Persistent fear and avoidance in patients with social anxiety disorder (SAD) has been associated with reduced testosterone levels. Because threat avoidance is a major maintaining factor in SAD, and because testosterone administration promotes social approach, we tested whether testosterone administration can directly facilitate threat approach behavior in SAD. In a double-blind, placebo-controlled study, 17 female participants with SAD received a single dose of testosterone before performing a well-established social Approach-Avoidance Task. This objective implicit measure of social motivational action tendencies requires participants to approach or avoid visually presented emotional faces. After testosterone administration, the patients showed increased approach tendencies to angry facial expressions. These results suggest that testosterone can counteract persistent automatic social avoidance tendencies in SAD. This finding advances our understanding of steroid involvement in the regulation of social motivational action in general and in SAD in particular, and may have important clinical implications, promoting testosterone’s candidacy for pharmacological treatment-enhancement studies.

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