Is TRT Steroids? Anabolic Steroids vs. Testosterone Replacement Therapy

When you hear the term “steroids,” you probably picture ripped bodybuilders and overly aggressive behavior (“roid rage”). But steroids are a form of testosterone—the same stuff your doctor might prescribe if you’ve been feeling draggy or down in midlife. 

So, how is taking steroids different from using testosterone replacement therapy (TRT) to treat a medical condition? And aren’t steroids used to treat medical conditions, too?

Whether you’re considering testosterone therapy but are concerned about steroid use, it’s important to understand how TRT and steroids are different, including their benefits, risks, and side effects.

About the Experts

Joshua Calvert, M.D., is a urologist who specializes in male infertility and low testosterone management.

Robert Howe, M.D., FACOG, is an OB-GYN and reproductive endocrinology and infertility specialist.

Andrew Sun, M.D., is a urologist specializing in TRT and sexual dysfunction and the director of men’s health for Urology Partners of North Texas.

What Are Anabolic Steroids?

Typically referred to simply as “steroids,” anabolic steroids are a synthetic testosterone compound that is often used in improper doses without a prescription for athletic performance.¹ Anabolic steroids are also legally prescribed for certain conditions, such as delayed puberty. and muscle loss from disease.²

“Steroids are a supercharged version of testosterone,” says urologist Andrew Sun, M.D., director of men’s health for Urology Partners of North Texas. “They are an alternative molecule that has a similar effect [to natural testosterone], but they are stronger and have more potential downsides.”

Anabolic steroids bind to the same androgen receptors as testosterone. However, they’re formulated to boost anabolic effects—muscle growth and repair—more than androgenic effects, which drive male traits like a deeper voice, facial and body hair, and libido.³

Testosterone Replacement Therapy vs. Anabolic Steroids

Testosterone replacement therapy (TRT) is a prescription to treat low testosterone levels in men (hypogonadism), while steroids are usually not taken to treat a medical condition. The terms “anabolic steroids” or “taking steroids” often refer to manmade steroids used by bodybuilders and athletes to build muscle and improve athletic performance.

TRT is bioidentical hormones made with the same compound testicles produce, and is designed to treat clinically low testosterone levels by replenishing exactly what the body has lost or stopped producing. Steroids are used to stimulate muscle growth. They typically elevate the body’s testosterone levels beyond a healthy amount and cause more serious side effects. 

“Both TRT and steroids involve testosterone or related hormones,” says urologist Joshua Calvert, M.D. “But the goals and doses are very different.”

Testosterone is the major sex hormone in men. It’s important not only for sexual development but also for physical growth and the following body functions:⁴

• Sex drive (libido)
• Sperm production
• Bone density
• Muscle strength and size
• Mood

Health Risks of Anabolic Steroids

Unlike physician-guided TRT, anabolic steroids are often used without medical supervision and at extra high doses that push testosterone beyond healthy ranges. That’s why they’re linked not only to mood swings and addiction but also to serious long-term risks:^{5 6}

• Heart attacks
• Stroke
• Blood clots
• High blood pressure
• Liver damage
• Kidney failure
• Testicular cancer

Steroids and TRT can share side effects—acne, testicular shrinkage, decreased sperm production, and elevated red blood cell counts that thicken the blood and raise clot risk.^{7 8 9} But clinically monitored TRT remains one of the safest ways to restore low testosterone.¹⁰

“There are remarkably few side effects of TRT,” says Robert Howe, M.D., FACOG, a reproductive endocrinology and infertility specialist, noting that loss of fertility and testicular shrinkage are common trade-offs.

Prolonged steroid use can also profoundly suppress your body’s own testosterone production. Often, men recovering from steroid use might need post-cycle therapy with a medication like Clomid to fully restore testosterone levels. “The younger and more hardcore men do steroids, the more it blows out their system,” says Sun. “Even when their serum level looks normal, they feel low—they need more to feel the same.” 

Similar to anabolic steroids, it might take some time to recover the body’s natural testosterone production if TRT patients stop taking their medication. Howe says most patients regain baseline production, though it can take months.Experts once feared TRT might raise prostate cancer risk, but newer studies suggest the risk is probably low.¹¹ “If you already have prostate cancer, you don’t want to take TRT out of fear of pushing it along,” says Sun. “If you don’t have prostate cancer, it’s totally OK to take it—especially if you have low testosterone.”

