The Difference Between Testosterone Replacement Therapy and Steroid Abuse

Testosterone Replacement Therapy is not even close to the same thing as steroid abuse.

Is testosterone a steroid? Technically yes, but not in the way most people mean. Testosterone is not an illegal steroid and will not cause “roid rage” or the development of breast tissue like illegal steroids will.

Testosterone is a naturally occurring steroid hormone produced in the body. Its natural role is to promote bone density, produce sperm in the testes, and stimulate lean muscle growth.

Unfortunately, the facts are muddled with myths, rumors, and confusion.

A middle-aged man in a white tank top is sitting on a weight bench while holding a dumbbell in his left hand. He seems puzzled, possibly wondering if testosterone is a steroid.

TRT Is Not the Same as Illegal Steroid Abuse

Many people are under the false impression that choosing Testoste­­­rone Replacement Therapy (TRT) to normalize testosterone levels will produce exactly the same effects as the extremely high testosterone levels that are caused by abusing steroids.

Many people mistakenly associate TRT with bodybuilding. They fear the possibility of becoming instantly and unnaturally bulky like “that guy” in the gym and of suffering uncontrolled side effects, like liver damage or the development of male breasts.

They’re worried about experiencing uncontrolled aggression, commonly known as “roid rage.”

However, these are misconceptions about TRT that couldn’t be further from the truth.

People are confusing two entirely different things.

TRT is a safe medical treatment for a legitimate medical condition. Illegal steroid abuse is unsafe and is not used to treat or prevent any medical condition.

The confusion is caused by the fact that steroid abusers use unsafe doses of the same medication (testosterone cypionate) commonly used in TRT.

What Does Testosterone Do?

Among other roles in your body, testosterone causes an increase in the size of your muscle cells. This means each individual muscle cell will grow.

Because bigger muscles tend to also be stronger, your strength can increase as a result. In turn, increased muscle mass burns more calories, helping to establish and to maintain a better balance between lean muscle and excess body fat.

Balanced levels of testosterone can improve an individual’s sense of emotional wellbeing as well as their concentration and focus, which can improve performance in the mental aspect of work or competition.

TRT and Steroids — What’s the Difference?

If you’re suffering from low testosterone and are experiencing deficiencies in strength, muscle mass, sexual performance, or concentration, restoring normal testosterone levels may help restore performance, including at work, in sports, and in the bedroom.

Obtaining medication illegally and boosting testosterone to extreme levels may lead to artificial muscle gains, an increase in performance at your chosen athletic endeavor, and enhanced performance in the bedroom, but it may also have the opposite effect in those areas (in addition to being dangerous, potentially causing life-long damage to your body, and being illegal).

Thus, we begin to see the differences between the medical treatment known as TRT and the risky and illegal practice of steroid abuse for some competitive edge or cosmetic benefit.

The differences are found in the goals, purpose, amounts, and application.

The Facts About Steroid Abuse

Illegal steroids are abused for cosmetic benefits or physical performance reasons — to build muscle and lose body fat or to enhance one’s ability to perform in a sport or excel in bodybuilding.

Steroid abusers aren’t lacking in endogenous (naturally produced) testosterone, and they’re using supplementary testosterone to cheat natural processes.

The following are important facts about illegal steroid abuse:

  • Steroids are often obtained and injected illegally at very high doses.
  • This treatment is not approved by the FDA.
  • There are no diagnostic tests to determine if someone needs anabolic steroids for recreational purposes.
  • A total lack of medical oversight leads to uncontrolled side effects and health risks.

Steroid abusers usually don’t use testosterone only. In addition to huge doses of testosterone, they’re adding other substances on top, some of which may be illegal.

It’s a simple matter. The primary concern with steroid abuse is one of safety. It’s never advised to risk your long-term health for a competitive or cosmetic edge.

The Facts About Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy is a medical treatment prescribed and administered by health care professionals to help treat the effects of low testosterone levels in men.

Administration of supplemental testosterone begins only if medically valid diagnostic tests determine there is an actual deficiency in one’s testosterone level.

You generally need to exhibit symptoms of low testosterone and have a total level of testosterone below 300 ng/dL or a free testosterone level below 9.0 ng/dL (for men).

Because low testosterone is a recognized medical condition, your medical care provider can prescribe testosterone to you in a controlled TRT treatment protocol. The goal is to restore levels to an optimum range, not an extreme range.

Properly administered Testosterone Replacement Therapy has a number of potential benefits, including:

  • Increased lean muscle production and strength
  • Reduced fat tissue production
  • Improved erectile function
  • Increased sexual desire (libido)
  • Improved mood and increased sense of well-being
  • Reduced anxiety and improved concentration
  • Increased energy and motivation

These benefits are accessible to patients following a monitored treatment protocol without all the countless and unpredictable side effects of steroids abuse.

