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Testosterone And Steroids: What You Need To Know

Nov 4, 2021
Testosterone And Steroids: What You Need To Know

Doctors use anabolic steroids to treat hormone deficiencies. Bodybuilders and some athletes misuse steroids by taking large doses to build muscle and increase strength.

Steroids are essential for life. You can’t live without these compounds, but if they are abused, they can cause serious health issues. This article will explore the misuse of anabolic steroids and contrast it with testosterone replacement therapy.

Anabolic steroids, more properly called anabolic-androgenic steroids, are used illegally by many to improve athletic performance, and increase muscle mass. The doses used are frequently 10 to 100 times higher than the levels naturally found in the human body. This is a case of too much of a good thing causing harm.

Anabolic steroids, on the other hand, are also used to treat low testosterone levels in men of all ages. Low testosterone levels in men can cause decreased energy levels, loss of muscle mass and bone density, and decreased sex drive.

Read More: How to Naturally Boost Your Testosterone

What Are Anabolic Steroids?

Anabolic-androgenic steroids (AAS) are synthetic versions of the male hormone testosterone. Fabricated versions of testosterone were first synthesized in Germany in the 1930s to treat depression. Professional athletes in the 1950s used them, and by the 1980s, they were being used by young men hoping to enhance their physical performance and personal appearance. However, the vast majority of AAS users are non-athlete weightlifters in their 20s and 30s.

Anabolic steroids promote muscle and bone growth and the production of red blood cells. Because of their ability to stimulate muscle growth, men have used them to increase their muscle mass beyond what natural testosterone levels could cause. AASs are available in at least 25 different brand name and generic versions. Each one includes a disclaimer stating that they will not enhance athletic performance and should not be used for this purpose.

Anabolic steroids come in a variety of forms, including pills, pellets implanted under the skin, injectables, and creams or gels. AAS travel through the bloodstream, binds to androgen receptors, and enters the muscle cell. Once they enter the muscle cell, they interact with DNA (carries your genetic code) and stimulate protein production.

AASs boost lean body mass, muscle mass, and maximal voluntary strength in men. However, the maximum gain for a given dose is unknown. Researchers have found that strength gains range from 5% to 20% of the initial strength with an increase of 2-5 kg in body weight.

Many users start with oral forms of AASs and progress to injectable forms, as injectables are associated with a lower risk of liver damage.

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Many AASs sold without a prescription online contain impurities such as human growth hormone and insulin. Human growth hormone increases muscle mass, often within a short period of time. However, this is due to increased water in the muscle and circulation, not increased body cell mass. Using human growth hormone with resistance exercise yields minimum, if any, gains in lean muscle mass, muscle size, and voluntary muscle strength.

Corticosteroids are another form of steroids. They are not androgens. In the sports world, they are commonly used to decrease inflammation after an injury. Like AAS, they are used medically to treat a variety of conditions.

Steroid Use Vs. Steroid Abuse

There are several medical indications for using testosterone steroids, including treating boys with late-onset puberty, hypogonadism (low testosterone levels), and conditions associated with muscle loss, such as cancer and AIDS.

Steroids are misused by men and some women who want to increase the size of their muscles. Men with a form of male body dysmorphic disorder called muscle dysmorphia often misuse AASs. These men are typically in their twenties and thirties and are preoccupied with what they perceive is their inadequate muscle size. Those who use AASs to gain strength are usually athletes who participate in weightlifting, shot-put throwing, and football.

What Is Testosterone?

Testosterone is one of the male sex hormones. It is produced in the male testes, the adrenal glands, and the female ovaries. Testosterone can bind to androgen receptors and affect the cells directly, or it can be converted to a more potent male sex hormone, dihydrotestosterone (DHT).

Testosterone And Steroids: What You Need To Know

Once testosterone binds to androgen receptors found throughout the body, it is transported into body cells such as muscle cells and bone cells, where it can exert its effect.

Common bodily processes that are supported or modulated by testosterone include:

  • Muscle mass and strength
  • Bone density and strength
  • Fat distribution
  • Red blood cell production
  • Sperm production
  • Libido and erections
  • Fertility
  • Skin elasticity
  • Mood

Low levels of testosterone cause side effects when these bodily processes are not optimally maintained and supported by normal physiologic levels of testosterone.

Read more: What is testosterone and how does it affect your health?

What Is Testosterone Replacement Therapy?

When your testosterone levels are low, symptoms may develop, including

  • Low energy
  • Reduced endurance
  • Fatigue
  • Visual field changes
  • Inability to smell
  • Depression
  • Reduced motivation
  • Poor concentration
  • Impaired memory
  • Irritability
  • Infertility
  • Reduced sex drive
  • Erectile dysfunction
  • Enlarged breast tissue

Testosterone replacement therapy is a medical treatment prescribed by a healthcare provider to replace testosterone until it returns to normal physiologic levels. When testosterone replacement is properly prescribed for a man with suboptimal levels, it can improve energy, libido, muscle mass, cognitive function, and bone density. However, because each person may have different symptoms and risk factors, testosterone replacement therapy (TRT) should not be taken lightly. All medications and medical procedures have risks and benefits, and each man must weigh the risks and benefits for himself after talking with a knowledgeable healthcare provider.

