The Russian's on-court behaviour was put under the microscope again during the US Open when he berated the umpire after a photographer walked onto the court.
Medvedev went on to lose the first-round clash against Benjamin Bonzi and now, after the tempers have cooled, Medvedev said the sport just gets to him.
"The thing about tennis, what is beautiful about the sport, what is the toughest thing, and sorry, I go a bit far, I act a little bit crazy on the court sometimes," he said during the China Open.
"So many amateur people come to me in France or in Monaco. They go 'Look, I'm like you, I'm calm. When I'm in life, I am calm. On the road, I'm calm. Whatever. I argue with my wife, I'm calm. They say, I go play tennis and I go nuts, I go crazy.'
"Tennis can drive you crazy. Me, it drives me crazy because you don't know.
"You ask me why did I have a bad year? I don't have the exact answer. It could be my second daughter. It could be my relationship I don't know with coach Gilles [Cervara].
"It could be that I became older and started thinking more than when I was younger. It could be just bad luck or maybe physically I was not feeling well somewhere. You never know.
"So I don't have an answer to your question about expanding family. I definitely love my two daughters, I love my wife. It's not a problem for me. Even if I play somehow tennis worse because I have a second daughter, I'm happy about it and I don't care.
"For sure I was concerned. I'm still concerned. I'm trying to find a way to show everyone that I'm capable of doing big things again."
After a fairly dismal year, Medvedev is on a good run at the Chinese event, having reached the quarter-final where he will face Alexander Zverev.
Asked if he was getting back to his best tennis, Medvedev said: "step by step"
"It's a step-by-step process. Sometimes you can make, like, a big gap. You never know. For the moment it's a step-by-step process.
"Today, for example, I think I played better than the two matches in Hangzhou. Happy with that and looking forward to try to do it even a bit better next match.
"First of all, I don't think about last year's and the previous years' results because I was in a different position. I was sometimes coming after like the final of US Open. Last year I lost in quarters, but lost to Jannik. I was kind of only losing to Jannik or Carlos.
"Now I'm in a different position. I need to step-by-step bring my game back. That's when I can finally meet someone like Carlos [Alcaraz] or Jannik [Sinner] in the tournament."