Straight to the point

For decades, we’ve been living in a world of steroid smoke and mirrors. On one side, we have athletes and bodybuilders taking heroic doses of these substances in secret, often guided by “broscience” and internet forums rather than medical professionals. On the other, we have lawmakers and anti-doping agencies waging a quixotic war against performance enhancers, bellowing that such drugs are “positively un-American” and treating testosterone and growth hormones as if they’re as dangerous as heroin. Meanwhile, caught in the middle are millions of ordinary people who might benefit from hormone optimisation but are too afraid or ashamed to seek help. This situation is untenable, and it’s time we cleared the air.

Let’s start with a simple fact: testosterone levels in men have been declining for decades. A man aged 60 in 2002 had about 85% of the testosterone level of a man the same age in 1987. Even more alarmingly, we’re seeing a 20% deficit in testosterone levels in adolescent and young adult males. This isn’t just a matter of feeling less manly — it’s associated with a host of health problems, from obesity to diabetes. After all, as well as regulating libido, testosterone is crucial for building bone and muscle mass, distributing fat, and producing red blood cells.

For many men aged between 45 and 50, testosterone replacement therapy (TRT) could provide significant health benefits. When properly monitored by a physician, TRT can improve mood, increase muscle mass, reduce body fat, enhance libido, and even help with cognitive function. And yet, instead of treating this as a normal part of ageing care, we’ve stigmatised it, driving people to seek dangerous alternatives or suffer in silence.

This reluctance is rooted in misconceptions about the risks of testosterone therapy. Yes, like any medical treatment, it has potential side effects, such as increased blood pressure, cholesterol, and stroke risk. But these more remote dangers are often exaggerated, while the immediate and obvious benefits are downplayed.

I speak from personal experience. In March 2022, at age 40, I tore my left pectoral muscle. Coming on the heels of two decades of “clean” lifting, this injury led me to explore testosterone replacement therapy under the supervision of a physician. My regimen consists of weekly doses of self-injected testosterone cypionate, with regular blood work to monitor my health. The results have been significant: my testosterone levels have increased from 600 to around 1,000 nanograms per decilitre, with no increases in bad cholesterol or other negative side effects related to liver or kidney function. This hasn’t made me into any sort of superhuman — and I’m still nowhere near as ripped as I was in my late twenties — but during this period, I squatted 600 pounds and deadlifted 700 pounds for the first time in two decades of strength training.

Of course, for every story like mine, there are others that are far from successful. Indeed, just as with every case of stigma, the misleading debate around steroids has created an environment ripe for charlatans and unsafe practices. Just consider the case of Brian “Liver King” Johnson, who built a fitness empire on the claim that his muscular physique was the result of eating raw organ meats and following “ancestral” practices. When it was revealed that he was actually spending thousands of dollars a month on steroids, many were shocked. But should we have been? From “natural” bodybuilders who are anything but to supplement companies peddling magic pills and boilerplate “customised” workouts, the entire ecosystem is built on a foundation of lies. It’s a classic case of prohibition creating more problems than it solves.

So, how do we remedy this? Most obviously, we could bring the subject out into the open, creating the space for better regulation, education and safety. This could start with the acknowledgement that there are legitimate medical uses for steroids and hormones beyond just athletic performance enhancement. Their therapeutic potential in treating conditions like muscle-wasting diseases, severe burns, and hormone deficiencies is well-established, but is often overlooked in the moral panic about “cheating” in sports.

This is, of course, as much a marketing problem as a medical one. The distinction between “natural” and “enhanced”, for instance, is often arbitrary and inconsistent. Over the course of a two-decade career in marketing, I’ve been paid to promote everything from stem cell injections (even getting them myself and making a documentary about it) to kratom powder. Most of us don’t bat an eye at these unconventional treatments, much less caffeine use, nutrient supplementation, or even cosmetic surgery. We accept that a 70-year-old woman might take oestrogen to alleviate menopausal symptoms. Yet the moment someone mentions testosterone for a man the same age, people react as if it’s fundamentally different.

This inconsistency extends to how we regulate these substances. Current laws and regulations around steroids are often not based on sound science. In 1989, against the advice of the American Medical Association, then-Senator Joe Biden led the charge to classify anabolic steroids as controlled substances. This decision, driven more by sports moral panics, has caused more harm than good by driving usage underground, where users resort to unregulated black market sources, underground labs, and dangerous self-experimentation.

