Bradley D. Anawalt
Professor and Vice-Chair of Medicine
Department of Medicine
School of Medicine
University of Washington
Disclosure Summary: Consultant for the United States Anti-Doping Agency
Note from Nelson: Listen at 31 minutes 13 seconds. He summarizes what I have been saying for years in just a few seconds.
If you've ever wondered about steroids, testosterone therapy, or performance-enhancing drugs, you're not alone. Millions of men are curious about these substances - whether for athletic performance, muscle building, or just feeling better as they age. But there's a lot of confusion out there about what's safe, what works, and what the real risks are.
Let's clear up the confusion and talk straight about what these drugs actually do to your body.
Back in the 1950s, Russian and American weightlifters started experimenting with testosterone derivatives. A doctor named Ziegler worked with the American weightlifting team and gave them a synthetic testosterone called Dianabol - those little pink pills. The results were dramatic. Athletes gained strength fast.
But here's what happened: If one pill worked, athletes figured two would work better. Then they took four. Then eight. This set the pattern for how these drugs are still abused today.
The Ben Johnson Moment
In 1988, everything changed. Canadian sprinter Ben Johnson broke the 100-meter world record, running it in 9.79 seconds. He crushed his rival Carl Lewis and celebrated by looking back at him during the race. Days later, Johnson tested positive for steroids. His medal was taken away, and the world had to face facts: these drugs really do make you faster and stronger.
For decades, scientists doubted that anabolic steroids really improved athletic performance. Athletes knew better - they kept using them anyway.
Finally, in the late 1990s, researchers did a study that proved what athletes already knew. They tested four groups of men:
The results were eye-opening. The guys sitting on the couch taking testosterone increased their bench press by 20 pounds - without lifting a single weight. That's the same gain as the guys who were actually working out without testosterone. And when you combined weightlifting with testosterone? The gains were even bigger.
This finally convinced the medical community: steroids absolutely enhance performance.
Here's something shocking. In a famous survey from the 1990s, nearly 200 elite athletes were asked: "Would you take a banned drug that guaranteed you'd win every competition for 5 years, then die from the drug's side effects?"
More than half said yes.
Think about that. Winning was more important than living. While later studies found lower numbers, the message is clear: competitive athletes will take huge risks to win. The difference between first and second place can be a fraction of a second or a few pounds. Most people can't even name who came in second place.
Official tests show only 1-2% of athletes test positive for banned substances. But that's not the real story.
When researchers use anonymous surveys that protect athletes' identities, the numbers jump dramatically:
The testing catches very few people because athletes have learned how to beat the tests.
These are testosterone-like drugs that build muscle. They include:
This is the latest trend. Athletes think it makes them look "ripped" - meaning extremely lean with visible muscles. While scientists used to doubt it worked, recent studies show growth hormone can improve sprint performance by 4%. That might not sound like much, but races are won by hundredths of a second.
The list includes stimulants, blood doping methods, diuretics (which can mask other drugs), and even some medications used to treat diabetes.
Interestingly, alcohol was banned in Olympic sports until 2018. Caffeine is monitored but not banned.
Testosterone and similar steroids work in two main ways:
These drugs tell your muscles to grow bigger and stronger. Your body increases protein production, and muscle tissue expands.
This is less known but just as important. When you work out hard, you normally feel tired and sore the next day. Your body needs rest. But steroids reduce that fatigue and pain. They work on specific receptors in your brain that control how tired you feel.
This means athletes can train harder, more often, without feeling wiped out. They can beat up their bodies day after day without the normal recovery time.
Let's be clear: using high doses of anabolic steroids causes real damage to your body. This isn't scare tactics - this is medical fact.
Men who abuse steroids for more than two years face serious cardiovascular risks:
A recent study found that steroid abusers had increased coronary artery disease and problems with how their heart pumps blood.
Oral steroids are especially hard on your liver. The chemical process that makes them work as pills also makes them toxic to liver cells. This can lead to liver disease over time.
