Part 2: Myths, Lies & Truths About Testosterone & Anabolic Steroids

Part 2: Why the Fear Around Anabolic Steroids?

Why the Fear Around Anabolic Steroids?

It has been said that there are greater negative views for anabolic steroid use than opioid abuse, despite the fact that opioid addiction has caused a significant public health crisis and AAS has not. While both anabolic steroids and opioids have risks, AAS’s are not linked to overdose deaths like with opioids. Yet AAS carry a greater social stigma—especially in professional sports where their use is banned. Meanwhile, opioid addiction is viewed as a medical and mental health problem leading to a more compassionate response despite its devastating impact.

Despite their medical benefits, anabolic steroids are often demonized. Why?

This fear is largely driven by:

•  Misinformation spread by both medical professionals and the media.
•  Association with cheating in sports serious health risks.
• Association with cheating in sports rather than their legitimate medical applications.

AAS are not inherently dangerous—when used correctly under knowledgeable medical supervision. However, like any powerful medication, misuse can lead to serious consequences.

In the next section, we’ll explore the benefits, risks, and misconceptions surrounding AAS use.

In 2023, the CDC reported over 81,000 opioid-related deaths (1). In contrast, the relationship between anabolic androgenic steroid (AAS) use and mortality is far less clear. Many reported cases of AAS-related deaths involve *polypharmacy*—the concurrent use of multiple substances—making it difficult to isolate anabolic steroids as the sole cause of death.

A 2024 study published in The New England Journal of Medicine, titled “Higher Mortality is Associated with Anabolic Steroid Use” (2), found that AAS users have a 2.8 times higher risk of death than non-users. However, it is crucial to distinguish correlation from causation. While these findings suggest a link between AAS use and increased mortality, confounding factors make it difficult to establish a direct causal relationship. Furthermore, comprehensive and up-to-date statistics on deaths solely attributed to anabolic steroids remain limited.

To be clear, my intent is not to downplay the potential risks of AAS use and abuse. Rather, I emphasize that *data on AAS-related deaths is scarce*—especially when compared to mortality from tobacco, alcohol, or opioids.

All Drugs Have a Risk-to-Reward Ratio

Every drug—whether prescription medication, food, supplements or even oxygen—carries both risks and benefits. Oxygen is essential for life, yet excessive oxygen exposure can damage the lungs and be fatal. The same principle applies to *AAS and all medications*—their impact depends on dosage, duration, and medical supervision.

When used under careful medical oversight, AAS can:

• Enhance performance
• Increase lean muscle mass
• Reduce body fat
• Improve cholesterol levels

The widespread fear of AAS use is largely unfounded when they are used responsibly under medical guidance. Later in this blog, we will explore the benefits of testosterone and its analogs in greater detail.

The Risks of AAS Use

Using anabolic androgenic steroids (AAS) without medical supervision carries serious health risks, including potentially fatal consequences. However, when prescribed and monitored by a knowledgeable physician, these risks can be minimized and managed effectively.

Many articles present long, alarming lists of AAS risks, misleading the public into believing that all listed side effects are equally likely. The reality is *far more nuanced—risk levels depend on dosage, duration, individual genetics, and whether proper post-cycle therapy (PCT) is implemented. Additionally, the specific AAS used also plays a critical role in side effect severity.

When testosterone replacement therapy (TRT) is administered at physiologic doses—meaning it restores testosterone levels to a natural, healthy range—its impact on biomarkers is generally predictable and manageable.

However, even at physiologic doses, some biomarkers can be influenced. Let’s break down the most commonly cited risks for biomarkers, other side effects and vital signs:

1. “Roid Rage” – Aggression & Mood Changes

At physiologic doses, AAS enhance mood and can increase confidence and motivation. However, at high doses, they disrupt neurotransmitter balance, increasing aggression:

•  Increased dopamine → Heightened reward-seeking behavior and impulsivity.
•  Decreased serotonin → Lower impulse control, increasing irritability and aggression. (19, 20)

2. Acne

A well-documented side effect, acne worsens with higher doses. However, women are more prone to AAS-induced acne than men due to hormonal sensitivity. (18)

3. Hair Loss (Male Pattern Baldness)

AAS accelerate hair loss only in individuals genetically predisposed to male pattern baldness. This is due to increased dihydrotestosterone (DHT) levels, which can be mitigated with 5α-reductase inhibitors like finasteride.

4. Cardiovascular Risks

Medical opinions on testosterone replacement therapy (TRT) and heart health have reversed course over the last decade.

•  In 2010, a study prematurely halted TRT due to an alleged increase in cardiovascular (CV) risk. (21)
•  Public Citizen, an advocacy group, petitioned the FDA for a black box warning on testosterone, but the FDA rejected it, citing an equivocal causal relationship between TRT and heart disease.
•  Newer research, including a 2023 New England Journal of Medicine study, tracking 5,200 men aged 45–80, found no increased risk of heart attack or stroke with TRT use. (22)

Biomarkers of importance:

Total Testosterone (Range: 400–1,000 ng/dL) (Note that laboratories have slightly different ranges.

