A recent study conducted in the Netherlands on women suffering from social anxiety disorder revealed that participants with stronger avoidance tendencies experienced larger reductions in fear during a therapy session after receiving testosterone, compared to when they received a placebo. However, this effect did not persist into subsequent sessions, nor did it impact the severity of their symptoms. The study was published in Psychoneuroendocrinology.
Social anxiety disorder is a mental health condition characterized by an intense and persistent fear of social situations. Individuals with this disorder often experience overwhelming anxiety and self-consciousness in social interactions, leading to a strong desire to avoid social events (i.e., to social avoidance). Physical symptoms such as trembling, sweating, and a rapid heartbeat may accompany these feelings of distress. Social anxiety can significantly impact a person’s daily life, hindering their ability to form relationships, attend social gatherings, or perform in public.
The standard treatment for the disorder includes therapy and psychiatric medications, but scientists are constantly looking for new treatment options as well. One potentially promising substance for this purpose is testosterone, the male sex hormone. Previous studies indicated that its administration can stimulate approach behaviors in healthy individuals, but also in highly avoidant individuals with social anxiety disorder.
Study author Moniek H.M. Hutschemaekers and her colleagues aimed to investigate whether administering testosterone to women with social anxiety disorder during exposure therapy would effectively reduce their social avoidance tendencies. The hypothesis was that testosterone would be most effective in women with the highest avoidance tendencies. To explore this, the researchers conducted an experiment.
The study included 55 female participants suffering from social anxiety disorder, aged between 18 and 43 years. They were recruited from an outpatient clinic specializing in anxiety disorders at Radboud University Nijmegen, the Netherlands, and from the community.
The researchers randomly assigned participants to receive either testosterone or a placebo treatment. The testosterone treatment involved a solution containing 0.5 ml of testosterone and other substances. The placebo solution contained the same substances, excluding testosterone. Four hours before the first exposure therapy session, participants held their assigned solution under their tongue for 60 seconds. Neither the participants nor the researchers administering the treatment knew which solution each participant received.
Participants underwent two public speaking exposure sessions, each lasting 90 minutes. These sessions are termed ‘exposure sessions’ as they confront participants with an activity they fear – in this case, public speaking. The first session occurred after the administration of either the placebo or testosterone treatments, while the second session was scheduled a week later.
Participants completed assessments of social anxiety symptom severity (using the Social Phobia Scale), fear levels (using the Subjective Unit of Distress Scale), and approach-avoidance tendencies (using the Approach Avoidance Task) at multiple time points before and after the exposure sessions. They also provided saliva samples at eight different times throughout the study to enable the authors to monitor their testosterone levels.
The results indicated that those assigned to the testosterone treatment, particularly participants with higher avoidance tendencies, showed a greater reduction in fear immediately after taking testosterone compared to those with lesser avoidance tendencies. This effect was not observed in the placebo group.
However, analysis of the results from the second session did not reveal a correlation between avoidance and fear reduction in the testosterone group. Intriguingly, after considering baseline testosterone scores, stronger avoidance scores were linked to lower overall fear levels in this group. The study authors found no effect of testosterone on social anxiety symptoms or the relationship between these symptoms and avoidance tendencies.
“The current study adds to a growing body of literature indicating that individuals with SAD [social anxiety disorder] who enter exposure treatment with strong social avoidance tendencies may benefit from additional treatment with testosterone,” the study authors concluded.
The study sheds light on the effects of testosterone administration on women with social anxiety disorder. However, the study sample was very small. Due to this, researchers were not able to detect small effects.
The paper, “Social Avoidance and Testosterone Enhanced Exposure Efficacy in Women with Social Anxiety disorder: A Pilot Investigation”, was authored by Moniek H.M. Hutschemaekers, Rianne A. de Kleine, Mirjam Kampman, Jasper A.J. Smits, and Karin Roelofs.
