Ages ranged from 20 to 22
bears. The extensions of the index i2nd) and ring (4th) fingertips relative to
the middle fingertip were measured using the apparatus originally built by
George (1930) and rebuilt in Pvlichael Peters' laboratories (see Peters, et al.,
2002). The participants were asked to place their palms flat on a surface and
to bring the tip of the middle finger into gentle contact ~ i t ah fixed vertical
block. There were parallel sliders on the right and left sides. The assistant
moved these sliders until their vertical surfaces came into gentle contact with
the tips of the index and ring fingers, so that the extensions of the 2nd and
4th fingertips relative to the middle fingertip could be measured in 0.5-mm
steps. Using this method, the distances (extensions) between the tip of the
middle finger and the tips of the index and ring fingers can be accurately
measured. The reliabilities of measurements from the same investigator wcre
assessed using the intraclass correlation coefficient routine (ICCs, two-way
mixed effects model with absolute agreement definition) in SPSS Version
12. The ICCs (X=21) were found to be .94 and .99 for the 4D:2D exten-
sion ratios from the right and left hands, respectively (right hand, F,,=
27.07, p < .001; left hand, F,, = 129.3, p < .0001). Sex differences in fingertip
extension ratios were also assessed with effect size (q2),Body height was re-
corded in cm with 1-mm accuracy.
 The fingertip extension ratio 4D:2D was analyzed in the present study
instead of the ratio 2D:ID in analysis of finger-length patterns, to make the
results more consistent with studies related to finger-length patterns. Peters,
Mackenzie, and Bryden (2002) have also used the fingertip extension ratio
4D:2D in their study related to fingertip measurements.
To assess the serum testosterone and estrogen concentrations, intrave-
nous blood samples were taken between 10:OO and 14:00, when the fingertip
extensions were measured. After collecting the blood sample, the blood mias
stored at -IO°C. Serum concentrations of free testosterone and estradiol were
measured by radioimmunoassay using commercial kits (Diagnostic Systems
Laboratories, Webster, TX, USA).

Index Finger ( 2 0 )
Sex diffeere?zces.-The mean index fingertip extensions relative to the
middle fingertips of the right and left hands were significantly greater in
males than in females (see Table 1). Sex had a significant main effect on the
dependent variables, right and left index fingertip extensions (F,,4,1 = 60.3 1,
p < .OOOI; q2= 20). The sex difference was more pronounced for the right
hand than the left hand, namely, the mean difference between the index fin-
gertip extensions of males and females was found to be 2.7 mm (SE=0.2)
for the right hand, and 1.5 mm (SE=O.3) for the left hand. The mean index
fingertip extension for the right hand was significantly greater in males than

TABLE I
EXTENSIONS
(MM) OF SECOND AYD FOURTH FINGERTIPS RELATIVE TO
MIDDLEFIUGFRTIPS ~214) AND F E M ~ L (n
I N 'CIA1F 5 ( t = E S= 264)
-
-
F~npertloExtensron Sex 11.1 SD F D rlz

Female 9.1
Male 11.8
Female 9.2
Male 8.9
Female 1.1
Male 0.8
Left Hand
2D Female 10.i
Male 12.1
Female 8.7
Male 9.3
Fernale 0.9
Male 0.8
-... -
A\iotr.-2D = index fingertip extension; 4D = ring fingertip extension; 4D:ZD = ratio of ring to
index fingertip extensions.
 FINGERTIP EXTENSIONS AND HORMONE LEVELS 7

