Why gym-goers need to be wary of testosterone supplements for muscle building

The desire for a sculpted physique is prompting some gym-goers to experiment with synthetic steroids, particularly testosterone supplements. The trend is largely fueled by social media, where thousands of posts discuss ways to boost testosterone levels, and influencers promote the supposed benefits of using the synthetic hormone and even recommend products that can be purchased online without a prescription.

However, while synthetic testosterone may improve your appearance in the short term, its long-term effects on your health should not be ignored.

Testosterone is a steroid hormone that plays a role in the functioning of all organs in our body. Testosterone is produced in both men and women, although men have about 15 times more of it circulating in their bodies than women.

Testosterone not only stimulates sexual development and puberty, but also helps build muscle mass and control bone growth. This improves our strength, endurance, and cardiovascular fitness.

Many factors can naturally increase testosterone production, including exercise, stress, and sex.

But using synthetic testosterone supplements to boost your levels of the hormone, especially in amounts greater than your body's natural production, will have significant impacts on your health.

Initially, this may increase your sex drive and help your body build more muscle mass over a period of months. It may also cause acne, male pattern baldness, and breast enlargement in men. Women may experience amenorrhea (loss of menstrual periods), increased body hair growth, a deepening voice, and an enlarged clitoris.

But these side effects are minor compared to the serious effects that long-term and repeated abuse has on the body.

Steroid abuse changes the heart, causing it to enlarge, blood pressure to rise, and arteries to become less elastic. All of these changes make the heart work harder, increasing the risk of sudden death. Cardiovascular changes persist in most abusers.

Liver and kidney damage often develop in people who use steroids for long periods of time.

Testosterone also has psychological effects, including increased aggression, depression, and anxiety.

Crucially, testosterone supplements shut down the brain's normal testosterone-producing mechanisms. This causes hypogonadism, a condition in which the tissues that normally produce testosterone shrink. In men, this results in decreased sperm count and testicular volume.

Hypogonadism also contributes to a wide range of withdrawal symptoms. Some of these symptoms include depression and decreased libido, unless more testosterone is used.

Many men who abuse steroids become hypogonadal and require lifelong testosterone replacement therapy.

A Growing Problem The International Olympic Committee and the World Anti-Doping Agency banned testosterone and other anabolic steroids after the 1972 Olympics. Their reasoning was that while these agents enhance physical performance, they also have serious health consequences.

However, more than 40 years after this international ban, anabolic steroid use continues among some athletes. For example, in 2021, it was reported that between 29% and 43% of professional athletes in Iran had abused these substances. In a 2023 Australian study of 32 athletes (mostly women), about 43% of respondents reported using performance-enhancing drugs.

However, professional athletes now make up only a small part of the global doping problem. The cosmetic use of testosterone by non-athletes who want to improve their self-esteem and physical appearance means that the abuse of anabolic steroids has become a public issue. Some reports estimate that around 1 million people in the UK take steroids such as testosterone.

But given the well-known risks and harms of testosterone use, why would anyone choose to use it and continue to use it even when experiencing serious health problems? This is a question experts have been trying to answer for years.

One possible reason is that users perceive health problems as a future occurrence and that these problems are an acceptable risk to achieve better fitness or appearance in the short term.

Anabolic steroid addiction may play a role by affecting judgment and reducing awareness of potential harm.

Goldman's dilemma may also provide some insight. From 1982 to 1995, Bob Goldman, a physician and author, posed a Faustian hypothetical question to elite athletes: Would they be willing to take a magic pill that would ensure success at the Olympics but would also cause their death within five years?

He reported that about half of the athletes surveyed took the gold-for-death option. In a 2012–13 follow-up study, the proportion was lower, at 7%–14%, with elite athletes most likely to choose gold-for-death.

There is no doubt that abuse of testosterone and its synthetic analogues can lead to harm, yet many continue to abuse them. International bans have not been effective. With the growing number of non-athletes abusing testosterone, more needs to be done to educate the public about its many long-term health consequences.