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Can the testosterone supplement N1-T cause a psychosis?

Psychiatrists at the University of Padua suspect that the testosterone booster N1-T can cause psychosis in susceptible individuals. They base this on one single incident where this may have been the case. May we introduce you to Mr A.B.?

A.B. is 29 years old and a bodybuilding fanatic who visits the gym almost daily. Apart from that he's pretty much like the other members of his sex. He works, has friends and is in a normal long-term relationship. His parents are mentally healthy. A.B. is someone who you wouldn't expect to lose contact with reality, but that's what happened. A.B. had a psychotic episode.

In addition to training A.B. took the N1-T herbal-extract supplement made by Universal. He took one pill a day and noticed that it increased his strength, helped him to build up muscle mass more easily, that his sex drive increased and his erections were harder. N1-T lived up to the manufacturers' promises it seemed.

But in A.B.'s case N1-T did more. He became aggressive, and started to have hallucinations and delusions. He started to see that people on the street were no longer walking upright as a result of the effect of invisible forces. And he could feel these same forces starting to take over his own body and force it into unnatural contortions. He became convinced that monsters were following him and that his father had died. When family members told him that his father was still alive and well, he launched into a violent physical attack, after which he drove off in a car and caused an accident.

A.B. was admitted to a psychiatric institution and treated with haloperidol, an anti-psychotic. Within a week he had returned to normal. A.B. told his doctors that two months before his admission he had started to use N1-T. The doctors believe that the supplement was the cause of A.B.'s psychotic episode.

Can the testosterone supplement N1-T cause a psychosis?

N1-T contains a mix of plant extracts that according to the manufacturers should boost testosterone levels. The most important component is Tribulus terrestris, a small plant that enhances erections but, unlike the supplements industry's claims, has no effect on testosterone levels.

N1-T also contains Eurycoma longifolia, which you may know under its other name: Tongkat Ali. Animal studies have shown that Tongkat Ali raises testosterone levels and sometimes even stimulates muscle building. How this works is not known.

A third component of N1-T is Avena sativa common or garden oatmeal. Supplements makers claim that Avena sativa boosts testosterone levels, but there are no studies to confirm this.

The supplement also contains Herba epimedii, known in the sex supplements world as Horny Goat Weed. One of the active substances in Herba epimedii is icariin, a flavonoid which has been shown in animal studies to boost testosterone production and help erections.

If N1-T was indeed responsible for causing A.B.'s psychosis, then two other components are most likely to be the culprits: Erythroxylum catuaba and Salvia sclarea.

Erythroxylum catuaba also goes by the name of Trichilia catigua or simply catuaba. Food manufacturers sometimes use extracts of this plant in energy drinks. Animal studies have shown that Erythroxylum catuaba reduces pain and that the plant boosts endurance capacity probably via the neurotransmitter dopamine. [Evid Based Complement Alternat Med. 2011;2011:120820.] Substances that boost the effect of dopamine often also boost libido and testosterone production.

Salvia sclarea, another ingredient of N1-T, also probably has an effect on dopamine levels. This plant contains alpha-thujone [Opinion of the Scientific Committee on Food on Thujone, 2 December 2002] a psychoactive compound also found in absinthe. It is known to cause hallucinations and, yes, alpha-thujone also boosts the effect of dopamine. [J Ethnopharmacol. 2010 Jul 6;130(1):187-90.]

Overactive dopamine provokes psychoses. The quantities of Erythroxylum catuaba and Salvia sclarea are no doubt safe for most users, but they happened to be disastrous for A.B. It may be that he is genetically predisposed to psychotic episodes, the researchers suggest. A.B. has an aunt that suffers from an unidentified psychiatric illness.

Psychother Psychosom. 2012;81(4):248-9.

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