in females (F,,,,= 118.69, p < .OOOI; q 2 =.20), similar to the left hand for
which there was a smaller effect size (F,,,,=31.44, p < .0001; q 2 =.06). Since
there was a significant positive correlation between the index fingertip ex-
tensions and the body height (see Table Z), the ratios of the lingertip exten-
sons to body heights were used instead of the raw measurements. Using this
procedure yielded essentially similar results, showing significantly less extend-
ed index fingertips in females than in males (F,,,,~ 5 . 2 8 p. < .01; q2= .08).
However, the mean differences between males' and females' fingertip exten-
sions were almost equal for the right and left hands, 0.009 mm (SE= 0.003)
for the right hand and 0.009 m n ~(SE=O.O03) for the left hand. So the inore
pronounced sex difference in the right hand was due to the effect of body
height.
Estradzol and testosterone.-Serutn estradiol concentration showed a
negative correlation with the index fingertip extensions of the right and left
hands in women (see Table 3). This suggests that high serum estradiol levels
may be related to smaller index fingertip extensions from the right and left
hands of females (see Table I). On the other hand, serum estradiol concen-
trations had a positive correlat~onwith index fingertip extensions in men
(see Table 3).
In comparison to estradiol, serum testosterone levels were found to be
positively correlated with the index fingertip extensions of the right and left
hands of both women and men (see Table 3). Higher testosterone concen-
trations were associated with larger index fingertip extensions and lo\r tcstos-
terone with smaller fingertip extensions.
In the total sample (see Table 3), the serum estradiol concentration was
negatively correlated with the index fingertip extensions of the right and left
hands, while serum testosterone concentration positively correlated with the
index fingertip extensions of the right and left hands. That is, higher estra-
diol levels were associated with lower index fingertip extensions as in the
sample of women; lower estradiol levels were associated with greater index
fingertip extensions, as in the sample of men.
Rzng Fznger (40)
Sex dzffrences.-The fingertip extensions of the ring fingers for the
right and left hands mere not significantly correlated with body height, as
contrasted to the positive correlations for the index fingers (see Table 2).
Sex had a main effect on ring fingertip extensions (I;,-,,= 6.3 1, p < .005;
q 2 =.02), however, onl) for the left hand ( F,,,, = 6.03, p < .05; q2= .01) and
not for the right hand ( F ,,,,=2.45, p > .lo; q2= .00). Controlling for helght
changed these results: sex had a significant effect on the ring fingertip exten-
sion of the right hand (F,,, =3.94, p < .O5; q Z =.03), the estimated marginal
means being 9.4 mm (SE= 0.4) for females and 8.1 mm (SE= 0.3) for males.
Sex had no significant effect on the fingertip extensions of the left hand
(F,,,, =3.04, p > .Oj: q2= .03), the estimated marginal ineans being 10.4 mm
( S E = 0.45) for females and 9.3 mm ( S E = 0.35) for males. These results indi-
cate that there were different ring fingertip extension patterns in males and
females.

TABLE 2
PEARSON
<~ORREI..ATION
COEFFICIENTS
FORHEIGHIAND FINGERTIP ( i =~ 161)
EXTESSIOKS
--
---- ~ .- --
--
Trait Height -
-
Right Hand Left Hand
-- .- ~p
2D 4D 2D 4D
Height .31t .11 .1O+ .03
Right Hand
2D .33t -3Of .4lt .II
4D .11 -.jot .02 .26f
Left Hand
2D .30t .41i .02 -.26i-
4D .04 .11 ,261. -.26t
R H 4D:2D -. 01 -,rot .Sot -.19t .11
L H 4D:2D 19" -.16"' .U7 -.i/t --
,707
--... ..- - - -

Note.-2D = index fingertip extension; 4D = ring fingertip extension; 4D:2D = ratio of ring to
index fingertip extensions. "p< .05. t p < .01.