Is Taking TRT the Same As “Taking Steroids”?

Taking a testosterone injection, cream or pill as prescribed by your healthcare provider to improve hormone levels is not the same thing as taking steroids.

The phrase “taking steroids” as used in mainstream society often refers to misusing synthetic testosterone to promote growth and muscle mass in athletes and bodybuilders. This is different from taking prescription testosterone as directed by a doctor to treat male hypogonadism or low testosterone. 

When you take TRT, your doctor works with you to find the right dosage of testosterone. The dose for synthetic anabolic testosterone is often much greater.¹²

And while TRT is legally prescribed, using synthetic steroids without a prescription is neither safe nor legal.¹³

Is Testosterone Illegal in Sports?

According to the World Anti-Doping Agency (WADA), it’s illegal to use synthetic testosterone, as well as any other substance with a similar chemical structure, to compete in sports unless you receive an exemption.^{14 15} 

WADA makes some exceptions when it comes to using testosterone for male hypogonadism.¹⁶ But the athlete must apply for and meet the criteria for a therapeutic use exemption (TUE). This requires filling out a TUE form with a physician and providing supporting documentation. 

Athletes apply for a TUE through the U.S. Anti-Doping Agency (USADA) or their International Federation, depending on whether they’re a national or international athlete.¹⁷ The USADA requires a medical diagnosis for a condition causing low testosterone before granting a TUE.

The NCAA has also banned testosterone and anabolic steroids. But a student athlete may obtain an exception if they can demonstrate a medical need for the substance.¹⁸

Testosterone, anabolic steroids, and similar substances are banned in sports because they can enhance athletic performance, giving the athlete a competitive advantage.¹⁹ They can also pose harm to the athlete. Steroids were prohibited in Olympic competition beginning in 1976 and designated as a controlled substance in the U.S. in 1990.^{20 21}

TRT VS STEROIDS

I Switched From Steroids to TRT and Dropped 100 Pounds

Why Larry Wheels Switched From Steroids to TRT

How Do I Know If I Have Low Testosterone?

“Low testosterone” (male hypogonadism or testosterone deficiency) is typically defined as a total testosterone below 300 ng/dL (nanograms per deciliter) on two blood tests performed early  in the morning, when levels peak.²² Some experts use a 250 ng/dL cutoff.²³ Diagnosis involves considering testosterone levels as well as symptoms.

Normal testosterone levels decline with age. After adolescence (roughly 300–1,200 ng/dL), levels decline about one percent per year from the mid-30s. Typical reference ranges include: 40s: 252–916 ng/dL; 50s: 215–878 ng/dL; 60s: 196–859 ng/dL; 70s: 156–819 ng/dL.

Common symptoms of low testosterone levels:²⁴

• Low sex drive
• Erectile dysfunction
• Depression
• Fatigue
• Trouble focusing
• Loss of muscular strength and size
• Reduced armpit and pubic hair 

Men with low testosterone also report less motivation or drive, Calvert notes.

Testosterone replacement therapy can relieve symptoms when the body isn’t making enough of the hormone. The FDA approves TRT only for men whose levels are low due to a medical condition.²⁵ Causes include damage or dysfunction in the testes, pituitary gland, or hypothalamus.²⁶

Some clinicians, however, consider TRT for symptomatic men with low numbers even without an obvious secondary condition. “If a man has clear clinical symptoms—fatigue, low libido, erectile issues, loss of muscle, mood changes—TRT can be appropriate even without a known cause,” says Calvert. “The decision should be individualized; a man at 390 ng/dL with every symptom may still be functionally hypogonadal.”

Interested in reading more about testosterone?

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About the author

Dan Wagener is a seasoned healthcare writer and editor specializing in breaking down complex medical information for a broad audience. He has a deep focus on prescription medications, supplements, and health conditions.

About the reviewer

Natalie Kunsman, M.D., is a board certified physician specializing in functional, anti-aging, and regenerative medicine. She is a fellow of the American Academy of Anti-Aging medicine and the American Academy of Family Physicians.