As explained in “Is testosterone therapy a lifelong treatment?” testosterone therapy is in most cases a lifelong treatment. Not because men with hypogonadism who start testosterone therapy become “addicted” to it, but because it relieves bothersome symptoms caused by low testosterone levels and improves wellbeing, mood and quality of life (as well as objective health status).
Below is a list of several important differences between testosterone therapy and abuse of anabolic steroids, which highlight why they should not be confused.
Testosterone therapy that is prescribed and monitored by a doctor has well-established safety. In contrast, abusers of anabolic steroids use many-fold higher dosages than the recommended clinical doses.13 Doses up to 30 times greater than physiologic replacement doses have been reported.57 This results in supra-physiological blood levels of testosterone, in the range of 3000 – 5000 ng/dL. Compare this to the high end of the healthy physiological testosterone range, which is approx. 1300 ng/dL (depending on the laboratory assay, this value may vary +/- 300).
Continuous vs. cycling use
Testosterone replacement therapy is in most cases a lifelong treatment aimed to replace hypogonadal testosterone levels associated with aging and aging-related morbidities. In contrast, users of anabolic steroids cycle their use of preparations. Use of anabolic steroids often occurs in repeated cycles of around 12 weeks, followed by periods of non-use (breaks).57-59
However, it is becoming more and more common for anabolic steroid users to use anabolic steroids continuously - known as “cruising” - and on top of that add periodic cycles of other anabolic agents and/or increasing dosages – known as “blasting”.
Risks vs. benefits
The side effects of anabolic steroid use in high doses are well established in medical research.8,9,12,15,60-62 In contrast, longterm testosterone treatment is well-documented to be safe, and confers multiple health benefits.56,63,64 For more information on safety and benefits of testosterone therapy, see our Research News section, and the following reports:
Multiple beneficial effects of testosterone replacement therapy in men with testosterone deficiency
UK policy statements on testosterone deficiency
Testosterone therapy and cardiovascular risk - advances and controversies
Stacking: multi-drug combinations
Abusers of testosterone frequently practice ‘‘stacking’’ – i.e. simultaneously use of testosterone combined with multiple synthetic derivatives of testosterone, a practice called polypharmacy.58,65-68 In addition to testosterone and synthetic derivatives of testosterone, high doses of growth hormone and insulin are also commonly added to the mix,67,69 which further increased the health risks.
While polypharmacy may have synergistic effects on muscle growth and physical performance, it also results in more dangerous and potentially lethal consequences.60,70 In contrast, testosterone therapy in men with hypogonadism is done with testosterone (although for men who wish to become fathers in the near future, clomiphene citrate, hCG or aromatase inhibitors are recommended), which is provided in a controlled medical setting in physiological doses that improve health status.
Personal characteristics of users
Abuse of testosterone and anabolic steroids is strongly associated with illicit drug use and substance dependence,66,68,71 and aggressive alcohol use.72 Statements that testosterone therapy – which per definition is medically provided, monitored by physicians and fills important medical needs – supposedly is bad because it carries addiction risk, are unfounded. There is no evidence for testosterone abuse in men who are medically treated with testosterone therapy.73
It is important to keep in mind that just because something can be abused does not mean it has no medically legitimate use. Anything can be abused, even food. When considering the tremendous health benefits of testosterone therapy in hypogonadal men, the controversial discussions about testosterone therapy are moot if put in perspective. For example, one may question how come tobacco and alcohol – two highly addictive and widely available substances of abuse with no medical indications whatsoever – are legal, despite their widespread harms in society?