Here's something many guys don't realize: taking steroids can make you infertile. When you take testosterone or similar drugs, your testicles basically shut down. They stop making sperm.
The scary part? After you stop taking steroids, it can take 1-3 years for sperm production to return to normal. Some men never fully recover. If you're thinking about having kids someday, this should make you think twice.
Testosterone converts to estrogen in your body. When you take extra testosterone, you also make extra estrogen. This can cause breast tissue to grow in men - something nobody wants. Some athletes try to prevent this by taking drugs that block estrogen, but that causes other problems with bone health and sexual function.
When you're on high doses of steroids, you might feel great - energetic, confident, even aggressive. But when you stop taking them, withdrawal hits hard:
There's also "roid rage" - the aggressive, angry behavior some men show while on very high doses. It's real, though it mainly happens at extremely high doses.
Some damage reverses when you stop taking steroids. Some doesn't.
What Usually Recovers:
What May Not Fully Recover:
The longer you use steroids and the higher the doses, the harder it is to recover fully.
Here's where things get confusing, and it's really important to understand the difference.
A man with genuinely low testosterone (hypogonadism) may benefit from proper medical treatment. This is NOT the same as a healthy guy taking massive doses to get huge muscles.
The problem is these two things have gotten mixed up in people's minds. The dangers of steroid abuse are real, but that doesn't mean medical testosterone therapy for legitimate conditions is equally dangerous.
Around the early 2000s, testosterone prescriptions skyrocketed in the United States. Why? When testosterone gel was invented, drug companies launched a massive marketing campaign about "Low T syndrome."
Suddenly, every guy who felt a little tired saw ads telling him he might have low testosterone. Prescriptions went through the roof. In Britain, prescriptions stayed flat - they didn't buy into the marketing hype.
This created confusion. Are millions of American men truly deficient? Or did marketing convince healthy men they had a problem?
The truth is somewhere in the middle. Some men genuinely have low testosterone and benefit from treatment. Many others probably don't need it.
Testing has gotten sophisticated, but athletes stay one step ahead. Here's how they do it:
They take testosterone AND epitestosterone together to keep the ratio normal. Epitestosterone is biologically inactive but keeps the test from detecting the added testosterone.
They use short-acting drugs that clear the body quickly. Cyclists would drip testosterone intravenously at night, turn it off in the morning, and be clean by testing time.
They literally use someone else's urine. This is why collection has to be observed - yes, someone watches you pee.
Taking diuretics to make very dilute urine that's harder to test accurately.
Newer testing creates a baseline profile of your normal levels, then watches for changes. But if you start using steroids before your baseline test, you've set your "normal" at an already-enhanced level.
You don't have to be an Olympic athlete to encounter performance-enhancing drugs. Studies show that up to 25% of men at regular fitness clubs have used these substances.
If you're considering using steroids just to look better:
Let's end on a positive note. You can build muscle, get stronger, and improve your body without pharmaceutical help.
If you genuinely have symptoms of low testosterone - and they're affecting your quality of life - see a doctor. Real symptoms include:
Get properly tested. If your testosterone is truly low, treatment under medical supervision might be appropriate.
Performance-enhancing drugs work - let's not pretend they don't. Athletes use them because they provide real advantages in strength, muscle mass, endurance, and recovery.
But they come with serious costs: heart disease, liver damage, infertility, mental health problems, and potentially shortened lifespan.
For 99% of men, the risks far outweigh any benefits. You can achieve excellent results naturally with proper training, nutrition, and patience.
If you have genuine medical issues, work with a qualified doctor who will use appropriate doses and monitor your health closely. That's completely different from abusing these drugs for cosmetic or athletic purposes.
Ready to build a better body the right way? Here's what to do:
Remember: the goal isn't just to look good temporarily. It's to be healthy, strong, and functional for decades to come.
Your body is the only one you get. Treat it with respect.
Have questions about testosterone, muscle building, or men's health? Talk to your doctor about evidence-based approaches that are right for you. Don't gamble with your health based on what you see online or hear at the gym.