Estradzol and testostero;lze.-Serum estradiol concentrations did not show

any significant correlations with the ring fingertip evtensions of the right and
left hands of women (see Table 3). Serum estradiol concentration was found
to be positively related to the right-hand ring fingertip extension in men,
but not the left-hand ring fingertip extension (see Table 3). So serum estra-
diol concentration was associated only with the right hand and only in men,
suggesting an association of higher estradiol level with greater ring fingertip
extension in men, and shorter ring fingertip extension with loa~erestradiol
concentrations.
Serum testosterone level did not show any significant correlation with
the ring fingertip extensions from the right or left hands in men (see Table
31, while there was a negative correlation between serum testosterone levels
and ring fingertip extensions in women, i.e., higher testosterone levels were
associated with longer ring fingers in women. In the total sample (see Table
j),neither serum estradiol concentration nor serum testosterone concentra-
tion sho\ved a significant relation to ring fingertip extensions from the right
or left hands.
4D:2D Fifqgertip Extension Ratio
Sex dzfferences.-Sex had a significant inain effect on the 1D:2D finger-
tip extension ratio (F,,,, =25.28, p < .OOOl; q 2 =.lo). Tests of between-subjects
effects indicated that the sex difference was valid on11 for the right hand
 Drscussro~
Fingertip extensions were found to be positivelj correlated with body
height, a genetically and hormoilally determined trait, but only for the index
fingertip extensions and not the ring fingertip extensions of the right and
left hands. This result suggests an asymmetrical developmental effect of some
genes (HOXA, HOXD) and/or sex hormones (estrogen, testosterone) on the
differential development of the single fingertip extensions. These Homeobox
(Hox) genes are indeed involved in the zn utetw development of the urogeni-
tal system and fingers (Kondo, Zakany, Innis, & Duboule. 1997; Zakany &
Duboule, 1999). On the other hand, the genes controlling fingers and toes
may indeed influence the development of single fingers separately (see Davis
& Capecchi, 1996; Zakanj~& Duboule, 1999). It was also found in the pres-
ent work that adult serum estradiol concentration correlated negatively with
the fingertip extensions of the index fingers of the right and left hands, with
no significant relation to the ring fingertip extensions of the right and left
hands in the total sample. Serum testosterone levels also showed differential
relations with fingertip extensions, being positively correlated with Index fin-
gertip extensions of the right and left hands, and having no significant corre-
lation with the ring fingertip extensions (see Table 3 1. These results support
the hypothesis that sex hormones may differentiall) influence the develop-
ment of the finger-length patterns.
Index finger^.-The mean fingertip extensions of the index fingers of
the right and left hands were significantly greater in women than in men
(see Table 1). This sex difference was more accentuated for the right hand
than the left hand. After controlling for height, this right-left difference dis-
appeared, and the longer index fingertip extension in women than in men
were found for both hands. The sex difference in index fingertip extension
nlay contribute to the generally observed lower 2D:4D finger length ratio in
men than in women.
In the total sample, the right and left index fingertip extensions relawe
to the rniddle fiilgers showed negative correlations with the serum estradiol
concentrations. Serum testosterone cor~centratlonsshowed positive correla-
tions with the index fingertip extensions of the right and left hands. In other
words, lower estradiol and higher testosterone levels may play a role in rela-
tively shorter ring fingertip extension and longer index fingertip estension in
men, compared to women.
Concerning men and women separately, the serum estradiol concentra-
tions were negatively correlated with the index fingertip extensions in wom-
en, but positively correlated in men (see Table 3). Contrary to estradiol, tes-
tosterone showed positive correlations with the index fingertip extensions oi
the right and left hands in men and women. Thus, serum estradiol levels in
adults may be associated with greater index fingertip extension in both
sexes.
 FINGERTIP EXTENSIONS AND HOFWONE LEVELS 11