These benefits might help an athlete to improve their performance on the field to a small degree, but your body will not change to the unnatural degree it would when abusing steroids without proper supervision.

A man with short hair wearing a black tank top sits on a weight bench with a dumbbell between his feet. He may be wondering: Is testosterone a steroid?

The Difference Between TRT and Steroids at a Glance

To summarize, these are the primary differences between TRT and steroid abuse:

  • TRT is FDA-approved, while steroid use in the locker room is not
  • TRT is administered by a medical professional, while most steroid use for bodybuilding and athletic performance enhancement is not
  • TRT’s purpose is to treat a medical condition (Low T), while illegal steroid abuse is not a medical treatment at all

Ultimately, it comes down to dose and safety.

Steroid Abuse and TRT: Side Effects Are Different

Some of the side effects that can be caused by TRT include:

  • Acne
  • Slight male breast development
  • Enlarged prostate
  • Difficulty urinating
  • Mood swings
  • Fluid retention

When you’re being treated with medically indicated Testosterone Replacement Therapy, we’re monitoring your health, and we’re making very sure you aren’t given a dose that’s too high or too low. We know how to minimize these side effects or prevent them all together.

You can read more about the side effects of TRT and how we prevent them here.

Some of these same side effects can occur with steroid abuse, but their severity is much more pronounced due to the unnatural hormone levels reached when abusing testosterone. Other side effects of illegal steroid use are flat-out dangerous:

  • Large male breast development
  • Disease of the liver or spleen
  • High blood pressure
  • Increased cholesterol
  • Blood clots
  • Heart disease

Testosterone Replacement Therapy can be safe, effective, and side-effect free when provided under the guidance of a trained professional. This makes all the difference.

Making sure that your health is not sacrificed in the name of “higher T levels” is one of the most important roles of a TRT provider.

Learn More About Safe and Effective Treatment for Low T

Understand that any medicine can be a poison; it all depends on the dose and proper medical supervision. Make sure that when you choose someone to help you with your Low T symptoms, you select a provider with the knowledge and expertise to improve your quality of life while also keeping you safe.

To help you understand more about the TRT process, we have put together a complete guide that will answer any questions you may have about TRT — click to learn more.

Learn More About TRT


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(Bill) William J. White, PA-C

(Bill) William J. White, PA-C brings over 20 years of surgical experience to our practice. He is a decorated veteran of the United States Army where he served for nearly 6 years with duty assignments, both here and abroad.   During his military career, Bill was trained as a Certified Surgical Technologist, and following an Honorable Discharge from the Army, he attended Texas Tech University.   He graduated with a Bachelor of Science in Biology and went on to attend PA School at the University of Texas Southwestern Medical Center at Dallas. He spent the first 10 years of his career in Neurosurgery.


  1. John Calderon on 04/21/2019 at 4:53 pm

    hi Bill … I have a question . Im a 58yo male, I just recently had blood test on 13 April 2019, my testosterone serum was 569 ng/nl , free testosterone was 10.4 pg/nl , psa 0.6 would I be a good candidate for trt?

    • John,

      That depends on a few factors. First symptoms, do you have symptoms consistent with low testosterone? Next, what does you CALCULATED free testosterone (cFT) look like? It’s likely to look much different than the number you were given. And then, are there any contraindications? These are things to answer as you move forward. A total testosterone of 569 ng/dL is a normal result, so if your cFT is not low, then you would not be a candidate for therapy.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  2. Kenny Pollock on 09/12/2021 at 2:19 am

    Hi Bill
    I was considering taking tablet form TRT to boost weight training. Is this something you would recommend short term?

    • Hello Kenny!

      TRT definitely does help with the improvement of body composition and physical performance. However, it’s less likely to be worth the burden of therapy if only used for boosting weight training. If you don’t have other symptoms like decreased libido, fatigue, difficulty maintaining sleep, trouble concentrating, or irritability, TRT is usually not recommended.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Managing Partner

  3. Brian Millern on 11/28/2023 at 9:29 am

    I am on TRT for a year now. 0.9mL if Delatestryl injected weekly. I definitely have “Roid Rage”. Although I’m in my fifties, I am punching holes in walls and am filled with aggressive rage like a teenager. I’ve had to advise my doctor that they need to reduce my dosage.

    • Hello Brian,

      I am unfamiliar with that formulation, but “roid rage” often has a lot to do with your estradiol levels, perhaps even more so than your T levels.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas | Managing Partner

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