The prevalence of high social anxiety in boys with 47,XXY (Klinefelter syndrome) may be due to lower levels of testosterone, according to a study published in PLoS One. This finding suggests that clinicians should monitor anxiety among individuals with testosterone deficiency and XXY. 

This study included 20 boys with 47,XXY whose ages ranged between 8 and 19 years, as well as 25 nonclinical control participants with similar average age (F[1,43]=0.15; P =.69). Among those with 47,XXY, increased social anxiety was significantly associated with decreased levels of testosterone as measured through saliva. This association was strong and showed no dependence on pubertal development or age. Similarly, a high level of testosterone correlated strongly with lower levels of social anxiety (r = -0.64) regardless of pubertal development or age. Social cognitive skills, on the other hand, showed no association with levels of salivary testosterone.

No individuals in this study had previously used testosterone supplements. All participants with an extra X chromosome were recruited following prenatal diagnosis (50%) and through other means, such as support groups, referrals, or calls for study participants (50%). Facial expressions and perspective taking were assessed using cognitive tests, whereas social anxiety was measured using self-reported questionnaires.

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The study researchers conclude that “lower testosterone levels might contribute to high social anxiety in 47,XXY, suggesting that anxiety should be monitored in pubertal boys with XXY presenting with testosterone deficiency. This should be done in addition to exploring cognitive behavioral therapy or psychopharmacologic treatments targeting anxiety, which are more evidence based. In contrast, testosterone levels were not associated with social cognitive functioning, suggesting that other mechanisms are driving vulnerabilities in this domain.”

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van Rijn S. Salivary testosterone in relation to social cognition and social anxiety in children and adolescents with 47,XXY (Klinefelter syndrome) [published July 23, 2018]. PLoS One. doi:10.1371/journal.pone.0200882 

This article originally appeared on Psychiatry Advisor