Rifzg fi?zgers.--Males had a significantly shorter ring fingertip extension

than females, but only for the left hand, not the right hand, which was sta-
tistically not significant in males and females. After controlling for height,
there was a sex difference in the mean ring fingertip extensions, but only for
the right hand, not for the left hand. Namely, the mean ring fingertip exten-
sion was significantly less in males than in females for the right hand.
In the total sample, neither testosterone nor estradiol levels were found
to be significantly related to the ring fingertip extensions of the right and
left hands (see Table 3). This result suggests a nonhormonal determination
of the sex difference in the ring fingertip extension of the right hand. If men
and women were analyzed separately, significant relations of sex hormones
to ring fingertip extensions were discovered: the serum estradiol concentra-
tions were not significantly related to ring fingertip extensions of the right
and left hands in women (see Table 3). The serum estradiol concentrations
were positively correlated with ring fingertip extensions of the right hand of
men, but not the left hand. So the serum estradiol level seems to be associ-
ated only with the ring fingertip extension of the right hand in men. A high
estradiol level in men would be associated with the ring fingertip extension,
but only for the right hands of men.
In contrast to estradiol, the serum testosterone levels showed negative
correlations with the ring fingertip extensions of the right and left hand in
women. The high testosterone levels were associated with short ring finger-
tip exrensions, and low testosterone levels were associated with long finger-
tip extensions in these subjects. Therefore, serum testosterone level may be a
determining factor for the ring fingertip extension of both hands in women.
4D:2D fingertzp extension ratio.-The 4D:2D fingertip extension ratio
was found to be significantly greater in women than men (see Table 11, but
only for the right hand, not for the left hand. This result changed after con-
trolling for height: the 4D:2D fingertip extension ratio was significantly
greater in women than in men for both hands; the estimated marginal means
were .99 mm and .69 mm for the right hands of females and males, respec-
tively, and 1.11 mm and .81 mm for the left hands of females and males,
respectively. Apparently, the sex difference in fingertip extension ratio is
more prominent than that found for 2D:4D finger length ratio: 0.98 mm
(males) and 0.99 Inn1 (females) in an English sample, 0.96 mm (males] and
0.97 mm (females) in an Indian sample, 0.94 mm (males) and 0.95 mm ife-
males) for a South African sample (see Manning, Henzi, Venkatramana, Mar-
tin, & Singh, 2003).
In the total sample, the 4D:2D fingertip extension ratio was positively
correlated with the serum estradiol levels for the right and left hands (see
Table 3). In contrast, the serum testosterone levels negatively correlated with
4D:2D fingertip extension ratios of the right and left hands. These results
suggest that high estradiol levels may be associated with high ratios, as in
women, and low estradiol levels may be associated with low ratios, as in
men. On the other hand, high testosterone levels may be associated with low
ID:2D fingertip extension ratios. as in males, and low testosterone levels
may be associated with high fingertip extension ratios, as in females.
Considering men and women separately, estradiol was positively corre-
lated with 4D:2D fingertip extension ratios of the right and left hands, but
only m women, not in men (see Table 3), suggesting that estradiol could be
a factor in high ID:2D fingertip extension ratio, but only in women, not in
men. On the other hand, the serum testosterone levels were negasively corre-
lated with 1D:2D fingertip extension ratios of the right and lelt hands of
women. This was also found for men, but only for the right hand, not the
left hand (see Table 3 1. These results suggest that serum testosterone could
be a factor in the 4D:2D fingertip extension ratlo, high testosterone levels
being associated with low ratios, and low testosterone levels would be associ-
ated with high ratios for both hands of women, but only for the right hands
of men.
The above results indicating a positive correlation of 4D:2D fingertip
extension ratio with serum estradiol concentration and a negative correlation
with serum testosterone level are consistent with hlanning, et al. (19981, who
nleasured finger lengths, not the fingertip extensions, and repor~edsimilar
results, but only in the total sample without considering males and females
separately. Fingertip extension ratios may be a rough indicator of adult hor-
mone levels-but the results must be replicated in less homogeneous
samples. Xloreorer, measuring the second and fourth fingertip extensions
may also be an index for the prenatal sex hormone concentrations, since
prenatal sex hormone levels ma) actually correlate with adult sex hormone
levels (Jamison, et al., 1993), although Honekopp, et al. (2007) reported no
significant correlations between the adult sex hormone levels and 2D:ID fin-
ger length ratios in the normal population.
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Accepted Afay 30. 20118