There is considerable evidence from animal studies that gonadal steroid hormones modulate neuronal activity and affect behavior. To study this in humans directly, we used H 2 15 O positron-emission tomography to measure regional cerebral blood f low (rCBF) in young women during three pharmacologically controlled hormonal conditions spanning 4-5 months: ovarian suppression induced by the gonadotropin-releasing hormone agonist leuprolide acetate (Lupron), Lupron plus estradiol replacement, and Lupron plus progesterone replacement. Estradiol and progesterone were administered in a double-blind cross-over design. On each occasion positron-emission tomography scans were performed during (i) the Wisconsin Card Sorting Test, a neuropsychological test that physiologically activates prefrontal cortex (PFC) and an associated cortical network including inferior parietal lobule and posterior inferolateral temporal gyrus, and (ii) a no-delay matching-to-sample sensorimotor control task. During treatment with Lupron alone (i.e., with virtual absence of gonadal steroid hormones), there was marked attenuation of the typical Wisconsin Card Sorting Test activation pattern even though task performance did not change. Most strikingly, there was no rCBF increase in PFC. When either progesterone or estrogen was added to the Lupron regimen, there was normalization of the rCBF activation pattern with augmentation of the parietal and temporal foci and return of the dorsolateral PFC activation. These data directly demonstrate that the hormonal milieu modulates cognition-related neural activity in humans.An extensive body of data from animal studies indicates that gonadal steroid hormones modulate neuronal activity and affect behavior. In humans, however, the behavioral and cognitive evidence has not been conclusive, and direct neurophysiological data are scant. Effects of gonadal steroids in the human central nervous system have been inferred largely from behavioral changes during the menstrual cycle, during administration of ovarian hormones, or in a gender-specific context. These inferences are, by definition, indirect and associational and, further, are incapable of disentangling the effects of hormones, such as estrogen and progesterone, which are simultaneously present in women of reproductive age. We directly tested the central nervous system effects of gonadal steroid hormones in young women by measuring regional cerebral blood flow (rCBF) as a marker of local neuronal activity and by controlling their hormonal states with the gonadotropin-releasing hormone (GnRH) agonist leuprolide acetate (Lupron).GnRH is produced by the hypothalamus and causes the anterior pituitary to release follicle-stimulating hormone and leuteinizing hormone. Lupron is a synthetic nonapeptide used clinically when suppression and͞or control of gonadal steroid secretion is the goal, such as in infertility and endometriosis in women and prostate cancer in men. It is some 80-100 times more potent than native GnRH at anterior pituitary receptors (1), an...