Endocrine Abstracts

Introduction: Professional athletes commonly use anabolic-androgenic steroids (AAS) to enhance performance. AAS include testosterone and its numerous synthetic analogs. AAS have numerous adverse effects among which central nervous system effects that include psychosis, delirium, mania and depression. Trenbolone is an AAS medication which is used in veterinary medicine for cattle muscle growth. What makes Trenbolone interesting is that it’s also capable of inducing Selective androgen receptors modulators (SARM)-like effects. SARMs, as opposed to classic AAS, exert their action in a tissue-selective manner, providing the anabolic effects and suppressing the prostate adverse effects. However, Trenbolone remains different and needs to be evaluated through proper investigation. Herein, we report a case highlighting acute psychiatric effects of Trenbolone use in a young male.

Case Presentation: It’s about a 20yo male, who was admitted in the orthopedics department for polytrauma after defenestration during a psychotic break. No personal or familial history of mental health issues or substance abuse were found initially. 2months prior to admission, the patient started to brutally present disorganized behavior and aggressiveness. He started experiencing persecutory, religious and messianic delusions, as well as auditive hallucinations. CT scan, liver sampling, renal function and thyroid hormones were normal. Blood numeration was normal excluding meningo-encephalitis. Blood and urine toxicology screen were normal. A testosterone dosage found low testosterone levels (3.51ng/mL). A hypogonadotrophic hypogonadism was confirmed via suppressed FSH and LH levels. Pituitary MRI was performed in order to exclude organic lesions, and was normal. All the available data were consistent with a chronic steroid intake. After multiple interviews, the patient confessed that symptoms started concurrently with Trenbolone intake. The first few days in orthopedics the patient appeared to be reluctant and disorganized, but after 2weeks he didn’t display any psychotic symptoms or disorganized behavior. Testosterone levels returned to normal (5.5 ng/mL) after one month of intake. We concluded on a steroid-induced psychosis that we treated with 1mg risperidone.

Conclusion: AAS disturb the endogenous production of testosterone, which may persist months after drug withdrawal, thus explaining the low levels of testosterone in our patient. AAS can strongly affect the psyche and can induce psychotic features that are likely to be dose and drug dependent. In consequence, it’s important to assess its mechanisms of action and subsequent symptoms to evaluate its safety.