Rare cause of manic period trigger in bipolar mood disorder: testosterone replacement

Abstract

Hypogonadotropic hypogonadism is a rare congenital disorder characterised by the deficiency and the absence of puberty and infertility. It is caused by the deficient production, secretion or action of gonadotropin-releasing hormone, which is the master hormone regulating the reproductive axis. Gonadotropin-releasing hormone or gonadotropin injections and testosterone replacement therapy are required in the treatment of this disorder. Psychiatric symptoms and disorders may be seen with the use of anabolic androgenic steroids. In this case report, we present a case report in which a patient had behavioural symptoms in childhood and develops bipolar disorder after testosterone replacement therapy. This patient was reached to the remission by increasing the doses of psychiatric drugs without interfering with hormonal therapy. It should be considered that patients receiving testosterone replacement therapy may develop bipolar disorder or trigger mood changes in bipolar mood disease, so behavioural and mood state changes should be closely followed in patients who have bipolar mood disease.

Abnormal features of human self‐domestication in bipolar disorder

“…At follow‐up, elevated baseline testosterone levels predicted suicide attempts such that a 10 ng/dL increase in testosterone translated to a 16.9‐times increased probability of suicide attempt. While it should be noted that one study found no significant differences in salivary testosterone levels either between BD type I patients and healthy controls or between euthymic, depressed, and manic BD patients (Mousavizadegan & Maroufi, 2018), there are reports of hypomania (Freinhar & Alvarez, 1985) and mania (Elboga & Sayiner, 2018) induced by androgen administration, as well as homicide after a man with BD was administered testosterone for hypogonadism (Sher & Landers, 2014). In a case with comorbid Klinefelter syndrome, however, testosterone therapy has been reported to effectively treat a pattern of frequent manic episodes refractory to treatment with mood stabilizers and second‐generation antipsychotics (Kawahara et al, 2015).…”

Testosterone and Suicidal Behavior in Bipolar Disorder

“…Probably, both high and low levels of testosterone may contribute to the neurobiology of suicide in various patient populations [31]. Studies of the role of testosterone in the pathophysiology of suicidal behavior in bipolar disorder are important because endogenous and exogenous testosterone may affect suicidality in bipolar disorder [20,28,43,45]. The effects of endogenous and exogenous testosterone on suicidality in patients with bipolar disorder need further investigation.…”

“…In the U.S., testosterone preparation sales grew from around $100 million in 2000 to almost $2.7 billion in 2013 [41]. It has been reported that testosterone supplementation may trigger manic episodes in individuals with bipolar disorder [43]. Possibly, testosterone administration may lead to increase in self-violence and violence in individuals with bipolar illness.…”

Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders

“…Serum testosterone increases induced by valproate may contribute to the development of HMB ( Bilo and Meo, 2008 ; Flores-Ramos et al, 2020 ; Kenna et al, 2009 ; McAllister-Williams, 2006 ; O'Donovan et al, 2002 ; Rasgon et al, 2005b ; Zhang et al, 2016 ). Notably, in 2018, Elboga et al reported the case of a boy who had manic episode after being given testosterone replacement therapy for hypogonadotropic hypogonadism ( Elboga and Sayiner, 2018 ).…”