TRT vs Steroids: The Definitive Guide

What is the difference between TRT and steroids?

TRT and steroid use involve the same hormone. Testosterone is itself an anabolic-androgenic steroid (AAS), and US law names it in its definition of "anabolic steroid". What separates testosterone replacement therapy (TRT) from non-medical steroid use is why it is taken, how much, where it comes from and who checks the results. [1], [2]

• Diagnosis first. TRT is for men with symptoms and low testosterone confirmed on at least two morning blood tests. [21], [4]
• A replacement dose. Treatment aims to bring testosterone back into the normal range, not above it. [4], [5]
• A known product. Prescribed testosterone is an approved medicine made to regulated standards. By contrast, only 47% of 272 steroid samples collected from Dutch gym users contained the steroid named on the label. [21], [22]
• Monitoring. Guidelines check the testosterone level, hematocrit and prostate markers at set times. [4]

Non-medical use usually means several steroids (stacking) at doses far above replacement, taken to build muscle or change appearance, often without medical checks. Most people who do this are not competitive athletes but recreational weightlifters. [3], [23] The American College of Sports Medicine calls therapeutic use "an accepted mainstream treatment" and "deplores" use for sport and recreation. US labels state that testosterone "has not been shown to be safe and effective for the enhancement of athletic performance." [24], [21]

TRT vs steroids: the key numbers

This table shows the replacement doses and target levels in the US label and the main guidelines, checked in September 2026. The testosterone level each one aims for is the clearest line between replacement and excess.

[21], [4], [5], [25], [26], [27], [28]

A dash means the guideline gives no number for that column in the sections reviewed.

US and Canadian guidelines aim for the middle of the normal range, about 350–600 ng/dL (12.1–20.8 nmol/L). The BSSM aims higher, at 15–30 nmol/L (about 430–865 ng/dL), and the EAU points to the whole young-men range. They differ in how high they aim within the normal range, and the AUA, CUA and BSSM all grade the evidence for their targets as weak or conditional. For weekly injections, the guideline examples come to about 75–100 mg a week. In a 1991 trial, 100 mg of enanthate a week simply kept young men's testosterone at their own pretreatment level. The dose is adjusted by the blood level, not by how much muscle it builds. [4], [5], [25], [26], [27], [29]

What do studies report about non-medical doses?

This table describes what researchers measured or were told by people using steroids without a prescription. Each weekly amount is shown as a multiple of 100 mg a week, a typical replacement dose. These are findings, not doses to take.

[3], [22], [23], [6], [2]

Where sources disagree: the survey authors say five to 10 times a replacement dose; NIDA says 10 to 100 times. The measured averages fit the lower multiple better, but no single number applies to everyone. [6], [2], [22]

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Testosterone levels: treatment targets vs research doses

Total testosterone in ng/dL and nmol/L.

Each bar runs from 0 (left) to 2,600 ng/dL (right); the shaded part is 350–600 ng/dL, where US guidelines aim on treatment.

Treatment targets

Endocrine Society (2018)

350–600 ng/dL (12.1–20.8 nmol/L); target midway between injections

AUA (2018, reconfirmed 2024)

450–600 ng/dL (15.6–20.8 nmol/L); target on treatment

TRAVERSE trial (2023)

350–750 ng/dL (12.1–26.0 nmol/L); gel adjusted to stay in this band

Lower limit of normal (Endocrine Society)

264 ng/dL (9.2 nmol/L), harmonized assays

Research study, 2001 (not treatment)

Average trough levels in 61 healthy young men whose own testosterone was switched off, after 20 weeks of weekly enanthate.

Research dose: 125 mg a week

542 ng/dL (18.8 nmol/L)

Research dose: about 3 times replacement

1,345 ng/dL (46.6 nmol/L)

Research dose: about 6 times replacement

2,370 ng/dL (82.2 nmol/L)

US guidelines aim for the middle of the normal range. The two higher research doses gave troughs about 2 and 4 times the top of the US targets.

Is there an official cut-off for "supraphysiologic"?

No. Supraphysiologic means above the body's natural range, and we found no guideline or regulator that turns it into a milligram number. Three reference points help:

• The label's top dose. The US cypionate label's highest amount, 400 mg every 2 weeks, averages 200 mg a week. [21]
• The clinicians' view. The HAARLEM investigators, who run a Dutch clinic for steroid users, say a normal injectable replacement dose "should not exceed 100 mg per week". [7]
• A research definition. A 2025 paper proposed diagnosing lasting low testosterone after steroid use only in people who had taken at least 150 mg a week for at least six months. It is a proposal for research, not a guideline. [30]

The clearest evidence comes from blood levels. In a 2001 research study of 61 healthy young men whose own testosterone was switched off, three of the weekly enanthate doses tested were 125 mg, about 3 times and about 6 times a typical replacement dose. They gave average trough levels of 542, 1,345 and 2,370 ng/dL (about 18.8, 46.6 and 82.2 nmol/L). The 125 mg level sat inside guideline targets. The two higher doses gave troughs about 2 and 4 times the top of the US targets (600 ng/dL), well above the top of the BSSM range (about 865 ng/dL). Muscle mass rose with the dose, and so did hemoglobin, while HDL ("good") cholesterol fell. These were research doses, not treatment. [31]

How do the units work?

Testosterone levels appear in ng/dL (mostly in the US) or nmol/L (most other countries). Divide ng/dL by 28.84 to get nmol/L: 600 ng/dL is about 20.8 nmol/L. The testosterone unit converter switches between the two. Doses in this guide are weekly totals; an amount "every 2 weeks" is halved to give the weekly average.

What do "cycle", "stack", "blast and cruise", "TRT+" and "PCT" mean?

