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When you hear the term "steroids," you probably picture ripped bodybuilders and overly aggressive behavior ("roid rage"). In one study, stretched clitoral length increased from 1.4 cm at baseline to 3 cm after 4 months of receiving 200 mg testosterone cypionate every other week (226). Among AAS users there is the belief that AAS might cause gynecomastia through alternative pathways, such as increased progestin action at the mammary glands or increased prolactin levels. In the HAARLEM study, testosterone levels were similar 3 months after cessation of AAS use in those who did and did not perform PCT, but a small beneficial effect within this time frame could not be excluded (46).
Just like testicular testosterone production, spermatogenesis is governed by the HPGA. Testosterone levels decrease again after the agents are discontinued, implying that they do not solve the underlying cause of hypogonadism. However, recent or current unreported AAS use, reverse causality and other factors inherent to a case-control study design make it difficult to ascertain a true cause-and-effect relationship.
By understanding your health and goals, you and your doctor can work together to find the safest and most effective approach. They can assess your symptoms, run tests, and help you determine whether TRT is appropriate. The best way to make an informed decision is to talk to a qualified healthcare provider. If you are dealing with symptoms of low testosterone, TRT might be a safe and effective option, but only if it is prescribed by a doctor after proper testing. Some mild side effects, like skin irritation or fluid retention, can occur, but these are usually manageable.
Anabolic steroids have legitimate medical purposes. Side effects from nonprescription steroid injections are usually more severe and can be life-threatening. Anabolic steroids aren’t safe to use recreationally or without a prescription from your provider. You’ll probably need to wait at least three months between rounds of steroids. If you have a chronic (long-term) condition, you might need more steroid injections in the future. The steroid medication will circulate through your bloodstream and can affect other areas of your body.
The decrease was less than that of 2 control subjects in the same study who experienced a reduction of 49%. In the HAARLEM study, HDL-cholesterol decreased by 0.4 mmol/L during use and returned to baseline 3 months after cessation of use. While this might indicate a true difference compared with testosterone, it might also be attributed to the relatively low dosages used and small samples sizes that make the research liable to type II statistical errors (a ‘false negative’). Similar changes are seen in men receiving supraphysiological dosages (200–600 mg weekly) of testosterone enanthate (15, 37, 118, 119), although not all trials show a statistically significant decrease (34, 120, 121). The collective increase in these serum markers should thus be interpreted as a sign of liver damage, even in the presence of concomitant muscular exercise. The HAARLEM study also found no (sub)acute clinical signs of liver damage despite 67% of subjects reporting the use of oral AAS (39).
Non-prescribed steroid use is illegal in many countries and is considered abuse when used for non-medical purposes. TRT is a legal treatment prescribed by a doctor for medical conditions like hypogonadism. TRT may help regain muscle mass and strength lost due to low testosterone. Yes, but only within the limits of restoring testosterone to normal levels. Steroids, on the other hand, are often used non-medically in higher doses to enhance muscle growth, performance, and physical appearance. Choosing the right path means prioritizing your health and long-term well-being over short-term results. Ultimately, TRT and steroids are not interchangeable, and they serve very different purposes.

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