Few things garner stronger opinions among sports and fitness enthusiasts than the topic of steroids — the majority of said opinions being negative.
But with the hate comes a lot of misinformation and half truths. Steroids have been demonized so much that viable forms of medical treatment have been lumped in with illegal steroid use, not because of the treatments themselves or what they do, but because of the misuse of the drugs and treatments by many steroid abusers.
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One such treatment is testosterone replacement therapy (TRT).
What Is Testosterone Replacement Therapy?
As I discussed in my article on testosterone, TRT is a common method used to help treat men with low T levels. And testosterone, to be clear, is a form of anabolic steroid, the same kind athletes use have been known to use illegally.
TRT is used to help men achieve natural levels of testosterone within the body. There are four main forms of testosterone replacement therapy:
- Subcutaneous implant: With this form of TRT, a small pellet is implanted under the skin, either in the abdomen or the buttocks. The pellet, which is no larger than a grain of rice, works to keep T levels elevated, and only needs to be replaced every four to five months. However, this form of TRT comes with a number of potential side effects, including anxiety, agitation, infection, and adrenal exhaustion, which makes some doctors hesitant to recommend it.
- Transdermal patch: Like the implant, this method provides the body with a steady stream of testosterone via a patch placed on the upper arm or scrotum. The downside of this method, however, is that it often leads to skin irritation.
- Gels and creams: Gels and creams are a popular form of TRT because they are easy to administer and are very effective. Patients can apply them to the arms or shoulders once or twice a day. Testosterone creams also have the added benefit of helping raise HDL levels — the good kind of cholesterol.
- Injections: Getting injections is probably the most effective, beneficial, and safest method of TRT. This method is low cost, can be done at home, has minimal side effects, and mimics natural testosterone fluctuations.
Testosterone pills are also available, but are not recommended by doctors due to the adverse effects they can have on the liver. The above forms of TRT bypass the liver entirely.
Despite the fact that these methods of testosterone replacement therapy are recommended by doctors for men with low testosterone, many people view TRT as just another method of steroid use.
So that begs the question: Is it?
What Are Steroids?
What most people actually think of when they hear the word “steroid” is a class of substances know as “anabolic-androgenic steroids” or simply “anabolic steroids”, a synthetic version of testosterone.
These drugs were originally developed as a treatment for men whose testes were not producing the necessary amount of testosterone. What they discovered, however, is that these substances could also be used to help increase skeletal muscle and increase bone density.
In addition to anabolic steroids, there is another class of steroids called corticosteroids. These are synthetic substances used in medical treatments to help the body fight inflammation by mimicking the effects of cortisol, the body’s natural defense against inflammation.
Many of us only think of steroids as drugs used by bodybuilders and athletes to gain a competitive edge. However, there are many medical uses for steroids.
Corticosteroids are most commonly used in the medical treatment of diseases and conditions such as arthritis and asthma. For arthritis sufferers, they work by reducing inflammation and pain in the joints. When it comes to asthma, corticosteroids help open up air passageway swelling.
Since inflammation is present in many diseases, these types of steroids can also be used to treat things ranging from skin conditions to Crohn’s disease and multiple sclerosis, and also help reduce the nausea caused by chemotherapy in cancer patients.
In rarer cases, anabolic steroids are prescribed to help treat certain medical conditions. This includes things like delayed puberty in young boys, loss of muscle mass in cancer and AIDs patients, damaged tissue after an injury, and, of course, low testosterone.
The majority of anabolic steroid use, however, is done illegally by those looking to increase their muscle mass, get stronger or increase their athletic performance.
How Steroids Work
When anabolic steroids enter your system, they are broken down and attach themselves to your androgen receptors. When this happens, the receptors are activated.
Once these receptors are activated, you body starts speeding up the muscle building process. More proteins than normal are produced, which your body uses to build muscle mass. In fact, the word “anabolic” is derived from the Greek word anabole, which means “to build up”.
But that’s not all that happens. Some of your androgen receptors inhibit hormones called glucocorticoids. By doing this, your body speeds up the breakdown of proteins into amino acids, providing energy to your muscles faster. This shortens the recovery time needed between training, meaning you can train harder while needing less rest.
In theory, it’s possible for anabolic steroid use to help you build muscle and get stronger. This study tested the effects of anabolic steroid use in athletes. Researchers found that the participants who were given the drugs saw a 5-20% increase in strength, and a two to five kilogram increase in lean muscle mass in just 10 weeks.
But what about patients going through TRT?
While many of the men undergoing testosterone replacement therapy do report feeling like they’re stronger and have more muscle, the difference doesn’t tend to be significant.
While increasing testosterone levels above natural levels — what steroid users do — can help you add appreciable mass, increasing T levels within the natural range does not seem to have the same effect, according to this study.
However, that same study also showed that increasing testosterone levels within the natural range can lead to a decrease in body fat percentage. This could explain why TRT participants report seeing appreciable muscle gains: The quickest way to look like you’ve gained muscle is to lose body fat.
It could also have to do with the increased energy levels and decreased fatigue associated with low T levels. Having more energy will lead to better workouts and results.
TRT vs. Steroids: What’s the Difference?
The drugs used by TRT participants and steroid users are actually quite similar, in that they both contain forms of testosterone. However, the poison, as they say, is in the dose.
I asked John Romaniello, fitness coach and co-author of the New York Times bestseller Engineering the Alpha, his thoughts on the difference between TRT and steroids.
“The first thing to remember is that in most cases, the compounds being used by someone in TRT vs. someone using steroids for performance or physique enhancement are identical. What differs—other than the obvious, like legality and medical supervision—is the reason for use and the dose,” he says.
“TRT doses are intended to keep your testosterone levels in the normal range (usually at the high end). Steroids, on the other hand, are usually used to push you into what is called the supra-physiological range of testosterone. That is, higher levels than what you could produce naturally.”
With a few exceptions, anabolic steroid use is normally not done under the supervision of a doctor. In fact, anabolic steroids are illegal in the United States. Despite that, many bodybuilders, physique, and performance athletes use anabolic steroids to help them improve both body composition and performance.
And while both TRT and steroid use have their side effects, the side effects of taking anabolic steroids are much more pronounced, and can be life-threatening.
Because no studies have ever been done on the side effects of steroid use (doing so would require prescribing participants with an unethical dose), most of the known side effects are anecdotal. These include:
- Development of breasts
- Shrunken testicles
- Enlargement of the prostate
- Liver abnormalities and rupture
- Increased LDL (bad) and decreased HDL (good) cholesterol
- High blood pressure
- Heart problems
Since anabolic steroids are illegal in the U.S., most need to be purchased from other countries. This means that they aren’t subject to government testing and safety standards, increasing the risk for impurity.
Testosterone replacement therapy is a medical procedure designed to help patients attain optimal testosterone levels in order to improve their quality of life. TRT is legal and done under the supervision of a medical professional.
When done under the supervision of a medical professional, the side effects of TRT are minimal at worst.
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The Final Word on TRT and Steroids
Low testosterone is a real problem among men today, and testosterone replacement therapy is one of the best methods available for reversing it.
The use of steroids, however, addresses a problem that only exists in the mind of the user — not feeling big enough or strong enough.
TRT is a safe, natural way to increase the quality of life of those with low T.
Romaniello, who has first-hand experience with TRT, agrees: “TRT allows me to feel the way I did when I was 24 — at 34 years old. I sleep more easily, I recover well, and in general I am just more physically capable than I was before I started. There have been some changes to strength and body composition, but nothing insane. It’s more just about feeling better and slowing the aging process.”
Illegal steroid use is a quick fix, with long-term side effects outweighing short-term gains.