These are community and research terms, not medical ones. This section explains what they mean; it does not describe how to do any of them.

• Cycle. Cycling means "taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again", in NIDA's words. [2]
• Stack. Stacking means taking "two or more different anabolic steroids", often mixing tablets and injections and sometimes veterinary products. The Endocrine Society also describes pyramiding: raising and then lowering amounts within a cycle. [2], [3]
• Blast and cruise. Blast and cruise means "cycles with multiple high dose AAS are alternated with a lower maintenance dose", "never completely ceasing drug use". In a survey of 2,385 men using steroids, 47.3% described this pattern, and clinicians who treat steroid users list continuous use among the signs of higher-risk use. [7], [8], [6]
• UGL. An underground lab is an unlicensed maker of unapproved products.
• TRT+. We found no medical, research or regulatory definition. Online it is used for replacement-range testosterone plus another steroid, or for testosterone above the replacement range. US labels describe taking "higher doses of legally obtained testosterone than prescribed" as misuse. [21]
• PCT. Post-cycle therapy means medicines taken after a cycle to try to restart the body's own testosterone, most commonly selective estrogen receptor modulators (SERMs), human chorionic gonadotropin (hCG, a hormone that copies the brain's signal to the testes) and aromatase inhibitors. [32]

Is a "cruise" the same as TRT?

No. A cruise is the lower-dose phase of continuous non-prescribed use. It is not TRT, because it did not start with a diagnosis of low testosterone, and any low testosterone the person now has was usually caused by the steroids themselves. [7], [8]

Does PCT work?

The evidence is thin. A 2026 review concluded that "from an academic standpoint, PCT is generally not recommended because of uncertain benefits and potential risks." [32] In the US, FDA has not approved clomiphene, hCG or testosterone to treat steroid withdrawal, and no treatment for it has been tested in clinical trials. [33]

• In a UK clinic of 641 men, those who used PCT had normal hormones sooner (a median of 13 vs 26 weeks), but PCT made no difference for men who had stopped more than 3 months earlier. [34]
• In a 2026 records study of 79 men who had used steroids for 6 months or less, hormones were normal in every group by month 6. Normal sperm results at 12 months were more common with clomiphene plus hCG (87.5%) than with no treatment (58.6%), but the men chose their own treatment, so this is not a fair comparison. [35]

The medicines themselves are covered in their own guides: clomiphene, enclomiphene, tamoxifen, anastrozole and hCG. None of those guides gives a PCT schedule, and neither does this one.

Why do steroids and TRT switch off your own testosterone?

Because the brain measures testosterone in the blood and turns down its own signal when there is enough. This happens with any outside testosterone, prescribed or not, and longer use slows recovery. [21], [9], [36]

The pituitary gland releases LH (luteinizing hormone), which tells the Leydig cells in the testes to make testosterone, and FSH (follicle-stimulating hormone), which supports sperm production. When outside testosterone raises blood levels, the brain cuts both, so the testes make less testosterone and fewer sperm, and can shrink. During one steroid cycle in the HAARLEM study, 77% of men had a total sperm count below 40 million. [9]

TRT does the same, which is why the AUA says men should be told about its effect on sperm. [5] The difference comes at stopping: a man on TRT had low testosterone before he started, while a man coming off steroids usually had normal levels, and his own production has to restart from a switched-off state. US labels say people taking supratherapeutic doses "may experience withdrawal symptoms lasting for weeks or months", including depressed mood, fatigue, low libido and hypogonadotropic hypogonadism (low testosterone because the brain's signal is off). [21] The stopping TRT guide and the TRT and fertility guide cover the prescribed side.

Recovery can also be incomplete at the testes themselves. About 2 years after stopping, former users had lower Leydig cell capacity when their testes were stimulated in tests, and lower levels of INSL3, a hormone made by Leydig cells, about 32 months after stopping. [37], [38]

Why do non-medical steroids cause more harm than replacement?

Four things add up:

• Dose. Harms rise with the amount. In the 2001 dose-response study, hemoglobin rose and HDL cholesterol fell as the dose went up, and the Endocrine Society describes dose-related rises in hemoglobin and hematocrit, with polycythemia (too many red blood cells) "a frequent adverse event". [31], [3]
• Other steroids. Stacks often include oral steroids with a chemical change (17-alpha-alkylation) that makes them work as tablets. "Virtually all" steroid-related liver damage is linked to these tablets. [3]
• Unknown products. Many products do not contain what the label says (see underground testosterone). [39]
• No monitoring. In a survey of 2,385 users, 56.1% had not told their doctor about their steroid use. [6]

What does the research show?

Most of what is known about steroid harms comes from people using steroids outside medicine: volunteers followed through a cycle, national registries, surveys and case reports. The few randomized trials gave testosterone alone to healthy men for weeks. Real-world studies show links more often than proof of cause, and their results do not apply to prescribed TRT. [40], [31], [11]

Does a steroid cycle cause lasting low testosterone?

Usually not permanently, but recovery is slower and less complete than many expect, and a minority are still low years later.

This fits an expert review's summary that men who used steroids for less than a year "typically recover" within a year of stopping. [33] Former users about 2 years off also had lower testosterone (median 14 vs 19 nmol/L) and lower quality of life than non-users. [43] The stopping TRT guide covers recovery after prescribed testosterone.

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Recovery after stopping non-medical steroids, study by study

After stopping

1. About 3 months

   HAARLEM (2021, 100 men, one cycle): testosterone back to baseline in most men.

2. 6–12 months

   EAU guideline (2026): sperm numbers usually improve over this time.

3. 10.7 months

   Australian study (2020, 31 past users): average time for LH to recover.

4. 14.1 months

   Same Australian study: average time for sperm output to recover.

