Supraphysiological testosterone levels from anabolic steroid use and reduced sensitivity to negative facial expressions in men

Background: Anabolic-androgenic steroids (AAS) are used to improve physical performance and to achieve a muscular appearance, with significant physical and psychiatric consequences. Approximately 30% of people who use AAS develop a dependence, increasing the risk for undesired effects, largely driven by endocrine dysfunction. AAS use has been associated with antisocial behaviors and decreased empathy, indicating impaired social cognitive abilities, but the potential mediating role of hormone levels is not well-established. Methods: In total 156 male weightlifters, including those with current (n=45) or previous (n=34) AAS use and never-using controls (n=77), completed the Emotion Recognition Task (ERT) as part of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Participants were presented with morphed faces expressing one out of six emotions (sadness, happiness, fear, anger, disgust and surprise) and were instructed to indicate by a button press which of the six emotions the face displayed. ERT accuracy and response time were recorded and used as behavioral outcomes and evaluated for association with AAS use status, AAS dependence, and serum reproductive hormone levels. Mediation models were used to evaluate the mediating role of androgens in the relationship between AAS use and ERT performance. Results: Compared to never-using controls, men currently using AAS (“On”) exhibited lower recognition accuracy for facial emotional expressions, particularly anger (F=4.29, pFDR=0.03) and disgust (F=3.87, pFDR=0.05). Those with AAS dependence (n=47) demonstrated worse recognition of fear relative to men without dependence (t=-2.26, p=0.03). Recognition of disgust was negatively correlated with serum free testosterone index (FTI), however FTI did not significantly mediate the association between AAS use and recognition of disgust. Conclusions: Our findings demonstrate impaired facial emotion recognition among men currently using AAS compared to controls. While further studies are needed to investigate potential mechanisms, our analysis did not support a simple mediation effect of serum FTI.