Biden’s crusade against steroids is a perfect example of how hysteria can lead to bad policy. In 1989, as he led the push to reduce access to steroids and increase penalties for their distribution, he claimed: “The illegal use of steroids is a major drug abuse problem in this country. Steroids are dangerous drugs that threaten the physical and mental health of hundreds of thousands of young people.” There was, naturally, no mention of their potential benefits when used under medical supervision. Indeed, in 2004, when the Controlled Substances Act was made even stricter by removing the requirement that an anabolic steroid classified as a controlled substance had to actually “increase muscle growth”, Biden was that bill’s sponsor, too.

More than three decades have passed since then, and the current system treats them as if they’re nearly as lethal as opioids. This, despite the fact that you can’t overdose on testosterone the way you can on fentanyl. Yet possession of anabolic steroids can lead to hefty fines and even prison sentences — punishments that far outweigh any potential harm caused by the drugs themselves.

So, what’s the alternative? Well, imagine a world where, instead of being ashamed to discuss declining testosterone levels with their doctor, men viewed hormone check-ups as a routine part of health maintenance, like checking cholesterol or blood pressure. The fact that vanishingly few men know that the normal range for male testosterone levels falls between 300 and 1,000 nanograms per decilitre is criminal; such information should be as widespread as awareness of normal blood pressure. This is more than a matter of virility: low testosterone is associated with a host of health problems, including increased risk of cardiovascular disease, osteoporosis, and cognitive decline. By addressing hormone imbalances early, we could potentially prevent or mitigate these issues, improving overall health outcomes and reducing healthcare costs in the long run.

There are also problematic double standards in how male versus female hormone therapies are regulated and perceived. Women’s hormone replacement therapy is widely accepted, while men’s is often viewed with suspicion. Or consider the case of transgender individuals. Here in the United States, if a transgender man is prescribed testosterone (a controlled substance), the physician must hold a Drug Enforcement Administration (DEA) licence in addition to being registered with the relevant state medical board. The quantity of the prescription is strictly controlled. However, when a transgender woman is prescribed oestrogen, these stringent controls do not apply. This discrepancy is difficult to justify on medical grounds and seems to stem more from cultural biases about masculinity and femininity.

A more rational approach to hormone regulation could also help tamp down some of the hysteria associated with gender transitioning itself. Today, hormone therapy is treated like some radical act that has to be shouted to the heavens. But if we normalised the idea that hormones are just another tool for optimising health and well-being, it might take some of the charge out of these debates: turning them into discussions about identity rather than simply chemical imbalances.

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Hanging over all this is the need for a more evidence-based approach to steroid and hormone regulation. This means several key changes in our approach. First and foremost, we must decriminalise personal use and possession of steroids. Treating steroid use as a criminal issue rather than a health issue has been a costly failure, driving users into the shadows and preventing many from seeking proper medical guidance.

We should also regulate steroids like other prescription drugs, not as controlled substances. This shift would allow for better quality control and medical oversight, ensuring that users have access to safe, pharmaceutical-grade products rather than potentially dangerous black market alternatives. Encouraging more research into the potential therapeutic uses of steroids and hormones — something long championed by the likes of Dallas Mavericks owner Mark Cuban — is also crucial. However, as Cuban told me when I interviewed him and his research team in 2020, the regulatory environment as it currently exists makes it difficult to conduct large-scale, publicly-funded studies on the long-term effects of hormone optimization. By easing these restrictions, we could gain valuable insights that would inform both medical practice and public policy.

Finally, we must address the root causes of declining testosterone levels in the population. This could include research into environmental factors, dietary changes, and lifestyle interventions that might be contributing to this troubling trend.

Imagine a future where hormone optimisation is viewed as a normal part of health maintenance — and where following the best available science might mean most men starting TRT as they enter their mid-forties, if not earlier. A future where athletes can be open about their use of performance-enhancing substances, allowing for better monitoring and research. Where men don’t have to suffer in silence as their testosterone levels decline with age. Where we can have rational, nuanced discussions about the role of hormones in gender identity that are fully divorced from performative partisan politics.

This future is possible, but only if we’re willing to step out of the shadows and confront our societal hangups about hormones and enhancement. It’s time to clear away the smoke and break the mirrors. As I’ve learned from my own careful experimentation, the future of health is one of normalisation, not prohibition. Let’s embrace it.

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Source: UnHerd Read the original article here: https://unherd.com/