•  Goal: Maintain levels within an optimal physiological range

Free Testosterone (Range: 10–30 pg/mL)

•  Measures active testosterone (more relevant than total T)
•  Influenced by SHBG levels- too high reduces free testosterone. 
• SHBG reduction means to increase free T include: increasing resistance training, increase protein intake, optimize thyroid, take Zine and Magnesium

Estradiol (Ideal: ~20–40 pg/mL)

•  Too high → Water retention, gynecomastia (male breast tissue growth), mood swings, breast tenderness
•  Too low → Joint pain, fatigue, low libido
•  Managed with AI (aromatase inhibitors) if necessary, but overuse can be harmful
•  Using testosterone cream tends to reduce this issue vs injected testosterone!!

Hemoglobin/Hematocrit

•  T can increase red blood cell (RBC) production
•  Too high → Risk of blood thickening (polycythemia), high blood pressure, stroke, cardiovascular risks
•  Managed by donating blood (therapeutic phlebotomy) or adjusting dose

Prostate-Specific Antigen (PSA) (Ideal: <4.0 ng/mL)

•  TRT doesn’t cause prostate cancer, but monitoring PSA ensures early detection of abnormalities
•  Significant increase → Further evaluation needed

Lipid Panel (Cholesterol)

•  LDL (“Bad” Cholesterol) – High levels increase cardiovascular risk with supraphysiological dose of TRT, but physiological dose reduces LDL (28,)
•  HDL (“Good” Cholesterol) – physiological TRT is now belived to have little impact on HDL, (29)

Liver Enzymes (ALT, AST)

•  Oral AAS (e.g., Anavar, Dianabol) can stress the liver, but injectable or topical TRT has minimal impact
•  We never use oral AAS in our research because of the impact on the liver

Blood Pressure (Ideal: ~120/80 mmHg)

•  TRT can increase blood pressure, especially if hemoglobin/ hematocrit is high
•  Monitor regularly to prevent hypertension-related issues

Insulin Sensitivity & Blood Sugar

•  Measure fasting Blood Glucose & HbA1c (Long-term blood sugar control)
•  TRT can improve insulin sensitivity, reducing risk of type 2 diabetes

The Benefits of AAS Use – Who Should Consider TRT or Other AAS? Optimization of Body and Health

Over the past 15 years, medical recommendations on exogenous testosterone have shifted dramatically. Initially, concerns about heart disease and other risks fueled caution, but newer evidence has overturned these fears.

Past Concerns vs. Updated Findings

•  JAMA studies (2013, 2014) (7,8) reported a 30% increase in cardiovascular events in men with pre-existing heart disease.
•  In 2014, the FDA warned about potential heart risks, partly due to overprescription in “low-T” clinics.
•  However, by 2025, expert consensus supports TRT’s benefits, provided it’s used correctly and monitored by medical professionals.

When properly administered and supervised, the benefits of TRT and AAS far outweigh the risks.

Key Benefits of TRT & AAS in Medically Supervised Use

1. Physical Benefits

• Increased Muscle Mass & Strength – Boosts protein synthesis and nitrogen retention, leading to 3–5 kg of lean muscle gain per year.
• Fat Reduction – Enhances fat metabolism, particularly reducing visceral (abdominal) fat.
• Improved Bone Density – Prevents osteoporosis and strengthens spinal & hip bone mineral density (BMD).
• Enhanced Recovery & Performance – Increases red blood cell production, improving oxygen delivery and endurance.

2. Mental & Cognitive Benefits

• Higher Energy & Less Fatigue – Most men report feeling revitalized within weeks of starting TRT.
• Better Mood & Mental Health – Testosterone regulates dopamine and serotonin, reducing depression and anxiety.
• Cognitive Function – Some studies suggest testosterone improves memory and processing speed, potentially reducing the risk of Alzheimer’s disease.

3. Sexual & Reproductive Benefits

• Higher Libido & Improved Sexual Function – TRT boosts sex drive and erectile function in men with low T.
• Preserving Fertility (with hCG or SERMs) – While TRT alone reduces sperm count, combining it with hCG, GnRH, or SERMs (like Clomid) can maintain fertility.

4. Metabolic & Cardiovascular Benefits

• Improved Insulin Sensitivity – Lowers the risk of type 2 diabetes.
• Better Cholesterol & Heart Health – Can lower LDL (bad cholesterol) and increase HDL (good cholesterol).(28)
• Testosterone supports heart function when used responsibly, though excessive doses can increase CV risk.

Who Benefits Most from TRT?

Men experiencing clinically diagnosed low T (below ~400 ng/dL) with symptoms like:

• Androgen Deficiency in the Aging Male – The ADAM questionnaire
• Metabolic syndrome: elevated BP, obesity or insulin resistance
• Reduced muscle mass
• Lower energy, motivation or drive
• Reduced productivity
• Chronic fatigue
• Depression
• Decreased sex drive/low libido
• Poor sleep
• Erectile dysfunction

The informed medical community has reversed its stance on TRT, recognizing its overwhelming benefits when used responsibly. The fear surrounding AAS use stems largely from misuse, misinformation, and unsupervised administration. With proper medical oversight, AAS can be both safe and highly beneficial.