Testosterone therapy and related supplements have become a booming industry. Prescription testosterone replacement therapy (TRT) alone generates more than $1 billion annually in the United States, with over 5 million prescriptions written each year.
Meanwhile, so-called “testosterone boosters”—often marketed as herbal or vitamin products—make up part of a global market valued at $3.7 billion, projected to nearly double by 2030.
The appeal is clear: testosterone and anabolic-androgenic steroids (AAS) can increase energy, lean muscle mass, libido, and confidence. These effects have made TRT and AAS attractive not only to men with medical conditions but also to athletes, bodybuilders, and everyday people seeking better performance or appearance.
Medical Use vs. Misuse
Anabolic steroids are synthetic versions of testosterone. In the U.S., they are Schedule III controlled substances. Doctors prescribe them for specific conditions, such as delayed puberty in boys, testosterone deficiency in men, certain cases of breast cancer, and gender dysphoria.
However, many people use these drugs without medical supervision. Some obtain steroids illegally through the internet or black-market sellers. Others rely on over-the-counter “boosters” that promise similar benefits but are not regulated or proven safe.
Who Is Using Testosterone?
The typical anabolic steroid user is a man in his 20s to 40s who engages in bodybuilding, intense exercise, or competitive sports. Increasingly, women are also turning to testosterone for performance, energy, or sexual health, although no FDA-approved testosterone product currently exists for women.
Marketing often targets middle-aged men worried about “low T,” promoting TRT as a way to reverse fatigue, low libido, and age-related decline. While TRT is FDA-approved only for men with medically documented hypogonadism, off-label prescribing and self-medication are common.
Health Risks and Side Effects
While testosterone may improve strength, energy, and body composition, the risks of misuse are significant:
For men: shrunken testicles, infertility, enlarged breast tissue (gynecomastia), and higher risk of prostate cancer.
For women: deepened voice, irregular menstruation, increased body or facial hair, and irreversible genital changes.
For both sexes: acne, elevated cholesterol, heart attack, stroke, and psychiatric effects such as aggression or “roid rage.”
Addiction is also a concern. Up to 30% of long-term anabolic steroid users may develop dependence, with withdrawal symptoms ranging from depression to severe fatigue and even suicidal thoughts.
Addiction and Mental Health
Research shows anabolic steroids affect the brain’s reward system by boosting dopamine, similar to drugs like cocaine or amphetamines. Users may start with short “cycles” but often escalate to higher doses or combinations of multiple drugs, known as “stacking.”
Dependence typically begins in the late teens or 20s, peaking in the 30s and 40s. Most dependent users are not professional athletes but recreational lifters or individuals chasing an idealized body image. Muscle dysmorphia—a condition where people believe they are too small or inadequately muscular—is strongly linked to steroid use.
The Bottom Line
For men with clinically low testosterone, TRT can be safe and effective when prescribed and monitored by a doctor. But widespread misuse of testosterone and anabolic steroids carries serious physical, psychological, and social risks.
Awareness and education are key. Understanding the difference between medically appropriate TRT and illicit steroid use can help patients make informed decisions—and reduce the growing problem of misuse and addiction.
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