Individuals with a social anxiety disorder (SAD) show hypofunctioning of the hypothalamus–pituitary-gonadal (HPG) axis, which is linked to social fear and avoidance behavior. As testosterone administration has been shown to facilitate social-approach behavior in this population, it may enhance the effectiveness of exposure treatment. In this proof-of-concept study, we performed a randomized clinical assay in which 55 women diagnosed with SAD received two exposure therapy sessions. Session 1 was supplemented with either testosterone (0.50 mg) or placebo. Next, transfer effects of testosterone augmentation on within-session subjective fear responses and SAD symptom severity were assessed during a second, unenhanced exposure session (session 2) and at a 1-month follow-up, respectively. The participants having received testosterone showed a more reactive fear pattern, with higher peaks and steeper reductions in fear levels in session 2. Post-hoc exploration of moderating effects of endogenous testosterone levels, revealed that this pattern was specific for women with high basal testosterone, both in the augmented and in the transfer session. In contrast, the participants with low endogenous testosterone showed reduced peak fear levels throughout session 1, again with transfer to the unenhanced session. Testosterone did not significantly affect self-reported anxiety. The effects of testosterone supplementation on fear levels show transfer to non-enhanced exposure, with effects being modulated by endogenous testosterone. These first preliminary results indicate that testosterone may act on important fear mechanisms during exposure, providing the empirical groundwork for further exploration of multi-session testosterone-enhanced exposure treatment for SAD.

患有社交焦虑症 (SAD) 的个体表现出下丘脑-垂体-性腺 (HPG) 轴功能减退，这与社交恐惧和回避行为有关。由于睾酮给药已被证明可以促进该人群的社交行为，因此它可能会提高暴露治疗的有效性。在这项概念验证研究中，我们进行了一项随机临床试验，其中 55 名被诊断患有 SAD 的女性接受了两次暴露疗法。第 1 节补充有睾酮 (0.50 毫克) 或安慰剂。接下来，分别在第二次非增强暴露会话（会话 2）和 1 个月的随访期间评估睾酮增强对会话内主观恐惧反应和 SAD 症状严重程度的转移效应。接受睾酮的参与者表现出更反应性的恐惧模式，在第 2 节中恐惧水平的峰值更高，恐惧水平下降得更快。 对内源性睾酮水平的调节作用的事后探索表明，这种模式是特定于基础睾酮水平高的女性，在增强会话和转移会话中。相比之下，内源性睾酮水平低的参与者在第 1 次会议期间表现出降低的峰值恐惧水平，再次转移到未增强的会议。睾酮对自我报告的焦虑没有显着影响。睾酮补充剂对恐惧水平的影响显示转移到非增强暴露，其影响受内源性睾酮调节。这些初步结果表明，睾酮可能在暴露期间对重要的恐惧机制起作用，