Meeting abstract

https://doi.org/10.24869/spsih.2026.272

Manic Psychotic Episode Associated With Nonmedical Testosterone Use – A Case Report

Ilijana Stanivuk ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; Faculty of Medicine in Rijeka, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia *
Ena Paparić ; County Special Hospital Insula Rab, Kampor 224, 51280 Rab, Croatia
Sandra Blažević Zelić ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; Faculty of Medicine in Rijeka, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
Ivona Škarpa ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
Aristea Pavešić Radonja ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; Faculty of Medicine in Rijeka, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia

* Corresponding author.

Abstract

Introduction: Anabolic-androgenic steroids (AAS),
including testosterone, are used among athletes
to increase muscle mass and enhance sports performance.
Although their somatic side effects are
well known, the psychological consequences often
remain insufficiently recognized in clinical practice.
Case report: We present the case of a man in
his twenties, a competitive bodybuilder, who was
hospitalized due to several days of insomnia, elevated
mood, accelerated thought processes, and
delusional ideas of grandiosity and persecution. The patient was convinced that he possessed exceptional
social influence and that he was being
subjected to organized surveillance. During the
assessment, the history revealed several months
of using high doses of testosterone obtained on
the black market. After the introduction of antipsychotic
and mood-stabilizing therapy, there
was a gradual remission of psychotic and affective
symptoms. Discussion: The available literature
indicates an association between higher doses
of testosterone and other AAS and the onset
of manic and psychotic symptoms, particularly
in predisposed individuals. The mechanisms include
modulation of dopaminergic and serotonergic
neurotransmitter systems and disruption
of neuroendocrine regulation. In the presented
case, the temporal association between symptom
development and testosterone use suggests a possible
causal relationship. Conclusion: In younger
individuals engaged in bodybuilding who present
with new-onset manic or psychotic symptoms,
it is necessary to actively investigate the use of
anabolic-androgenic steroids. Timely recognition
of this association can significantly influence the
diagnostic and therapeutic approach and reduce
the risk of recurrent psychiatric episodes.

Keywords

testosterone; anabolic-androgenic steroids; psychosis; mania; bodybuilding

Hrčak ID:

352961

URI

https://hrcak.srce.hr/352961

Publication date:

15.6.2026.

Article data in other languages: croatian

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