Professor and Vice-Chair of Medicine
Department of Medicine
School of Medicine
University of Washington
Disclosure Summary: Consultant for the United States Anti-Doping Agency
Note from Nelson: Listen at 31 minutes 13 seconds. He summarizes what I have been saying for years in just a few seconds.
The Truth About Steroids and Testosterone: What Every Man Needs to Know
Understanding Performance-Enhancing Drugs and Your Health
If you've ever wondered about steroids, testosterone therapy, or performance-enhancing drugs, you're not alone. Millions of men are curious about these substances - whether for athletic performance, muscle building, or just feeling better as they age. But there's a lot of confusion out there about what's safe, what works, and what the real risks are.
Let's clear up the confusion and talk straight about what these drugs actually do to your body.
The History: How Steroids Became Popular
Back in the 1950s, Russian and American weightlifters started experimenting with testosterone derivatives. A doctor named Ziegler worked with the American weightlifting team and gave them a synthetic testosterone called Dianabol - those little pink pills. The results were dramatic. Athletes gained strength fast.
But here's what happened: If one pill worked, athletes figured two would work better. Then they took four. Then eight. This set the pattern for how these drugs are still abused today.
The Ben Johnson Moment
In 1988, everything changed. Canadian sprinter Ben Johnson broke the 100-meter world record, running it in 9.79 seconds. He crushed his rival Carl Lewis and celebrated by looking back at him during the race. Days later, Johnson tested positive for steroids. His medal was taken away, and the world had to face facts: these drugs really do make you faster and stronger.
Do Steroids Actually Work? The Science Says Yes
For decades, scientists doubted that anabolic steroids really improved athletic performance. Athletes knew better - they kept using them anyway.
Finally, in the late 1990s, researchers did a study that proved what athletes already knew. They tested four groups of men:
- Couch potatoes - no exercise, no testosterone
- Couch potatoes with testosterone - no exercise, but taking testosterone
- Weightlifters - exercise but no testosterone
- Weightlifters with testosterone - both exercise and testosterone
The results were eye-opening. The guys sitting on the couch taking testosterone increased their bench press by 20 pounds - without lifting a single weight. That's the same gain as the guys who were actually working out without testosterone. And when you combined weightlifting with testosterone? The gains were even bigger.
This finally convinced the medical community: steroids absolutely enhance performance.
What Athletes Are Willing to Risk
Here's something shocking. In a famous survey from the 1990s, nearly 200 elite athletes were asked: "Would you take a banned drug that guaranteed you'd win every competition for 5 years, then die from the drug's side effects?"
More than half said yes.
Think about that. Winning was more important than living. While later studies found lower numbers, the message is clear: competitive athletes will take huge risks to win. The difference between first and second place can be a fraction of a second or a few pounds. Most people can't even name who came in second place.
How Many Athletes Actually Use These Drugs?
Official tests show only 1-2% of athletes test positive for banned substances. But that's not the real story.
When researchers use anonymous surveys that protect athletes' identities, the numbers jump dramatically:
- 26-39% of German elite athletes had used performance-enhancing drugs at some point
- Up to 50% used them in the past year
- 25% of regular gym members in the Netherlands used these drugs recently
The testing catches very few people because athletes have learned how to beat the tests.
What Drugs Are We Talking About?
Anabolic Steroids
These are testosterone-like drugs that build muscle. They include:
- Testosterone itself
- Synthetic versions like Dianabol
- Drugs that increase your body's own testosterone production
Growth Hormone
This is the latest trend. Athletes think it makes them look "ripped" - meaning extremely lean with visible muscles. While scientists used to doubt it worked, recent studies show growth hormone can improve sprint performance by 4%. That might not sound like much, but races are won by hundredths of a second.
Other Banned Substances
The list includes stimulants, blood doping methods, diuretics (which can mask other drugs), and even some medications used to treat diabetes.
Interestingly, alcohol was banned in Olympic sports until 2018. Caffeine is monitored but not banned.
How Do Steroids Work in Your Body?