5. Within 36 months

   UK clinic records (2023, 641 men, one test each): 48.2% had normal LH, FSH and testosterone.

6. About 2.5 years

   Danish case-control study (2016, 33 former users): 27% had testosterone below 12.1 nmol/L (about 350 ng/dL).

HAARLEM, counted from the start of the cycle

1. During the cycle

   HAARLEM: 77% had a total sperm count below 40 million.

2. 1 year after the cycle began

   HAARLEM: 9 men (11% of those tested) still had low testosterone and 25 (34%) a sperm count below 40 million.

Each marker comes from one study, with different men and methods; no curve is drawn between them.

Do steroids damage the heart?

The evidence points strongly that way, though most of it is observational.

• Deaths. In Denmark, 1,189 men caught using steroids in gym testing were compared with 59,450 similar men for about 11 years. 33 of the users died (2.8%) against 578 of the others (1.0%), a hazard ratio of 2.81. Deaths from unnatural causes (hazard ratio 3.64) and natural causes (2.24) were both higher. The study was not adjusted for other health factors and cannot prove cause. [11]
• Heart disease. In the same Danish group, users had about three times the rate of heart attack (adjusted hazard ratio 3.00) and nearly nine times the rate of heart-muscle disease (cardiomyopathy, 8.90). They also had more heart failure (3.63), clots in veins (2.42) and rhythm problems (2.26). The abstract gives these as relative figures only, without absolute numbers, and because it is the same cohort, this is not a second confirmation. [44] In Sweden, the 409 men who tested positive for steroids, out of 2,013 men tested, had twice the rate of heart disease and death of those who tested negative (adjusted hazard ratio 2.0). [45]
• Heart structure. In 140 experienced weightlifters, the heart's pumping strength (ejection fraction) averaged 52% in steroid users against 63% in non-users, and users had more plaque in their heart arteries. [12] A 2026 review of 35 studies found pumping strength 2.25 points lower in users, and another found the largest drop, 7.39 points, in athletes who had used steroids for more than six years. [46], [47] In a Danish imaging study of men and women (61 of the 80 current users were men), soft (non-calcified) plaque in the heart (coronary) arteries showed up in 19 of 80 current users (23.8%) against 6 of 58 non-users (10.3%). [48]
• Does it recover? During a single cycle in HAARLEM, pumping strength fell 4.9% and was back to baseline a median of 8 months after stopping. [49] The HAARLEM researchers describe the effects they measured as "generally reversible", with acute life-threatening toxicity rare, in healthy men doing one cycle. [50] But in another study, mildly reduced blood flow in the heart's small vessels was about as common in former users (8 of 31) as in current users (9 of 32), against 1 of 27 non-users. Clearly impaired flow was seen in 6 of 32 current and 1 of 31 former users. [51]

Most of these studies compare users with non-users at one point in time, and users often differ in other ways, such as other drugs and risk-taking. [11]

Does TRT carry the same heart risk?

The largest trial of prescribed testosterone did not find more heart attacks or strokes. TRAVERSE randomly assigned 5,204 men aged 45 to 80 with low testosterone and existing heart disease or high heart risk to daily testosterone gel or placebo gel. Heart attack, stroke or cardiovascular death (MACE) occurred in 7.0% of men on testosterone and 7.3% on placebo (hazard ratio 0.96), which met the trial's safety goal. [13]

Some problems were more common on testosterone: atrial fibrillation 3.5% vs 2.4%, acute kidney injury 2.3% vs 1.5%, and pulmonary embolism 0.9% vs 0.5%. [14] Its limits matter too: it tested only a daily gel, men used it for an average of 21.7 months, about 61% stopped their study gel early, and it enrolled men already at high heart risk. [13], [14]

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TRAVERSE: absolute results

Testosterone gel (2,596 men)Placebo gel (2,602 men)

Heart attack, stroke or heart death

Testosterone 7.0% vs placebo 7.3% (182 vs 190 men; hazard ratio 0.96, 95% CI 0.78–1.17; met the 1.5 safety margin)

Nonfatal rhythm problems needing treatment

Testosterone 5.2% vs placebo 3.3%

Atrial fibrillation

Testosterone 3.5% vs placebo 2.4%

Clinical fracture

Testosterone 3.5% vs placebo 2.5% (91 of 2,601 vs 64 of 2,603 in the full analysis set)

Acute kidney injury

Testosterone 2.3% vs placebo 1.5%

Venous clots (all)

Testosterone 1.7% vs placebo 1.2%

Pulmonary embolism

Testosterone 0.9% vs placebo 0.5%

About 5,200 men aged 45–80 at high heart risk; daily gel; mean treatment 21.7 months; about 61% stopped their study gel. Not a trial of injections.

The two cannot be compared directly: TRAVERSE tested replacement doses in older men under medical care, while the steroid studies describe younger men using far higher doses of several drugs. Neither result transfers to the other group. In February 2025 FDA told the makers of all testosterone products to add the TRAVERSE results to their labels and remove boxed-warning language about increased heart risk. Newer brand labels carry the results, but the Depo-Testosterone vial label (August 2026 version) still says long-term heart-safety trials "have not been conducted". Checked September 2026. [52], [21] The TRT and heart health guide covers the trial in full.

What happens to blood pressure, cholesterol and red blood cells?

They all move in the wrong direction during a cycle, and mostly move back afterwards. In HAARLEM, systolic blood pressure rose by an average of 6.9 mm Hg during a cycle, and hematocrit rose by 0.03 L/L (3 percentage points). HDL cholesterol fell by 0.40 mmol/L (about 15 mg/dL), and LDL ("bad") cholesterol rose by 0.45 mmol/L (about 17 mg/dL). Three months after the cycle, all were back to baseline. [53] The same study found no clear shift toward faster blood clotting. [54]

An expert review lists very low HDL cholesterol, very low SHBG (a protein that carries testosterone in the blood) and an unexplained high red-cell count as clues that someone is using steroids. [33] Prescribed testosterone affects some of these markers too: FDA says blood-pressure studies confirmed "an increase in blood pressure with use of all testosterone products", and hematocrit is one of the main safety checks on TRT. [52], [21] See the hematocrit on TRT guide.

