Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone designed to promote muscle growth and enhance physical performance. Talk with your healthcare provider as soon as possible if you feel like you’re dependent on anabolic steroids. Anabolic steroids are powerful medications that affect your hormone levels and body composition. Misuse of anabolic steroids can be harmful to your health. Misuse of anabolic steroids can cause a variety of side effects ranging from mild to harmful or even life-threatening. With steroids, you often lack medical supervision, increasing the risks. Most people who use anabolic steroids do so without medical supervision, which can be dangerous. Your healthcare provider should always be your first point of contact when considering either TRT or anabolic steroids. Unlike TRT, anabolic steroids are not typically prescribed to treat medical conditions outside of specific rare cases. TRT is a medical treatment specifically designed for individuals diagnosed with low testosterone levels, also known as hypogonadism. Whether you are considering TRT for medical reasons or are tempted by steroids for performance enhancement, the long-term effects should weigh heavily in your decision. TRT is a medically supervised treatment designed to bring testosterone levels back to the normal range. The capacity to be metabolized by 5α-reductase and the AR activity of the resultant metabolites appears to be one of the major, if not the most important determinant of the androgenic–myotrophic ratio for a given AAS. Conversely, certain 17α-alkylated AAS like methyltestosterone are 5α-reduced and potentiated in androgenic tissues similarly to testosterone. 19-Nortestosterone derivatives like nandrolone can be metabolized by 5α-reductase similarly to testosterone, but 5α-reduced metabolites of 19-nortestosterone derivatives (e.g., 5α-dihydronandrolone) tend to have reduced activity as AR agonists, resulting in reduced androgenic activity in tissues that express 5α-reductase. In contrast to testosterone, DHT and other 4,5α-dihydrogenated AAS are already 5α-reduced, and for this reason, cannot be potentiated in androgenic tissues. This differs from anabolic steroid use, which often involves taking high doses to enhance muscle growth or athletic performance. Low testosterone levels, also called hypogonadism, can happen for many reasons. TRT is designed to restore testosterone levels to a normal range, improving these symptoms and helping men feel better. It affects muscle mass, bone density, mood, energy levels, and sexual health. In clinical practice, dosages of 0.5–1.0 mg/kg bodyweight daily are usually prescribed. It is also a potent teratogen in women and therefore carries a high risk of birth defects when used during pregnancy or in the few weeks before conception. Despite its effectiveness, isotretinoin treatment is generally reserved for severe nodulocystic scarring acne or acne resistant to other therapies (68). In the same publication, a second nonblinded trial is described in which AAS users self-administer their own cycle. In a double-blind trial, nandrolone decanoate (200 mg weekly) for 8 weeks decreased Lp(a) compared with baseline, but not compared with placebo, in a group of bodybuilders (124). In contrast, cross-sectional research demonstrated impaired CEC in AAS users compared with age-matched, strength-trained nonusers and sedentary controls (139). Regardless of the mechanism of action, it is uncertain how an AAS-induced decrease in HDL-cholesterol might affect CVD risk. Research in this field has shown that structural modifications in anabolic steroids are critical in determining their binding affinity to ARs and their resulting anabolic and androgenic activities. A short (1–2 months) use of androgenic-anabolic steroids by men followed by a course of testosterone-boosting therapy (e.g. clomifene and human chorionic gonadotropin) usually results in return to normal testosterone production.) Prolonged use of androgenic-anabolic steroids by men results in temporary shut down of their natural testosterone production due to an inhibition of the hypothalamic–pituitary–gonadal axis. Although all anabolic steroids have androgenic effects, some of them paradoxically results in feminization, such as breast tissue in males, a condition called gynecomastia. Acne is fairly common among AAS users, mostly due to stimulation of the sebaceous glands by increased testosterone levels. These risks are further increased when athletes take steroids alongside other drugs, causing significantly more damage to their bodies. This can lead to rapid muscle gains, increased strength, and improved recovery, but also increases the risk of serious side effects, especially when used without medical supervision. This benefit allows users to train more frequently and at higher intensities without the usual fatigue or soreness. Unlike TRT, these benefits are typically achieved by using doses much higher than what the body naturally produces. TRT may help improve brain function, particularly in older individuals or those with low testosterone. Low testosterone is often linked to sleep disturbances, such as insomnia or poor-quality sleep. TRT can help restore bone density, reducing the risk of osteoporosis and related injuries. Low testosterone can result in weaker bones, making fractures more likely. Low testosterone can lead to a reduced sex drive (libido) and erectile dysfunction. Men and women need the proper amount of testosterone to develop and function normally. As a result, there is some controversy about which men should be treated with supplemental testosterone. Women may have a testosterone deficiency due to diseases of the pituitary, hypothalamus or adrenal glands, in addition to removal of the ovaries. Men taking testosterone replacement must be carefully monitored for prostate cancer. There are times when low testosterone is not such a bad thing.
