“But steroids give you brain cancer!”

I can’t even imagine the number of times I’ve heard this, usually from somebody who was offering Lyle Alzado as the prime example of androgen supplementation gone wrong. Steroid hormones are some of the most well known but misunderstood hormones in our bodies today. Let’s talk more about them, and in particular about a family of hormones called androgens, and their anabolic and androgenic effects on the body.

But first, let’s define some terms!

“Hormones” are molecules that exert their primary effects in the body by some form of binding to another molecule called a “receptor.” These molecules fit together something like a key and lock, and when the two molecules are in the locked position, this assemblage is called a “complex.” A “steroid” is an organic molecule with the multi-ring structure of cholesterol. “Steroid hormones,” then, are obviously hormones with a steroid structure. (Stick with me. I promise this gets interesting in a minute.)

Here are the fun terms. An “androgen” is a substance that stimulates the androgen receptor. Androgens usually exert some kind of physiological effect that is considered to be masculinizing: things like increasing muscle mass, decreasing body fat, increasing strength, increasing growth in facial and body hair, and promoting male pattern baldness. There is more than a single kind of androgen. Testosterone is an androgen. So is DHT. So are nandrolone, trenbolone and oxymetholone. I use the term “androgen” to refer to all of these substances; when I’m talking about a particular substance, I’ll use that substance’s particular common or chemical name.

An “anabolic” substance is any substance that promotes physical growth. Therefore, strictly speaking, estrogens (also steroid hormones) are anabolic, since they increase the deposition of body fat. Androgens are anabolic, too, in that they promote muscle growth. So you can’t just say “anabolic steroid” when you’re talking about androgens specifically. There’s misunderstanding #1 taken care of!

The term I like to use when talking about testosterone and its close relatives is “anabolic/androgenic steroid,” or AAS. (We have to have an acronym for everything, right?) Now that we have some definitions straight, let’s move on to the subject of the crazy things people say about AAS.

Lies, Damned Lies and Other Stuff

I started this article with a reference to Lyle Alzado. Alzado was an NFL football player who passed away a few years ago from a debilitating disease, possibly AIDS. At one point he said, in public, that his ultimately fatal condition was caused by his “steroid abuse.” The North American media latched onto this and integrated it into their smear campaign against these drugs, something that had been going on for several years previously. Androgens were placed on a restricted access schedule in the US in the mid-80’s, mostly because of anti-drug hysteria. (As a side note, Alzado’s personal physician has stated publicly that Alzado’s death was completely unrelated to his AAS use.) The most visible subculture that uses these drugs regularly is the bodybuilding world. In fact, a lot of the misinformation about AAS comes from within bodybuilding. In other cases it originates from outsiders who do not understand what is going on. One frequent argument that you hear is that AAS supplementation is dangerous because… well, think about how unhealthy competitive bodybuilders look. And heck yes, they’re unhealthy. They starve themselves, tan incessantly, supplement sloppily with Human Growth Hormone (HGH), play with insulin and thyroid medications, take crazy diet supplements like DNP (originally used as a bug poison) and take dangerous diuretics before competition. Of everything that bodybuilders take, AAS are without a doubt some of the safer drugs.

LIE #1: AAS can kill!

This is nonsense. There is no known lethal dosage of androgens, and no documented cases of death caused by androgen supplementation.

LIE #2: AAS cause “‘roid rage!”

Supplementing with AAS can cause increased aggression. The phenomenon of ‘roid rage–which is generally painted as some bodybuilder going on a crazy rampage and beating the shit out of people–is nonexistent. There is no such thing as ‘roid rage. AAS will not cause a person to go crazy and become homicidal.

Taking AAS can intensify your personality, though. If you were an asshole before you started taking AAS, you might be more of an asshole while you’re taking them. The moral of this story is: don’t be an asshole!

LIE #3: AAS can ruin your liver and kidneys!

There is no empirical evidence and no research to support the assertion that AAS can be linked to kidney failure. On the subject of the liver, it is typically only stressed when one takes 17-alpha alkylated androgens orally. Injecting your AAS can be a much safer alternative if an experienced person shows you how to do it.

LIE #4: You should only take AAS in normal physiological doses.

