Testosterone supplements: the health risks of steroid abuse

The pursuit of a more sculpted body is leading some recreational gym users to try synthetic steroids, particularly testosterone supplements.

Social media is a major force behind this trend. Thousands of posts explore methods of raising testosterone levels, while prominent influencers promote the claimed advantages of the synthetic hormone and sometimes recommend products that can be bought online without a prescription.

Although synthetic testosterone may alter your appearance in the short term, the potential long-term effects on health must not be overlooked.

Testosterone is a steroid hormone involved in the functioning of every organ in the body. Men and women both make testosterone, although men have around 15 times more testosterone circulating in their bodies than women.

As well as driving puberty and sexual development, testosterone supports the development of lean muscle and regulates bone growth. These functions contribute to strength, sporting endurance and cardiovascular fitness.

A range of factors can raise testosterone production naturally, including exercise, stress and sex.

However, taking a synthetic testosterone supplement to elevate levels, particularly at doses above those the body produces itself, can affect health in numerous ways.

How synthetic testosterone affects the body

At first, synthetic testosterone can increase sex drive and enable the body to build greater muscle mass over a number of months. It can also result in acne, male-pattern baldness and breast growth in men. Women may develop amenorrhoea, meaning the loss of periods, alongside increased body hair, a deeper voice and enlargement of the clitoris.

Yet these side-effects are relatively minor compared with the severe damage caused by repeated, long-term steroid abuse.

Steroid misuse alters the heart: it can become enlarged, blood pressure can increase and arteries can lose elasticity. Together, these changes make the heart work harder and raise the risk of sudden death. For most people who misuse steroids, cardiovascular changes remain.

People who take steroids over the long term also commonly develop liver and kidney damage.

Testosterone can affect mental health as well, including by increasing aggression, depression and anxiety.

Importantly, testosterone supplements switch off the brain's normal signals to produce this hormone. This results in hypogonadism, a condition in which the tissues that would usually make testosterone shrink. For men, this means lower sperm counts and reduced testicular volume.

Hypogonadism also plays a part in a broad range of withdrawal effects. These can include depression and reduced libido, unless further testosterone is taken.

As a consequence, many men who have misused steroids become hypogonadal and need testosterone replacement treatment for life.

Growing problem

After the 1972 Olympics, the International Olympic Committee and World Anti-Doping Agency banned testosterone and other anabolic steroids. They concluded that, while these substances improve physical performance, they also carry serious health consequences.

More than 40 years after this international prohibition, however, some athletes continue to use anabolic steroids.

In 2021, for instance, reports suggested that between 29% and 43% of professional athletes in Iran had misused these substances. A 2023 Australian study involving 32 athletes, most of them women, found that roughly 43% of interviewees reported using performance- and image-enhancing drugs.

Professional athletes now account for only a small share of the worldwide doping problem. Testosterone is increasingly used cosmetically by non-athletes seeking greater self-confidence and an improved physical appearance, making anabolic steroid misuse a public concern.

Some estimates suggest that about 1 million people in the UK take steroids including testosterone.

Why testosterone abuse continues

Given the established risks and damage associated with testosterone, why do people decide to use it, and keep using it even after experiencing serious health problems? Experts have been attempting to answer this question for years.

One possible explanation is that users see health problems as something that will happen in the future, and regard them as an acceptable risk in exchange for improved short-term performance or appearance.

Dependence on anabolic steroids may also be a factor, since it can affect judgement and reduce awareness of the possible harms.

The "Goldman dilemma" may offer further understanding. From 1982 to 1995, physician and publicist Bob Goldman asked elite athletes a Faustian hypothetical question: would they take a magic pill that guaranteed Olympic gold medal success but caused their death five years later?

He found that roughly half of the athletes he interviewed accepted the "gold for death" choice. When the study was repeated in 2012-13, the proportion was lower, at 7-14%, with elite athletes the group most likely to select "gold for death".

There is no denying that misusing testosterone and its synthetic mimics can cause harm, but many people still misuse them. International bans have not worked.

As increasing numbers of non-athletes misuse testosterone, greater efforts are needed to make the public aware of its many long-term health consequences.

Colin Michie, Deputy Lead, School of Medicine, University of Central Lancashire

This article is republished from The Conversation under a Creative Commons licence. Read the original article.