Testosterone and similar steroids work in two main ways:
1. Building Muscle Directly
These drugs tell your muscles to grow bigger and stronger. Your body increases protein production, and muscle tissue expands.
2. Mental Effects - The Hidden Power
This is less known but just as important. When you work out hard, you normally feel tired and sore the next day. Your body needs rest. But steroids reduce that fatigue and pain. They work on specific receptors in your brain that control how tired you feel.
This means athletes can train harder, more often, without feeling wiped out. They can beat up their bodies day after day without the normal recovery time.
The Dark Side: Serious Health Risks
Let's be clear: using high doses of anabolic steroids causes real damage to your body. This isn't scare tactics - this is medical fact.
Heart and Blood Vessel Problems
Men who abuse steroids for more than two years face serious cardiovascular risks:
- Increased risk of heart attacks
- Higher chance of stroke
- Heart failure
- Increased blood pressure
- Dangerous drops in "good" HDL cholesterol
- Inflammation in blood vessels
A recent study found that steroid abusers had increased coronary artery disease and problems with how their heart pumps blood.
Liver Damage
Oral steroids are especially hard on your liver. The chemical process that makes them work as pills also makes them toxic to liver cells. This can lead to liver disease over time.
Fertility Problems - This Is Critical
Here's something many guys don't realize: taking steroids can make you infertile. When you take testosterone or similar drugs, your testicles basically shut down. They stop making sperm.
The scary part? After you stop taking steroids, it can take 1-3 years for sperm production to return to normal. Some men never fully recover. If you're thinking about having kids someday, this should make you think twice.
Breast Tissue Growth (Gynecomastia)
Testosterone converts to estrogen in your body. When you take extra testosterone, you also make extra estrogen. This can cause breast tissue to grow in men - something nobody wants. Some athletes try to prevent this by taking drugs that block estrogen, but that causes other problems with bone health and sexual function.
Mental Health Issues
When you're on high doses of steroids, you might feel great - energetic, confident, even aggressive. But when you stop taking them, withdrawal hits hard:
- Depression that can last months
- Extreme fatigue
- Irritability and anger
- Loss of motivation
There's also "roid rage" - the aggressive, angry behavior some men show while on very high doses. It's real, though it mainly happens at extremely high doses.
Other Side Effects
- Acne and oily skin
- Hair loss
- Shrinking testicles
- Sleep problems
- Increased risk of blood clots
Can These Effects Be Reversed?
Some damage reverses when you stop taking steroids. Some doesn't.
What Usually Recovers:
- Sperm production (but it takes 1-3 years)
- Testicle size (gradually)
- Natural testosterone production (in most men)
- Mood (eventually)
What May Not Fully Recover:
- Heart and blood vessel damage
- Liver problems from oral steroids
- Some men never regain normal testosterone production
The longer you use steroids and the higher the doses, the harder it is to recover fully.
Testosterone Therapy vs. Steroid Abuse - A Crucial Difference
Here's where things get confusing, and it's really important to understand the difference.
Testosterone Abuse (Steroids)
- Taking 10-100 times normal doses
- Often using multiple different drugs at once ("stacking")
- Going on and off in cycles
- No medical supervision
- Getting drugs from gyms, online, or dealers
- Clear health risks at these doses
Medical Testosterone Therapy
- Using doses that bring you to normal levels
- Prescribed by a doctor for diagnosed low testosterone
- Regular blood testing and monitoring
- Treating symptoms like fatigue, low sex drive, or bone loss
- Much lower doses than abuse
A man with genuinely low testosterone (hypogonadism) may benefit from proper medical treatment. This is NOT the same as a healthy guy taking massive doses to get huge muscles.
The problem is these two things have gotten mixed up in people's minds. The dangers of steroid abuse are real, but that doesn't mean medical testosterone therapy for legitimate conditions is equally dangerous.
The "Low T" Marketing Explosion
Around the early 2000s, testosterone prescriptions skyrocketed in the United States. Why? When testosterone gel was invented, drug companies launched a massive marketing campaign about "Low T syndrome."
