If I Hadn’t Self-Medicated I Would Be Dead: Self-medicated testosterone replacement therapy (TRT) and why it is practised

Estimated reading time: 6 minutes

Anabolic androgenic steroids (testosterone and synthetic androgens similar to testosterone) are categorised as ‘enhancement drugs’. But they aren’t always used for enhancement – sometimes they are used for repair. What’s more, this therapeutic use of these drugs is not always conducted in the medical system. In this paper I describe what some bodybuilders have told be about one way enhancement drugs may be used for repair outside of the medical system: self-medicated TRT.

Now, some of you may read my paper on this (Underwood, van de Ven and Dunn 2021), and one of you actually posted it in the forum (thanks for that 😊), but there are some of you who won’t have access to the full paper, or who just couldn’t be arsed reading the whole thing, so I thought I would summarise it here.

Some of you reading this may have talked to me about your self-medication practices. I am especially grateful to you, as you helped me understand. Hopefully my paper will inspire more research, or maybe even policy changes so everyone can access the help they need to be healthy and happy.

What is self-medicated TRT?

Self-medication is when you take a medicine without medical supervision. Self-medicated TRT is when an individual takes testosterone because they feel that they are lacking in testosterone. That is, they are not using it go beyond what is considered normal or healthy (enhancement), they are doing it to be normal or healthy.

“A year and a half ago, my wife had more testosterone than me. I was at, like, four or five for a couple of weeks and I think the highest it went was 10 [nmol/L]. Which is like a 100-year-old man level [Chris].”

Typically bodybuilders self-medicate with black market testosterone, but sometimes they use pharmaceutical grade testosterone acquired through the black market.

Self-medicated TRT is described as very similar to medically prescribed TRT: between 125 and 200mg of testosterone per week. These doses of testosterone are termed ‘TRT doses’ or ‘physiological doses’ by bodybuilders.

Some bodybuilders who self-medicated with testosterone did not meet the clinical criteria to have testosterone prescribed. However, they still felt that their testosterone was low enough to warrant treatment.

“The ‘normal range’ is not broken down by age. It’s anyone from 18-70 years old. So, if you are 40 and at the lowest of normal, in my unprofessional broscience opinion that’s not normal. This is why I TRT on my own. I was at the low end of normal 5 years ago at 35 years old. You just do what’s right for you and be sure to monitor blood [forum comment].”

Some bodybuilders self-medicate because they have low test to start with, and others because their use of enhancement doses of testosterone (200mg plus per week) have affected their natural production of testosterone.

All those who described their testosterone use as ‘self-medicated TRT’ had their testosterone levels tested to confirm their suspicions of low test levels before beginning TRT.

Why self-medicate?

Bodybuilders describe many reasons for practicing self-medicated TRT.

Depression

Depression is one of the symptoms of low testosterone.

“I mean when my T was low, I was more on the side of depression, like I was a lot more depressed. But then as soon as I hopped on gear [steroids] I felt like a million bucks; I’d wake up with a smile on my face, I couldn’t wait to get out and do things, and it overall made my life better. … If I hadn’t self-medicated I would be dead. I would have killed myself because of the mental depression [Chris].”

Self-medicating TRT relieved their depression and allowed them to reduce or stop using anti-depressants:

“Was on 150mg desvenlafaxine, since [self-medicated] TRT have dropped to 50mg. Looking to get off completely one day [forum comment].”

“Was on a SSRI for depression and once l started a self medicated TRT dose l was able to get off the SSRI’s. My issue was low T essentially l feel coupled with a little bit of hereditary mental illness however since a couple of Dr’s didn’t think the T was the issue (test levels between 5-7 n/mol) l was put on some pretty mild SSRI’s. After being on 150mg [of testosterone] a week (puts me in the middle or normal test range) l don’t feel like necking myself every month [forum comment].”

No other option

Some had tried to get TRT prescribed and failed. Some had tried many health professionals but still hadn’t gotten anywhere.

“I know a number of guys that have put themselves on UGL [underground lab] TRT and trying to manage their condition themselves, because their doctors were so unwilling to help [forum comment].”

“I think you’ll find that almost everyone on here [the particular forum] is self-medicating. Not because they are all irresponsible jerks, but because properly produced pharmaceutical grade steroid medications are almost impossible to obtain here in Australia. This is due to a variety of factors, one of which is that 99.9% of doctors and Endocrinologists are literally terrified about prescribing TRT, terrified to the extent of completely shutting the door on men’s health [forum comment].”

My question posted in a forum: Have you self-medicated with underground testosterone to manage or fix your own low testosterone, rather than seeking medical help or treatment?

Consumer response: ‘…rather than seeking medical treatment…?’ you realise there are almost no options for medical treatment right? [forum comment].

Instead of prescribing testosterone, in some cases health professionals treated the symptoms of low testosterone rather than the low testosterone itself.

“I was prescribed Zoloft (anti-depressant SRI) to treat low testosterone. Yes, you read that correctly. I was prescribed an anti-depressant to treat low testosterone levels. Instead of treating the root cause of the problem which was low testosterone, I was given a treatment for one of the symptoms that having low testosterone brings which was major depression [forum comment].”

For some, self-medication was the only option. Indeed, one endocrinologist even told one of my research participants to self-medicate:

“She’s [the doctor was], like, you’ve got to see an endo [endocrinologist]. I’m, like, I’ve seen three and they’re not going to help me. Like, someone has got to help me. Like, I want to take my life. I can’t deal with this shit anymore. … Ended up I saw four GPs, three endocrinologists, and one endo said, I will lose my licence giving it to you, so go do it yourself [i.e. self-medicate][Chris].”

By self-medicating these individuals felt they were taking control of their own health, and taking back their lives.

