The desire for a sculpted physique is driving some amateur gymgoers to experiment with synthetic steroids - specifically, testosterone supplements. This trend is largely being driven by social media, with thousands of posts discussing ways to boost testosterone levels, and high-profile influencers promoting the supposed benefits of using the synthetic hormone - and even recommending products that anyone can purchase online without a prescription.
Author
Colin Michie
Deputy Lead, School of Medicine, University of Central Lancashire
But while synthetic testosterone might improve your appearance in the short term, its long-term consequences to your health should not be ignored.
Testosterone is a steroid hormone that plays a role in the function of all of our organs. Both men and women produce testosterone, though men's bodies have about 15 times more circulating testosterone than women.
Not only does testosterone drive sexual development and puberty, it also helps us build lean muscle mass and controls bone growth. This improves our strength, athletic endurance and cardiovascular fitness.
Many factors can naturally increase testosterone production - including exercise, stress and sex.
But using a synthetic testosterone supplement to boost levels - especially in amounts that exceed those produced by the body - will have many effects on your health.
Initially, it may lead to an increase in sex drive and help your body build more muscle mass over several months. It may also cause acne, male-pattern balding and breast enlargement in men. Women may experience amenorrhea (loss of their period), an increase in body hair, deeper voice and enlargement of the clitoris.
But these side-effects are minor when compared with the serious consequences that long-term, 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 it harder for the heart to perform, increasing risk of sudden death. Cardiovascular changes persist in the majority of abusers.
Damage to the liver and kidneys frequently develops in people who use steroids long-term.
Testosterone has psychological effects, too - including increased aggression, depression and anxiety.
Crucially, testosterone supplements turn off the normal drives for this hormone in the brain. This causes hypogonadism, a condition where the tissues that normally produce testosterone shrink. In men, this leads to a fall in sperm count and testicular volume.
Hypogonadism also contributes to a wide range of withdrawal effects. Some of these symptoms include depression and reduced libido - unless, of course, more testosterone is used.
Many men who have abused steroids will become hypogonadal and require life-long testosterone replacement as a result.
Growing problem
The International Olympic Committee and World Anti-Doping Agency prohibited testosterone and other anabolic steroids following the 1972 Olympics. Their reasoning was that although these agents increase physical performance, they also have serious consequences on health.
Yet more than 40 years after that international ban, anabolic steroid use continues among some athletes. For example, between 29% and 43% of professional athletes in Iran were reported to have abused these agents in 2021. And an Australian study of 32 athletes (mostly women) in 2023 found that around 43% of those interviewed had reported using performance- and image-enhancing drugs.
However, professional athletes are now just a small proportion of a global doping problem. Cosmetic uses of testosterone by non-athletes who want to improve their self-confidence and physical appearance mean that abuse of anabolic steroids is now a public issue. Some reports estimate that around 1 million people take steroids such as testosterone in the UK.
But given the well-known risks and harms of using testosterone, why would anyone choose to use it - and continue to use it even when they experience serious health problems? This is a question that experts have been trying to answer for years.
Perhaps one reason is that users perceive health issues to be a future problem - and that these issues are an acceptable risk to take if it means a better performance or appearance in the short-term.
Addiction to anabolic steroids may play a role, as it may influence judgment and minimise awareness of the potential harms.
The "Goldman dilemma" may also provide some insight. Between 1982 and 1995, Bob Goldman, a physician and publicist, put a Faustian hypothetical question to elite athletes: would they be willing to take a magic pill that would ensure Olympic gold medal success, but which would also cause their death five years later?
He reported that about half the athletes interviewed accepted the "gold for death" option. In a 2012-13 repeat of the study, this proportion was smaller, at 7-14%, - with elite athletes the most likely to choose "gold for death".
It's undeniable that abuse of testosterone and its synthetic mimics can lead to harm, yet many continue to abuse it. International bans have not been effective. With a growing number of non-athletes abusing testosterone, more needs to be done to inform the public of its many consequences to health in the long term.
Colin Michie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
