Testosterone is the most important male sex hormone and influences numerous bodily functions – from regulating muscle mass and bone density to controlling libido and energy levels. It plays a key role in physical performance and recovery, which is why it is of great importance in sports and especially in bodybuilding.
While testosterone replacement therapy (TRT) under medical supervision can help men with proven hormone deficiency, testosterone is often misused in bodybuilding to increase muscle growth beyond natural levels ( Horn, 2023 ). But where is the line between medical necessity and potentially dangerous hormone abuse?
What is testosterone replacement therapy (TRT)?
Testosterone replacement therapy (TRT) is a medically indicated treatment for men with a proven testosterone deficiency (hypogonadism) ( Kanakis et al., 2023 ). Symptoms of deficiency can include:
-
Persistent fatigue and loss of energy ( Ferreira & Mendonça, 2022 )
-
Declining muscle strength and mass ( Mouser et al., 2016 )
-
Loss of libido and erectile dysfunction ( Pandit et al., 2024 )
-
Mood swings and depressive moods ( Shores et al., 2005 )
The goal of testosterone replacement therapy (TRT) is to bring testosterone levels into a normal, healthy range ( Barbonetti et al., 2020 ). This is achieved under medical supervision through controlled doses of testosterone in the form of gels, injections, or implants. Test your testosterone level now.
Important point: Medically supervised TRT keeps testosterone levels within physiological limits – that is, within the range that the body naturally produces.
If you would like to know more about the application methods of TRT, please read our article " Testosterone Therapy: Everything You Need to Know ".
Testosterone abuse in bodybuilding
While testosterone replacement therapy (TRT) serves to compensate for hormonal deficiencies, testosterone is frequently misused in bodybuilding to increase muscle mass, strength, and recovery beyond the natural maximum. This practice is not new – hormonal doping has been part of bodybuilding culture for decades and remains a widespread phenomenon today ( Andreasson & Johansson, 2019 ).
Why is testosterone misused in bodybuilding?
Many bodybuilders resort to performance-enhancing substances because they want to acquire physical attributes that would be unattainable through training, diet, and the body's own hormone production alone. The use of high doses of testosterone or anabolic steroids, often in combination with other substances (so-called "stacking"), is intended to achieve the following goals:
-
Maximum muscle growth: Testosterone accelerates protein synthesis, leading to faster muscle growth ( Griggs et al., 1989 ).
-
Faster recovery: Muscles recover faster after intense training sessions, making harder and more frequent training sessions possible ( Griggs et al., 1989 ).
-
Increased strength: Testosterone improves muscle strength, which is advantageous in competition and training ( Srinivas-Shankar et al., 2010 ).
-
Reduced body fat percentage: The hormone can help lower body fat percentage while maintaining muscle mass ( Fui et al., 2016 ).
Societal influences and the role of social media
A well-trained, muscular body is often associated with strength, masculinity, dominance, and success ( Lennon & Johnson, 2021 ; Murnen & Don, 2012 ). Bodybuilders and fitness influencers are therefore frequently seen as role models for physical perfection on social media. Adolescents and young men who feel insecure about their body image are particularly susceptible to this influence ( Murnen & Don, 2012 ).
Social media exacerbates this problem by promoting unrealistic body standards. The constant exposure to idealized body images leads to dissatisfaction with one's own body for many and can intensify the desire for rapid, drastic changes. Studies show a direct link between social media use, body image problems, and an increased likelihood of steroid abuse ( Griffiths et al., 2018 ; Fardouly & Vartanian, 2016 ).
The contradiction between health and steroid abuse
Ironically, a muscular physique is often associated with good health. Indeed, studies show that higher muscle mass correlates with a lower mortality rate ( Srikanthan & Karlamangla, 2014 ). However, when this condition is achieved through the abuse of steroids or testosterone, the health benefits are reversed.
The abuse of testosterone and anabolic steroids can have serious health consequences:
1. Hormonal dysregulation
The external administration of high doses of testosterone suppresses the body's own production. This occurs through negative feedback in the hypothalamic-pituitary-testicular axis (HPTA) system, which leads to hormonal imbalances in the long term. After discontinuation, it can take months or even years for the body to return to normal testosterone production – in some cases, this impairment remains permanent ( Rasmussen et al., 2016 ).
2. Cardiovascular risks
Testosterone abuse is associated with an increased risk of high blood pressure, arteriosclerosis, heart attack, and stroke. Studies show that anabolic steroids place a significant strain on the cardiovascular system and can particularly increase the risk of sudden cardiac death in young athletes ( Vanberg & Atar, 2009 ).
If you want to learn more about cardiovascular diseases, listen to our podcast episode: " The silent danger of cardiovascular diseases" .
3. Liver and kidney damage
Regular intake of high doses of testosterone can impair liver function and, in severe cases, lead to liver failure. The kidneys are also affected, as they have to process increased amounts of metabolic waste products, resulting in long-term strain ( Pahlavani & Veisi, 2025 ).
4. Psychological side effects
The term "roid rage" describes the increased aggression that can accompany testosterone abuse. In addition to outbursts of anger and mood swings, depressive episodes and anxiety disorders are also possible, especially after discontinuing the substances ( Hall et al., 2005 ).