Read more: Testosterone replacement therapy TRT

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Science provides information and data based on what is known at the time. As you have seen with the COVID-19 pandemic, treatment recommendations may change when more information becomes available. The same is true for testosterone replacement therapy.

Replacing testosterone has been linked to increased prostate size (BPH), which causes urinary retention, an increased risk of developing prostate cancer, and an increased risk of cardiovascular disease. There has been a lack of research to support these claims. However, with that said, there has also been very little research to support that replacing testosterone does not cause these and other problems. There are no medications or medical procedures that can be used without a concern for risks. TRT has benefits and risks. Only you can determine whether the benefits outweigh the risks for you.

Read more: TRT separating myths and truths

Testosterone Replacement Therapy Vs. Steroid Use

Testosterone can be legally prescribed by a licensed healthcare provider both online and in a brick-and-mortar medical office. A prescription is required because TRT has risks and benefits—a licensed healthcare provider will go through the shared decision-making process with you to determine whether TRT is right for you. AASs obtained online in any other way are illegal, dangerous, and likely to have many more side effects.


There are numerous legal uses for AASs, all of which require a prescription. Legal steroid use requires an appointment with a licensed healthcare provider, labs to verify your current testosterone levels, and a plan to restore your testosterone levels to normal.

Read More: How to buy testosterone injections online for low T

Like all medications with potentially serious side effects, AASs are legally available by prescription only after a medical professional has diagnosed hypogonadism. Since 1990, the non-medical use of steroids is not permitted in the U.S. under the Anabolic Steroids Control Act of 1990. Androgens are labeled as a schedule III drug.

The Anabolic Steroids Control Act imposes penalties on physical trainers or advisors who encourage their clients to use AASs. The Act also defined anabolic steroid as any drug or hormonal substance that promotes muscle growth in the same way as testosterone.

Testosterone And Steroids: What You Need To Know

In 2004, Congress passed the Anabolic Steroid Control Act of 2004, which banned over-the-counter steroid precursors, increased penalties for making, selling, or possessing illegal steroid precursors, and provided funds for educational efforts to combat steroid misuse.

Read More: Is it legal to buy testosterone online?

Medical Supervision

Testosterone replacement therapy is only legally available with a prescription. Any company or website that sells testosterone or AASs of any kind without first consulting with a licensed healthcare provider and receiving a prescription is not operating legally, and they are not adhering to standard treatment guidelines for prescribing testosterone. Buying AASs from anyone other than a licensed, board-certified healthcare provider, and a licensed pharmacist is illegal and unsafe.

According to a 2018 survey, while 87% of the website researchers investigated offered common anabolic steroids, none of them required a prescription. Injectable forms of testosterone can be easily purchased online and delivered to your home without a prescription. However, most of these products are manufactured by unregulated international pharmacies and are of unknown content or quality.

If you are seeking testosterone replacement therapy, you should be as choosy about who you see for your medical evaluation and where you get your prescription filled as you would with any other complex medical condition.

Frequency Of Use

When you are prescribed testosterone for replacement therapy, you may need to undergo a series of lab tests to determine the best dose for you. After being stabilized on a dose, you can expect to stay on TRT for life.

Your body makes a given amount of testosterone. If you have suboptimal testosterone levels, TRT replaces the deficit and brings your testosterone levels to a normal physiologic level. Replacing a deficit should not adversely affect your natural testosterone production.

This is not the case when AAS is used at supra-physiologic levels. In order to trick their endocrine system, users of AAS experiment with different start and stop cycles (cycling and pyramiding) in the hopes that their natural testosterone production will return to its normal level at the end of the cycle. By using multiple forms of AASs simultaneously (stacking), they believe they will achieve more muscle growth than any one drug can produce on its own. However, this belief has not been scientifically proven.

Read More: How long does testosterone replacement therapy typically last?

Side Effects

While it is true that the same drug can be used for both testosterone replacement therapy and illegal AAS use, the dosages are vastly different, as are the potential side effects.

Side effects associated with AASs include an increased risk of:

  • Heart attacks and strokes due to increased red blood cell production
  • Liver tumors
  • Kidney failure
  • Gynecomastia or enlarged male breasts
  • Psychiatric disorders such as aggression, hypomania, mania, depression, and even suicidality
  • Viral hepatitis and HIV if needles are shared
  • Acne
  • Shrinkage of testicles
  • Fluid retention
  • Baldness in men and hirsutism in women
  • High blood pressure
  • Decreased sperm production
  • Tendon injuries


As we have seen, the underlying goal of TRT prescribed for a man with low testosterone levels differs greatly from using an unsafe, illegal substance to increase muscle mass or enhance sports performance.

Testosterone replacement therapy is a customized medical treatment that aims to restore your testosterone to normal physiologic levels while minimizing side effects. Take care of yourself by seeing a knowledgeable, licensed healthcare provider such as those at Invigor Medical rather than taking your chances on illegally purchased AASs.

Read more: Decreased libido with age? Your hormones may be to blame

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

Testosterone And Steroids: What You Need To Know

Leann Poston, M.D.

Dr. Leann Poston is a licensed physician in the state of Ohio who holds an M.B.A. and an M. Ed. She is a full-time medical communications writer and educator who writes and researches for Invigor Medical. Dr. Poston lives in the Midwest with her family. She enjoys traveling and hiking. She is an avid technology aficionado and loves trying new things.


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