Suddenly, every guy who felt a little tired saw ads telling him he might have low testosterone. Prescriptions went through the roof. In Britain, prescriptions stayed flat - they didn't buy into the marketing hype.
This created confusion. Are millions of American men truly deficient? Or did marketing convince healthy men they had a problem?
The truth is somewhere in the middle. Some men genuinely have low testosterone and benefit from treatment. Many others probably don't need it.
How Athletes Cheat the Tests
Testing has gotten sophisticated, but athletes stay one step ahead. Here's how they do it:
Testosterone Masking
They take testosterone AND epitestosterone together to keep the ratio normal. Epitestosterone is biologically inactive but keeps the test from detecting the added testosterone.
Timing
They use short-acting drugs that clear the body quickly. Cyclists would drip testosterone intravenously at night, turn it off in the morning, and be clean by testing time.
Substitution
They literally use someone else's urine. This is why collection has to be observed - yes, someone watches you pee.
Dilution
Taking diuretics to make very dilute urine that's harder to test accurately.
The Biological Passport
Newer testing creates a baseline profile of your normal levels, then watches for changes. But if you start using steroids before your baseline test, you've set your "normal" at an already-enhanced level.
What About Regular Guys at the Gym?
You don't have to be an Olympic athlete to encounter performance-enhancing drugs. Studies show that up to 25% of men at regular fitness clubs have used these substances.
Why Regular Guys Use Them
- Wanting to look better faster
- Pressure to have a perfect physique
- Seeing others with amazing results
- Believing the risks aren't that serious
- Easy availability through gyms or online
The Reality Check
If you're considering using steroids just to look better:
- The health risks are real - you're not immune just because you're younger or healthier
- The results aren't permanent - when you stop, you lose much of what you gained
- There are legal consequences - possessing these drugs without a prescription is illegal
- You're gambling with your fertility - future you might want kids
- Natural results are possible - they just take longer and more work
What Works Without Drugs?
Let's end on a positive note. You can build muscle, get stronger, and improve your body without pharmaceutical help.
The Proven Basics
- Consistent weight training - 3-5 days per week
- Adequate protein - about 0.7-1 gram per pound of body weight
- Enough calories - you need fuel to build muscle
- Good sleep - 7-9 hours nightly for recovery
- Patience - natural muscle growth takes months and years, not weeks
When to See a Doctor
If you genuinely have symptoms of low testosterone - and they're affecting your quality of life - see a doctor. Real symptoms include:
- Persistent fatigue
- Decreased sex drive
- Difficulty getting erections
- Loss of muscle mass
- Mood changes
- Decreased bone density
Get properly tested. If your testosterone is truly low, treatment under medical supervision might be appropriate.
The Bottom Line
Performance-enhancing drugs work - let's not pretend they don't. Athletes use them because they provide real advantages in strength, muscle mass, endurance, and recovery.
But they come with serious costs: heart disease, liver damage, infertility, mental health problems, and potentially shortened lifespan.
For 99% of men, the risks far outweigh any benefits. You can achieve excellent results naturally with proper training, nutrition, and patience.
If you have genuine medical issues, work with a qualified doctor who will use appropriate doses and monitor your health closely. That's completely different from abusing these drugs for cosmetic or athletic purposes.
Take Action: What You Can Do Today
Ready to build a better body the right way? Here's what to do:
- Get a physical - Know your baseline health, including testosterone levels if you have symptoms
- Start a solid training program - Consistency beats intensity
- Dial in your nutrition - You can't out-train a bad diet
- Track your progress - Take measurements and photos monthly
- Be patient - Natural results take time, but they're sustainable and healthy
Remember: the goal isn't just to look good temporarily. It's to be healthy, strong, and functional for decades to come.
Your body is the only one you get. Treat it with respect.
Have questions about testosterone, muscle building, or men's health? Talk to your doctor about evidence-based approaches that are right for you. Don't gamble with your health based on what you see online or hear at the gym.
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