Do steroids cause "roid rage", and are they addictive?

"Roid rage" is not a medical term, and the trials disagree. In a crossover trial, 50 men received 6 weeks of testosterone rising to about six times a typical replacement dose. Of these, 84% had minimal psychiatric change, 12% became mildly hypomanic (unusually elevated, energetic or irritable mood) and 4% markedly so. [55] In another trial, 43 men were randomly assigned to the same dose or to placebo injections for 10 weeks, and "neither mood nor behavior was altered". [40] Both used testosterone alone in screened volunteers, which is not how most people use steroids. US labels list hostility, aggression, mania and major depression among the serious reactions reported with steroid abuse. [21]

Dependence is common. About 30% of users may develop it, according to the Endocrine Society; pooled studies put it at 32.5%, and a 2023 meta-analysis of 18 studies at 34.4%. [3], [56], [57] In HAARLEM, 48% of men described themselves as addicted, and 65% used again in the second year. [22], [58] In a large survey, 60% of attempts to stop failed. [6] Withdrawal is common too: in a UK survey, 95.1% of men who had stopped reported at least one symptom, most often low mood (72.9%), tiredness (58.5%) and low libido (57.0%). [59] Steroid users also report more symptoms of muscle dysmorphia, a preoccupation with not being muscular enough. [60]

For prescribed TRT, US labels state that "drug dependence in individuals using approved doses of testosterone for approved indications has not been documented." [21]

What about the liver, kidneys, tendons and skin?

• Liver. Serious liver damage is linked almost entirely to oral 17-alpha-alkylated steroids. The US label for oxandrolone warned of peliosis hepatis (blood-filled cysts in the liver), liver tumors and cholesterol changes. [3], [61] Testosterone labels also note rare reports of liver cancer with long-term, high-dose androgen use. [21]
• Kidneys. A case series described 10 bodybuilders with long-term steroid use and kidney damage. Biopsies showed scarring of the kidney filters (focal segmental glomerulosclerosis) in 9, and one of 8 men followed for about 2 years progressed to end-stage kidney disease. A case series cannot show how often this happens. [62]
• Tendons. Among 142 bodybuilders, 22% of steroid users had torn a tendon at some point, against 6% of non-users. [63]
• Skin, breasts and libido. Over one year in HAARLEM, every man reported at least one unwanted effect, including acne (28%), breast growth (gynecomastia, 19%) and low libido after the cycle (58%). Four of the 100 had a serious event: heart failure, pancreatitis, suicidal thoughts or a flare of bowel disease. [64]
• Injuries. Danish users had more than twice the rate of fractures in the following year (adjusted hazard ratio 2.23), and any injury was 7.8 percentage points more common than in similar men. [65]
• Not everything rises. The Danish users did not develop diabetes more often (2.0% vs 2.3%), and a small study found only subtle changes in breathing during sleep. [66], [67]

Do the muscle gains last?

Mostly not. In a 2026 study of 79 men followed through a self-chosen cycle, fat-free mass rose by an average of 4.4 kg during the cycle, but only 1.2 kg remained three months after stopping. The authors concluded that "most gains are lost within months." [68] For what prescribed testosterone does to muscle, see the TRT muscle and fat guide.

How common is non-medical steroid use?

A 2014 meta-analysis estimated that 3.3% of people worldwide (6.4% of men) have used steroids at some point, although the surveys varied hugely. [69] A 2014 estimate put the number of Americans aged 13 to 50 who had used them at 2.9 to 4.0 million, of whom about 1 million may have become dependent. [56] In 2022, 1.3% of US 12th graders reported misusing steroids in the past year. [2]

Is TRT safer than steroids?

At replacement doses, with a confirmed diagnosis and monitoring, TRT has a known and much smaller set of risks than non-medical steroid use. This section covers prescribed testosterone; the steroid risks are in the research section.

Is TRT safe?

Its risks are well described and monitored for, but it is not risk-free. The main safety checks are blood pressure and red blood cells, and guidelines add the effect on sperm production described above. TRAVERSE, which tested a daily gel for an average of 21.7 months, found no increase in heart attacks or strokes (7.0% vs 7.3%). It did find more atrial fibrillation (3.5% vs 2.4%), acute kidney injury (2.3% vs 1.5%) and pulmonary embolism (0.9% vs 0.5%) (details above). [52], [21], [5], [13], [14] Since 2016 all US testosterone labels have also carried a warning about abuse and dependence. They tell prescribers to counsel patients on the serious reactions linked to abuse, and to consider abuse in patients who have a serious heart or psychiatric event. [70], [21] The TRT side effects guide covers the full list.

Who should be especially cautious?

• Men who have recently used steroids. Blood tests taken during or soon after use do not show your natural level, and an expert review suggests considering TRT only if symptoms and low testosterone persist after at least 12 months off. [21], [71]
• Men who want children now or soon. Both TRT and steroids lower sperm production. The AUA says testosterone should not be prescribed to men trying to conceive, and the EAU says not to use it to treat male infertility. [5], [27] See TRT and fertility.
• Men with a high hematocrit, untreated severe sleep apnea or high blood pressure. The Endocrine Society lists the first two as reasons for caution or not to start, and all testosterone products raise blood pressure. [4], [52]
• Men with a history of depression, because mood often drops during steroid withdrawal. [41]
• Drug-tested athletes. Testosterone is prohibited at all times. [19]
• Under-18s. Testosterone for teenagers belongs only in specialist care. US labels report that steroid abuse in adolescents has caused early closure of the bones' growth plates, ending growth. [21]
• Women. This guide is written for men. For testosterone treatment in women, see testosterone therapy for women.