5. Fertility problems
Persistently elevated testosterone levels lead to a reduction in the gonadotropic hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which are essential for sperm production. This can result in a near-complete cessation of sperm production, which in the worst case leads to irreversible infertility ( Osta et al., 2016 ).
Learn more about testosterone and its effects on fertility in our blog post “ Testosterone and fertility: How the hormone affects fertility ”.
Important distinction: TRT vs. abuse
Medically indicated testosterone replacement therapy (TRT) is often mistakenly equated with the performance-enhancing abuse of testosterone. This leads to persistent prejudices against TRT – many of which are based on outdated studies that examined the dangers of steroid abuse and did not differentiate between medically supervised therapy and uncontrolled use.
TRT: Medical necessity vs. misuse for performance enhancement
The following overview shows the clear differences between TRT and the abuse of testosterone in bodybuilding:
TRT (Testosterone Replacement Therapy)
-
Medically prescribed therapy for the treatment of clinical testosterone deficiency (hypogonadism)
-
Normal, physiological dosage to restore healthy testosterone levels
-
Goal: To improve quality of life, energy, libido, and overall health.
-
Monitoring by doctors and regular laboratory tests to minimize risks
-
Minimal side effects when used correctly
Testosterone abuse in bodybuilding
-
Independent use without medical indication , often in an illegal context
-
Supraphysiological dosage , which far exceeds natural testosterone levels.
-
Goal: Maximum muscle growth, increased strength and shorter recovery times
-
Uncontrolled use , often combined with other performance-enhancing substances
-
Increased risk of serious side effects such as hormonal imbalances, cardiovascular problems, and psychological changes.
Misunderstandings surrounding TRT: Why do the prejudices persist?
Many people automatically associate the term testosterone replacement therapy with the negative effects resulting from the abuse of steroids and other performance-enhancing substances. This is partly because:
-
Previous studies did not clarify the difference: Many older studies on the risks of testosterone were based on data from athletes who abused steroids in high doses – not on patients receiving medical TRT.
-
Media reports often focus on extreme cases: news about heart attacks, liver problems, or psychological changes caused by steroids is frequently related to "testosterone" in general, without differentiating between abuse and medical TRT.
-
The societal perception of muscularity and doping plays a role: As already mentioned, excessively muscular bodies are often admired, but at the same time also associated with doping. This leads to men who need TRT being placed in the same context.
-
Old myths persist: For a long time, it was assumed that TRT automatically increased the risk of cardiovascular disease. However, recent studies show that correctly dosed TRT under medical supervision does not increase the overall cardiovascular risk – on the contrary, it can even offer health benefits in cases of testosterone deficiency ( Yeap et al., 2024 ).
You can learn about other persistent myths surrounding the topic of testosterone in our article " Myths and Facts about Testosterone ".
Case study: From self-experimentation to medically supervised testosterone therapy
Kevin, 34, had been an ambitious amateur athlete for years. Disciplined training , a protein-rich diet, and supplements defined his daily routine. But over time, his muscle growth stagnated – despite increasing training intensity and a sophisticated plan.
Within the bodybuilding scene, he frequently heard about the positive effects of testosterone: increased strength, faster recovery, and better results. Without medical advice, he started self-medicating: 250 mg of testosterone enanthate per week, obtained through unofficial sources within the gym.
The first few months seemed promising: more power during training , better sleep, visible muscle growth. But then the first side effects appeared: mood swings, skin problems, fluctuating libido, and water retention.
Kevin researched further and came across the possibility of medically supervised testosterone replacement therapy (TRT) .
The turning point: From abuse to individual TRT
During a hormone consultation and prior blood test, Kevin had his hormone levels medically checked for the first time. Due to previous self-medication, his testosterone level was significantly above the physiological range. His body had largely shut down its own production.
After discontinuing the illegal substances, there was a seamless transition to a structured, medically supervised treatment . The testosterone dose was reduced to a healthy level , with the aim of maintaining the positive effects on vitality, training , and well-being, while simultaneously minimizing the risks.
Today, Kevin is on a stable dose of testosterone replacement therapy , which is closely monitored – including lab results, therapy monitoring, and lifestyle advice. His energy levels are stable, muscle growth is progressing steadily, and he feels confident in managing his health again.
Why this way is better
Targeted therapy under medical supervision differs significantly from uncontrolled testosterone abuse. Modern testosterone replacement therapy (TRT) does not aim to achieve unnaturally high levels, but rather physiologically meaningful levels in the upper normal range.
Kevin did not have a laboratory-confirmed testosterone deficiency in the classical sense; however, it was shown that personalized testosterone therapy can also help when symptoms such as lack of motivation, stagnant progress or exhaustion occur without having slipped into a clinically relevant deficiency.
Find clarity for yourself and easily test your testosterone levels from home.
Conclusion: A differentiated analysis is necessary.
While testosterone abuse in bodybuilding poses significant health risks, medically prescribed TRT is a safe and effective therapy for patients with testosterone deficiency. Unfortunately, persistent misconceptions often lead men with genuine health problems to hesitate to consider TRT—out of fear of social stigma or misconceptions about the risks.
🔍 Adon Health offers comprehensive hormone diagnostics and medical consultation to determine whether TRT is right for you. Learn more about safe and responsible hormone therapy!
