TRT as gender affirming care
The rise of testosterone therapy, and what this means for men
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Testosterone and performance enhancing drugs (PEDs) have gone mainstream. They used to be just for bodybuilders and were seriously frowned upon. Now Jeff Bezos, RFK Jr, and Joe Rogan are on it, and nobody bats an eye.
How’d we get here?
Hollywood has certainly helped. Here’s a sampling of dudes who are between very likely to 100% confirmed that they took PEDs.
A Hollywood trainer in 2013 estimated 20% of actors use performance enhancing drugs (PEDs) to achieve their physique. A professor of physical therapy at the University of Southern California recently estimated that 50 percent to 75 percent of Marvel stars use some form of PED.
And then there’s the Internet. Reddit is a goldmine of steroid advice. A huge amount of Instagram and TikTok influencers are on steroids (also known as “gear”). Perhaps the most popular influencer for Gen Z, Sam Sulek, is geared to the gills.
The Youtube channel More Plates More Dates built its following on tearing down which celebrities he thinks are on steroids or now (“natty or not”).
Kenneth Boulet has a popular account where he goes up to jacked people at the gym and asks them if they’re natty or not. The answer? All the super jacked guys are on gear. He does it to poke fun at the industry, and yet he says he regularly has pro athletes and actors sliding into his DMs to get advice on their steroid use.
More recently, men over 40 with money have been doing testosterone supplementation simply to feel younger, stronger, and sharper. Joe Rogan, Dax Shepard, and RFK Jr are public about their use. Jeff Bezos is strongly suspected of using TRT.
Steroids 101
There are two major classes of PEDs: anabolic steroids and human growth hormone.
Anabolic steroids are used for muscle gain. “Anabolic” refers to tissue building - which in this case means muscle. Human growth hormone (HGH) can be used both as an “anti-aging” protocol or for building muscle or both. Technically, HGH is not a steroid. Both give men energy and muscles, albeit through different mechanisms.
And generally there are two different treatment goals: getting huge (having higher than normal levels of testosterone) and getting healthy (upping a deficient level of testosterone to “normal” levels). Testosterone Replacement Treatment (TRT) is a term reserved for treating testosterone deficiencies. Both treatment goals often use the exact same stuff: testosterone, aka anabolic steroids - just in different dosage amounts.
Benefits of steroids can include:
Looking jacked
More energy
Quicker recovery to workouts
Improved concentration
Downsides can include
Large purple pimples
Hair loss
Raisinette sized testicles
Mood swings, especially between frustration/anger and depression
Liver damage
Cardiovascular disease
Needing to inject yourself with needles like clockwork
Your body no longer being able to produce its own testosterone, making getting off testosterone very difficult.
Spending $$$. TRT can cost a few hundred to a few thousand dollars a month
If you’re interested to learn more about TRT, here is a great explainer from a PhD who bodybuilds, takes steroids, and is honest about the pros and cons.
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The grey area
Because the term “steroids” is associated with “getting as huge as possible,” people like RFJ Jr. will say they’re doing TRT for anti-aging, and so aren’t taking steroids.
I take issue with this for two reasons:
Taking testosterone means taking anabolic steroids
RFK Jr. is absolutely ripped for a 70 year old. Doctors may be prescribing testosterone as “anti-aging”, but the result is still about muscle gain and performance enhancement.
Most medical professionals are clear on their recommendations. If you’re medically deficient in testosterone, you feel like shit, and you can afford it, chances are they’ll consider prescribing TRT. If you’re not medically deficient, they won’t.
But increasingly, men over 40 who are taking TRT are simply have low testosterone - not medical deficiencies. And then they’re taking testosterone at levels that give them 20 pounds more muscle at 50 than they had at 30. It’s taking the notion of gender affirming care and putting it…on steroids.
As Dax Shepard has said on his popular podcast The Armchair Expert, “I spent my whole life as a medium boy, now I’m a big boy and I like it.”
The future of steroids
There are some who think that as Hollywood is forced to get honest with PED use, that PED use will get less popular. I disagree. I think steroids will become normalized and more popular. It will become an aesthetic decision like getting tattoos.
All the incentives point to wider usage. Most men with public personas or even a social media following will get more popular if they look bigger. And as the drugs get better and cheaper, I have to imagine this trend will accelerate.
I don’t know if all this is a net positive/negative for dudes. My guess is that it serves drug companies more than it serves the average man. On the flip side, if I can look jacked at 70 without totally undermining my health, sign me the hell up. Drug companies, you win again.
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