Which medicines interact with testosterone and other steroids?

• Blood thinners. US labels say androgens may increase sensitivity to oral anticoagulants such as warfarin, so the anticoagulant dose may need lowering. [21]
• Diabetes medicines. Androgens may lower blood sugar and insulin needs in people with diabetes. [21]
• Other steroids. Adding oral steroids adds their effects on HDL cholesterol and the liver, and extra steroids add to the rise in red blood cells. [3], [53]

Bring a complete list of what you take, including anything not prescribed, to a pharmacist or prescriber. Checked September 2026.

Is it legal to use steroids or testosterone?

Checked September 2026. Laws differ by country and change.

• United States. Testosterone and its esters are Schedule III controlled substances. Possessing a controlled substance without a valid prescription is a federal crime; a first offense can mean up to 1 year in prison, a minimum $1,000 fine, or both. A 2014 law (the Designer Anabolic Steroid Control Act) widened the legal definition of anabolic steroids. No proposal to deschedule testosterone has been published. [15], [72], [73]
• United Kingdom. Testosterone and its esters are Class C drugs. Possessing anabolic steroids for personal use is not an offense, and bringing them into the country is allowed only when you carry them in person for your own use, so steroids posted from abroad are not covered. Supplying them can mean up to 14 years in prison. [16], [74], [75]
• Canada. Testosterone is a Schedule IV controlled substance. Simple possession is not an offense, but importing, exporting or trafficking it without authorization is. [17]
• Australia. Testosterone is a Schedule 4 prescription-only medicine, and possessing anabolic steroids without authority is illegal. Importing them needs written permission, except your own prescribed medicine carried with you when you travel, an exception that athletes cannot use. [18], [76]
• Europe. Rules vary. Germany bans possessing more than a small amount of testosterone for doping in sport; Sweden bans importing, possessing or using it except for medical or scientific purposes; and Denmark allows possession only with a prescription. [77], [78], [79]

A prescription makes testosterone legal to possess for the person it was prescribed to; it does not make extra, non-prescribed testosterone legal. [72]

Is testosterone allowed in sport?

No. The World Anti-Doping Agency (WADA) prohibits testosterone at all times, and its 2027 list, published in September 2026, keeps the ban. [19], [80] An athlete with low testosterone can apply for a therapeutic use exemption, but WADA grants it only for low testosterone from a structural or genetic cause. It does not grant one for low testosterone caused by age, obesity or past use of anabolic steroids or selective androgen receptor modulators (SARMs). [20] Aromatase inhibitors and SERMs, often used during or after cycles, are themselves prohibited in sport. [32], [19] Testing labs track each athlete's urine steroid profile over time as part of the Athlete Biological Passport. [81]

What do guidelines say about stopping steroids and starting TRT?

We found no 2020–2026 medical society guideline on prescribing TRT to current or former steroid users. What exists is a European fertility recommendation, expert reviews from clinicians who treat steroid users, the product labels and the anti-doping rules. This section describes what they say; it is not a personal plan.

What happens when you stop steroids?

Your own testosterone has to restart, which takes months. Withdrawal symptoms such as low mood, fatigue and low libido can last "for weeks or months", and they are a common reason men go back to steroids. [21], [82]

• For fertility, the EAU says low sperm counts caused by steroids "should initially be treated by withdrawal" and usually improve "over a six to twelve-month period". It suggests waiting six to 12 months after stopping before considering fertility medicines (a weak recommendation). [83]
• For symptoms, FDA has not approved clomiphene, hCG or testosterone to treat steroid withdrawal in the US, and no treatment has been tested in trials. [33]
• For mood, withdrawal often includes depression, and in one study 29% of former long-term users had major depression during withdrawal. Severe low mood or thoughts of self-harm need prompt medical help. [82], [41]

Repeated morning tests of testosterone, LH and FSH over the following months show whether your own production is coming back; a single result soon after stopping says little. [33], [34]

Can you get TRT after using steroids?

Sometimes, but not straight away. Guidelines diagnose low testosterone (hypogonadism) with symptoms and at least two low morning tests, which only mean something once your own system has had time to restart. [4], [21]

• An expert approach from Dutch clinicians who treat steroid users says TRT should be considered "only in cases where biochemical hypogonadism with symptoms persists after at least 12 months of abstinence". [71]
• Another expert review lists switching to prescribed testosterone as one option for men who cannot stop, while noting that no approach has been tested in trials. [33]
• Labels warn that testosterone levels "may be in the normal or subnormal range" in men using synthetic steroids other than testosterone, so a normal result does not rule out use. [21]

The low testosterone guide and the starting TRT guide cover how low testosterone is diagnosed and what the first steps are.

Does fertility come back after steroids?

For most men, yes, given time, but not for all. The EAU says sperm counts usually improve over 6 to 12 months after stopping. [83] A year after the cycle began, 25 HAARLEM participants (34% of those tested) still had a total sperm count below 40 million. [9] One clinic study followed men with past anabolic steroid or testosterone use who were treated with clomiphene and hCG. Of 18 men with no sperm at the start, 27.8% still had no sperm at 6 months, and 9 of 24 couples who reported back had a pregnancy. [84] Guidelines say testosterone is not a fertility treatment. [27] The TRT and fertility guide covers semen testing and the medicines used.

Should you tell your doctor about steroid use?