Self-medication as the preferred option

Sometimes self-medication was preferred over prescribed testosterone. The black market was experienced as a much quicker and easier route to obtaining testosterone than the medical system. Furthermore, black market testosterone is typically less expensive than prescription testosterone.

“I can’t go out of town every week and wait for hour+ just to get a shot. That’s actually what brought me into the world of AAS… was searching for a source to get testosterone from [forum comment].”

“I found an endo [endocrinologist] that wrote me a script for test but after a year co-pays on blood tests every 90 days was killing me $$ and then insurance refused to pay for the script so I gave up and did some research and started making my own test from raws. It is easy and very inexpensive and I run my own blood work now. I’m happy! [forum comment].”

Black market suppliers were also experienced as providing more reliable access to testosterone than health practitioners. For instance, many in online enhancement communities noted the 2019 shortage of testosterone cypionate and testosterone enanthate, during which black market testosterone became the only option.

“… the sustanon and primoteston shortages have made heaps of guys resort to underground testosterone even though they have completely legit scripts & medical problem. some are lucky and have access to compounded testosterone cypionate [forum comment].”

Perceived incompetence of health professionals

Some bodybuilders felt more able to manage their testosterone on their own.

“I went to my family doc years ago to address the problems with TRT and he was only going to give me 50mg once every 3 weeks, which is obviously stupid. He didnt understand and thought it would just ‘supplement’ my natural production. … Even when talking to endocrinologists, some dont understand the need for checking E2 [estradiol] (or other markers) or why the use of HCG [human chorionic gonadotropin] is beneficial for fertility [forum comment].”

“I was put on TRT a few years ago by my family dr. Unfortunately, he didn’t know what he was doing…dude was giving me 400mg Test E/week in the beginning lol [laugh out loud]. Shut me down good [stopped his natural testosterone production]. Eventually I just did it on my own [self-medicated]. Currently taking 200 Test E/week [forum comment].”

“He [the general practitioner] basically wrote me a script and that was it, and he never did any follow up blood work except for the initial one to make sure I was in range after about six weeks of starting. When you’re on TRT, you need to be checking other things. Obviously, there are other hormones that testosterone can convert into and give you problems. Estrogen can be an issue to some, DHT [Dihydrotestosterone] can be an issue to some. When he wasn’t doing any of these follow up tests with me, I was very sceptical as to the knowledge that the doctor actually had about TRT [Sebastian].”

A lack of confidence in health practitioners inspired them to take control of their own health by self-medicating.

Self-medication allows for additional enhancement

My research was conducted in online enhancement communities, so all those I spoke to about TRT were also taking enhancement doses of testosterone. This enhancement use meant they preferred to self-medicate. Enhancement use of testosterone has an impact on various blood markers. Prescription TRT involves bloodwork whenever the health practitioner sees fit. So, if the individual wants to hide their enhancement use of testosterone from their health practitioner (as most do for fear of legal consequences, or consequences for health insurance) they would need to time their enhancement use so that it would not be detectable by their health practitioner. Therefore, some find it easier to self-medicate as they can do their own bloodwork, and use enhancement doses whenever they want.

A way forward?

Let’s face it, while some bodybuilders are quite knowledgeable, and some are very knowledgeable, it would be preferrable if health issues were monitored by a well-informed health professional who can remain objective. But the reality is, that health professionals may not be open to helping, may not be able to help, and even if they are open and able, they might not be well-informed enough to actually help.

An unfortunate reality is that we, as a society, don’t have a bloody clue when it comes to TRT.

There is no agreement regarding the thresholds for what constitutes ‘low’ testosterone (Sansone, Sansone, Lenzi, & Romanelli, 2017). A patient with T<8 nmol/L may qualify (Sansone, Sansone, Lenzi, & Romanelli, 2017), while in some other countries, such as Australia, the threshold may be lower (Cheng et al., 2018). Increased prescription rates in the United States of America (Tsametis & Isidori, 2018) have led many to believe that testosterone is being prescribed erroneously or too quickly, before lifestyle factors such as diet and exercise are considered.

Decisions regarding testosterone prescription should be based on a solid empirical foundation which we don’t have at this time. The evidence informing TRT practice is insufficient as we have only a very limited number of rigorously defined studies on this matter (Barbonetti et al., 2020).

From what I have seen, there are quite a number of men out there suffering from low testosterone who can’t get help. For some of them access to TRT is literally a matter of life and death. Is it any wonder, when the system fails them, that they start using ‘enhancement drugs’ to repair themselves?

References cited

Barbonetti, A., D’Andrea, S., & Francavilla, S. (2020). Testosterone replacement therapy. Andrology, 8 (6), 1551-1566. doi:10.1111/andr.12774

Cheng, Y., Bateson, D., Concepcion, K., Stewart, M., Lowy, M., Sweeney, S., Estoesta, J. & McGeechan, K. (2018). Initiation of testosterone replacement therapy. Australian Journal for General Practitioners, 47, 698-704. doi: 10.31128/AJGP-02-18-4480

Sansone, A., Sansone, M., Lenzi, A., & Romanelli, F. (2017). Testosterone Replacement Therapy: The Emperor’s New Clothes. Rejuvenation Research, 20(1), 9-14. doi:10.1089/rej.2016.1818

Tsametis, C. P., & Isidori, A. M. (2018). Testosterone replacement therapy: For whom, when and how? Metabolism, 86, 69-78. doi:10.1016/j.metabol.2018.03.007

Underwood, M., van de Ven, K., and Dunn, M. (2021) Testing the boundaries: Self-medication and the ‘problem’ of testosterone use outside of medical contexts, International Journal of Drug Policy 95 (103087), 1-9. doi: 10.1016/j.drugpo.2020.103087