There is increasing evidence that supraphysiological doses of AAS (that is, doses that are greater than the male body produces normally) are beneficial. To a certain point, the more you take, the more effective the drugs are. If you monitor your liver function and blood pressure, there is no reason that your physician should not be able to increase your dosage to two or three times what is considered acceptable for trans guys.

AAS in both replacement and supraphysiological doses are currently being investigated by the life extension folks for use in improving the quality of life in those who are aging. Life extension physicians are some of the most progressive physicians around today, and are an excellent resource for anyone wishing to investigate AAS. If you can find one in your area, latch on to her/him and don’t let go.

Side Effects

In fact, AAS are some of the safest drugs you can take. I’m not going to sit here and paint a perfectly rosy picture of them, though. They do have possible side effects. They include:

  • Water retention (edema)
  • Gynecomastia
  • Numbness
  • Inhibited natural testosterone production
  • Elevated blood pressure
  • Elevated blood lipid profiles
  • Accelerated hair loss
  • Aggression, moodiness
  • Acne
  • Increased risk of disease (from sharing needles)

These side effects are the most common. Less common–but not unheard-of–side effects include:

  • Insomnia
  • Decreased libido
  • Elevated liver values (specific to orals)

Let’s try explaining some of these. Estrogens, not androgens, cause water retention and gynecomastia. Estrogen is also most likely the cause of decreased libido. One interesting–and sometimes annoying–thing about AAS is that some types of AAS can convert in your body to estrogens. (It’s important to note that not all AAS convert to estrogens; just some of them.) You can mitigate or prevent these effects by taking anti-estrogenic drugs like clomiphene citrate, mesterolone or even some androgens that don’t metabolize to estrogens.

Numbness is thought to be caused by the sudden growth of muscle and the pinching of nerves. Inhibited natural testosterone production is a result of external AAS supplementation, since the body has no reason to produce anything naturally that is already present in such high levels. The body is smart that way. You really can’t do anything about either of these side effects if they do occur.

Elevated blood pressure and lipid (“cholesterol”) profiles are a common effect. Usually the elevation is minor, but you should have these checked regularly by a sympathetic health professional.

Accelerated hair loss? Yes. Unfortunately, if your family is prone to male pattern baldness, taking AAS is likely to speed things up. If you are worried about this, look into some of the standard hair loss treatments (Rogaine, etc.)

If acne becomes a problem, then using B5 or anti-acne medication will help, of course. Keeping your skin clean is even more useful.

I have no documentation for this, so don’t quote me on it, but I feel like moodiness is caused more by the fluctuations in hormone levels than the levels of the hormones themselves. I found that, when I was using AAS, I was moody for about the first week or two after starting and for the first week or two after stopping. Insomnia is not an uncommon side effect of AAS supplementation in doses higher than the healthy male body normally produces.

Elevated liver values are something different. The liver has a virtually unlimited capacity to metabolize testosterone. It’s not the testosterone that’s the problem: it’s the 17-alpha alkylated androgens (oral androgens) that stress the liver. Simply injecting your AAS instead of taking them orally can eliminate this potential side effect.

And increased risk of disease? Just don’t share needles. Let me say that again: don’t share needles. This is not a joke or something to be taken lightly. Don’t share needles. Essentially, if the drugs are taken intelligently, the medical risks are minimal. In most cases, non-oral AAS are probably safer than aspirin. Some female bodybuilders take doses of AAS that are greater than your doctor puts you on, and most are perfectly happy with being women. Think about that.

The benefits of AAS are phenomenal, especially for trans guys. Testosterone is nothing short of a miracle hormone. Its actions include such androgenic effects as deepening of the voice, increasing the size of your cock (perhaps formerly known as the clitoris) and increases in the amount and thickness of body hair. Just as exciting, IMO, is the increase in muscle mass and the redistribution of body fat to a more masculine physique. Perhaps most importantly, there’s a certain amount of psychological reward that goes along with making a positive change in your life. The choice to use or not use AAS is a very personal one. I just want you to go into it well informed, and realize that many of the things you’ve heard about them from the medical establishment are not entirely true.

Next time we’ll talk about how you can use AAS to help you further your body goals. We’ll pretend you’re a bodybuilder, and hopefully you’ll be able to come out of it lookin’ buff ‘n’ tuff. Until then, rock on!

(P.S.: You remember not to share needles, right?)