Yes, if you want your results read correctly: past or current use changes what testosterone, LH, FSH, hematocrit and cholesterol results mean. In a survey of 2,385 users, 56.1% had not told their doctor. [6] A review of steroid harms says "all men should be encouraged to stop", and in a Dutch study, 12% of men who had a harm-reduction consultation before a planned cycle decided not to start it. [85], [86]

What else do people ask about TRT and steroids?

Is 200 or 250 mg a week TRT or a cycle?

It depends on the level it produces and whether a diagnosis came first, but 250 mg a week is above every guideline's starting dose. The Endocrine Society starts at 75–100 mg a week, the AUA's example is 100 mg weekly, and the US label's highest dose averages 200 mg a week. [4], [5], [21] Guidelines judge a dose by the blood level it produces. In the 2001 research study, a weekly dose about 3 times a typical replacement dose gave average troughs of 1,345 ng/dL. That is more than twice the top of the US targets (600 ng/dL) and about 1.6 times the top of the BSSM range (about 865 ng/dL). [31], [26] A dose that keeps levels above the normal range is no longer replacement, whatever it is called. The TRT dosage guide covers prescribed doses in detail.

Is underground-lab testosterone the same as pharmacy testosterone?

No. Unlicensed products often do not contain what the label says:

• Counterfeit or substandard. A 2022 meta-analysis of 19 studies (5,413 samples, mostly seized by police or customs) found 36% of black-market steroids were counterfeit and, separately, 37% substandard. The counterfeit figure comes from 18 studies and the substandard figure from 8, so the two cannot simply be added. [39]
• Wrong or missing ingredient. In Denmark, 25–34% of seized products had no active ingredient or the wrong one, though only 7–10% had none or one from a different drug class. [87]
• Contamination. Bacteria grew from 2 of 22 used vials and 1 of 41 unused ampoules and vials sent in by users. [88] In December 2025, Health Canada warned that seized unauthorized testosterone products had "not been assessed for safety, efficacy, and quality" and may contain unlisted contaminants. [89]
• Injecting risks. In a UK survey of men who inject performance drugs, recruited at needle programs, 1.5% had HIV, 9% had signs of past or current hepatitis B and 5% had hepatitis C antibodies. In another UK survey, 42% had ever had redness, swelling or tenderness at an injection site and 6.8% an abscess or open wound. [90], [91]

Is Anavar (oxandrolone) approved?

Not any more in the US. FDA withdrew approval of Oxandrin (oxandrolone) on June 28, 2023, and later determined it had been withdrawn "for reasons of safety or effectiveness", so FDA will not approve generic versions. An FDA advisory committee had unanimously found "no evidence of efficacy" for it in 1984. [61], [92] Checked September 2026.

What about nandrolone (Deca)?

Nandrolone decanoate (Deca-Durabolin) is an injected steroid that was approved in the US; FDA determined in 2010 that it was not withdrawn from sale for safety or effectiveness reasons. [93] We could not confirm whether any nandrolone product is currently marketed in the US or UK (checked September 2026). Prescribed or not, it is an anabolic steroid, and adding it to testosterone is not replacement therapy.

Are SARMs steroids?

Not chemically, but they act on the same receptor. SARMs are "chemical substances that mimic the effects of testosterone and anabolic steroids" and are not approved by FDA. FDA considers products containing them unapproved drugs, not supplements, and links them to heart attack or stroke, liver injury, psychosis and infertility. [94] Anti-doping rules treat past SARM use like past steroid use. [20]

What do people in public communities report about TRT and steroids?

Public testosterone forums mix men on prescribed TRT with men using steroids for muscle, and the same words mean different things to each group. The threads below are recent public Reddit discussions, read with their replies. They show what people describe, not how often anything happens, and this guide does not repeat the doses of non-prescribed use that posters mention.

Where do people draw the line between TRT and a cycle?

The label itself is argued over constantly. One poster urged men already on TRT to push their levels above the natural range and call it "TRT+". Replies listed high blood pressure, high hematocrit, water retention and high estrogen at those levels, several men said they felt better at lower doses, and one wrote that it was not TRT+ but "good ole steroid use". [95] When another man described adding a second steroid to his testosterone as a "TRT+ strategy", the top reply called it a steroid cycle and TRT+ "a silly term". [96] A man whose clinic had prescribed nandrolone alongside his testosterone for joint pain called it TRT+; one reply said it was still a steroid, whoever wrote the prescription. [97]

Others argue about whether the dose or the blood level decides it; one poster said many people use "TRT" and "cruise" to mean the same thing. [98] A man whose testosterone was already in the normal range asked whether to start "TRT" or a cycle; replies said he would not be replacing anything, and he decided to wait for new blood tests. [99] Another later said that calling his planned cycle "TRT" had been a mistake. [100]

What do men on TRT report when they add more?

A recurring pattern is a man stable on a replacement dose who plans to add more. Two men on a prescribed 100 mg a week bought underground testosterone to raise their dose; one found it much thinner than his pharmacy supply and was not sure he could trust the seller's test results. [101], [102] Several asked how a planned cycle would look on the blood tests their prescriber ordered, and one said his specialist would stop prescribing if he saw it. [101], [103]

Accounts of adding more often end with a step back. One man said a higher testosterone dose had pushed his hematocrit and estradiol too high, and that an oral steroid gave him no major extra benefit but a worse cholesterol profile. [104] Another spent five months well above his prescribed dose and reported strength gains alongside collapsed libido, heavy bloating and poor focus; three weeks after cutting back, his libido had returned, and his conclusion was that "more is not better". [105] A man who added a product sold as a different steroid saw his testosterone, dihydrotestosterone (DHT) and estradiol results rise unexpectedly, with severe acne, and was left unsure what the vial had contained. [106]

What problems do people describe during a cycle?

Blood test changes are the most common worry. One man described his HDL cholesterol "crashing" on an oral steroid. [107] Another had very low HDL, raised liver enzymes and very high testosterone and estradiol results on a multi-steroid cycle, and one reply noted that another of his steroids can distort the estradiol test. [108] A third had heart palpitations on a combination of four drugs, which replies said made it impossible to tell which one was responsible. [109] A young man on his first cycle listed spreading acne, flushing and gut problems and decided the side effects outweighed the benefits. [110] Another developed cystic acne on his back and chest about two months after a cycle ended, bad enough to bleed through his clothes; it improved on an antibiotic his doctor prescribed. [111]

What do people report after stopping?

Recovery stories run in both directions. Some men felt normal again fairly quickly. One reported stronger libido than before two months after a short cycle, without blood tests. Another reported his testosterone back at his natural level less than two months after tapering off, and a third found his level higher 11 months after stopping than just after, with no pre-cycle result to compare. [112], [113], [114] After about six years of continuous use, one man had a very low but detectable sperm count two weeks after his last injection and his LH signal returning by four weeks, with repeat semen testing still to come. [115]

Others did not recover as they hoped. One man who had tested normal before cycling found, 20 months after stopping, his total testosterone about half and his LH about a third of his pre-cycle values, although a brief later use of testosterone complicated the picture. [116] A year after his first cycle, another man said his testosterone had climbed from a very low point but he still felt depressed, exhausted and without libido. He had stopped daily cannabis at the same time, which made the cause hard to judge. [117] Others described low libido five months after post-cycle tablets, or hormone results that were lower after a course of those tablets than before it. [118], [119] One recovery diary described two mostly normal weeks after the last injection, then a sharp fall in energy, mood and libido, and feeling mostly better by weeks 9 to 10. [120]

What do former users say about TRT later?

Some men who start prescribed TRT after years of steroid use describe a smaller response than they hoped for. A man who stopped steroids more than 20 years earlier said nearly a year of TRT, with levels in the upper part of the range, had improved his symptoms only slightly; replies split on whether his past use mattered. [121] A man in his mid-20s who had cycled from age 18 said his libido stayed almost absent on a prescribed 100 mg a week. [122] Another, who had started testosterone on his own before his endocrinologist finished testing, worried that the lower results afterward would complicate his diagnosis. [123] One man said a doctor had chastised him for mentioning that he had been prescribing testosterone for himself; he was seeing a sleep specialist before deciding whether to restart. [124]

Cost pulls some men toward unregulated supply: a man unhappy with his clinic's prices weighed an online clinic against underground testosterone, and replies split between price and a legal, prescribed supply. [125]

How can you judge a TRT or steroid story?

Ask: Was low testosterone confirmed with two morning tests before anything started? What exactly was taken, from what source and for how long? Did other drugs, weight-loss medicines, alcohol, cannabis, sleep or training change at the same time? Are there results from before, during and after, drawn at comparable times? How long after the last injection was recovery judged? And what did the next test show?

These selected discussions show what people experience and the questions research has not answered. They are not a survey of all men on TRT or all steroid users, a success rate or a substitute for the studies above.

What should you track?

What to track depends on where you are: on prescribed TRT, or recovering after steroids. Use this summary to prepare questions for your clinician; it is not a personal testing plan.

[4], [33], [21], [53], [52], [83], [59]

Because the time of day, the time since the last injection and recent steroid use all move the numbers, a series of morning results drawn under similar conditions says more than any one test. The TRT blood work guide explains when to draw each test.

Common questions about TRT and steroids

Is TRT a steroid?

Yes. Testosterone is an anabolic-androgenic steroid, and US law names it in its definition of anabolic steroids. The difference between TRT and steroid use is medical: TRT follows a confirmed diagnosis, uses a replacement dose aimed at the normal range, comes from a pharmacy and is monitored with blood tests. Non-medical use usually means far higher doses of several steroids with no diagnosis or monitoring. [1], [4], [3] See the difference.

Will one steroid cycle shut down my testosterone for good?

Usually not, but it can take months, and some men stay low. In a Dutch study of 100 men doing one cycle, testosterone was back to baseline 3 months after the cycle in most, but 9 of the men tested (11%) still had low testosterone a year after the cycle began. About 2.5 years after stopping, 27% of former users in a Danish study were still below 12.1 nmol/L. Longer use and more drugs make recovery slower. [9], [10], [34] See the recovery research.

Can former steroid users get TRT?

Sometimes, once the steroids have cleared and your own system has had time to restart. An expert approach from clinicians who treat steroid users suggests considering TRT only if symptoms and low testosterone persist after at least 12 months off. No medical society has a specific guideline on this, and anti-doping rules do not accept past steroid use as a reason for a testosterone exemption. [71], [20] See what guidelines say.

Is TRT addictive?

Not at prescribed doses, as far as is known. US labels state that dependence has not been documented in people using approved doses for approved uses. Non-medical steroid use is different: about a third of users develop dependence, and withdrawal symptoms are common. [21], [57], [59] See dependence.

Do steroids cause "roid rage"?

Sometimes, but not in most people in trials. At about six times a typical replacement dose of testosterone alone, one trial found that 84% of 50 men had minimal psychiatric change while 16% became hypomanic; another found no change in mood or behavior. Labels list hostility and aggression among the reactions reported with steroid abuse, often alongside other drugs. [55], [40], [21] See the research.

Glossary

Plain explanations of the medical, legal and research terms used in this guide. Underlined terms in the text link here.

Anabolic-androgenic steroid (AAS)

A drug that acts like testosterone, building muscle (anabolic) and producing male traits (androgenic). Testosterone itself is one; nandrolone and oxandrolone are others.

Aromatase inhibitor

A medicine, such as anastrozole, that blocks the enzyme that turns testosterone into estradiol.

Blast and cruise

Community slang for continuous non-prescribed steroid use: high-dose periods (blasts) alternated with lower-dose periods (cruises), never fully stopping. It is not a medical treatment.

Cohort study (records study)

A study that follows a group of people, or looks back at their records, without assigning treatments. It can show links but not prove that one thing caused another.

Controlled substance

A medicine whose prescribing and possession are restricted by law because it can be misused. Testosterone is Schedule III in the US, Schedule IV in Canada and Class C in the UK.

Controlled trial

A study that compares people who receive a treatment with a similar group who do not, often receiving a placebo instead. Randomly assigning people to each group makes the comparison fairer.

Cycle

In the steroid community, a period of non-prescribed steroid use followed by a break before any further use.

Dependence

A pattern in which a person keeps using a drug despite harm, finds it hard to stop, or has withdrawal symptoms when stopping. About a third of non-medical steroid users develop it.

Ejection fraction

The share of blood the heart's main pumping chamber pushes out with each beat. A lower value means weaker pumping.

FSH (follicle-stimulating hormone)

A pituitary hormone that acts on the cells supporting sperm production. Testosterone therapy lowers it.

Gynecomastia

Growth of breast tissue in men, often tender at first. It is linked to a higher estrogen-to-testosterone balance.

Hazard ratio

A measure comparing how often an event happens over time in two groups. A hazard ratio of 1 means no difference; 0.96 means about 4% lower in the first group.

hCG (human chorionic gonadotropin)

A hormone that acts like LH, telling the testicles to make testosterone and support sperm production. It is an approved medicine used in some fertility treatment.

Hematocrit

The share of the blood made up of red blood cells. Testosterone raises it, and most guidelines act when it reaches about 54%.

Hypogonadism

Low testosterone caused by a problem in the testicles or in the brain and pituitary signals that control them, confirmed with symptoms and repeated morning blood tests.

Hypogonadotropic hypogonadism

Low testosterone because the brain and pituitary send too little LH and FSH to the testicles. It can be present from birth or start later. Also called secondary hypogonadism.

Leydig cells

Cells in the spaces between the testicle's tubules that make testosterone when LH or hCG reaches them.

LH (luteinizing hormone)

A pituitary hormone that tells the testicles to make testosterone. Testosterone therapy switches it off.

MACE (major adverse cardiovascular events)

A combined measure used in heart-safety trials. In TRAVERSE it meant heart attack, stroke or death from heart disease.

Meta-analysis and systematic review

A systematic review gathers all studies on a question in a planned way. A meta-analysis combines their results statistically.

Placebo

A dummy treatment with no active ingredient, used as a comparison in studies.

Polycythemia (erythrocytosis)

Too many red blood cells, shown by a high hematocrit. Testosterone therapy is a common cause.

Post-cycle therapy (PCT)

Drugs taken after an anabolic-steroid cycle to try to speed the return of the body's own testosterone, most commonly SERM tablets, hCG and aromatase inhibitors. The schedules used online have not been tested in trials.

SARM (selective androgen receptor modulator)

A lab-made drug designed to act on the same receptor as testosterone. None is approved by FDA, which treats products containing them as unapproved drugs.

SERM (selective estrogen receptor modulator)

A tablet, such as clomiphene, enclomiphene or tamoxifen, that blocks estrogen's feedback in the brain so the pituitary releases more LH and FSH.

SHBG (sex hormone-binding globulin)

A blood protein that carries testosterone. Testosterone bound to it is not immediately available to tissues, so SHBG affects how much free testosterone there is.

Stacking

Taking two or more steroids at the same time, often mixing tablets and injections.

Supraphysiologic

Above the body's natural range. No guideline sets a milligram cut-off for testosterone; a dose that keeps levels above the normal range is supraphysiologic.

Therapeutic use exemption (TUE)

Permission from an anti-doping body for an athlete to use a prohibited medicine for a genuine medical need. For testosterone, WADA grants it only for low testosterone with a structural or genetic cause.

Trough level

The lowest level of a drug in the blood, measured just before the next dose.

TRT (testosterone replacement therapy)

Prescribed testosterone, by injection, gel or other forms, for men with low testosterone. It switches off the brain's LH and FSH signals.

Underground lab (UGL)

An unlicensed maker of steroids and other drugs. Its products are not approved, inspected or tested by a regulator.

WADA

The World Anti-Doping Agency, which publishes the list of substances banned in sport. Testosterone is banned at all times.

How this guide was researched

This guide is built from a thorough review of the sources cited throughout it: clinical guidelines, US product labels, laws and regulator notices from several countries, anti-doping rules, and published studies of people using steroids with and without a prescription. We also reviewed public online forums where people describe their own experiences with TRT and steroids.

The guide cites 125 sources, including 42 original studies in people, 25 guidelines, reviews and expert statements, 27 labels, laws and regulator documents, and 31 public community discussions. Each type of source answers a different question. Guidelines and labels show what clinicians are told to do. Studies show what researchers measured, mostly by following people who chose to use steroids. Personal accounts show what individual people experienced. Every numbered citation links to its entry below, labeled by source type.

How this guide was made

Research and drafting were AI-assisted. Every cited source was checked against the original, and the guide was reviewed and edited by Doserly before publication. It has not had an independent clinical review, and Doserly does not currently have medical reviewers. Doserly makes a medication and health-tracking app and runs Doserly Academy, both of which are promoted in this guide. Read our editorial policy for how guides are researched, updated and corrected.

This guide is for educational purposes. It summarizes what the reviewed sources report so the research is easier to understand; it is not medical advice, and it does not describe how to use steroids. For a deeper dive, or to check any point for yourself, go straight to the cited sources.

Explore the sources