Testosterone & Anabolics

The Mental Glow-Up (Or Down): What Actually Happens

• Mood and energy boost: Guys on TRT often feel like someone flipped their mental power switch to “ON” – better mood, more energy, and mental clarity, especially if they were running on empty T-wise before. Some research backs this up, showing T can help kick mild depression to the curb for these men.

• Confidence goes up, anxiety goes down: The receipts don’t lie – users consistently report feeling more confident and less anxious while on cycle or TRT. This probably comes from just feeling better overall, plus testosterone might directly mess with your brain chemicals (in a good way).

• Aggro vibes (at high doses): When you’re taking superhuman amounts, some people (not everyone) get more impulsive or irritable. Those infamous “roid rage” episodes and manic behavior are real, though most people taking moderate amounts don’t turn into the Incredible Hulk.

• Brain gains (or changes): T can switch up how your brain works – some users swear they can focus better or think more spatially. The research is all over the place on this, but we do know low testosterone can fog up your thinking, so TRT might clear that fog simply by fixing the fatigue.

• The brutal comedown: When you stop taking steroids (especially after high-dose use), your mental state can completely crash – mood tanks, anxiety spikes, fatigue hits hard, and your confidence evaporates because your body’s natural T production got shut down. This is why proper PCT (post-cycle therapy) isn’t just some optional extra – it’s absolutely crucial to avoid the mental nosedive.

The Old School Way (Spoiler: It Wasn’t Great)

Back in the day, medical testosterone use was basically: massive needle, massive dose, massively spaced out. Doctors would use long-acting testosterone versions (enanthate or cypionate) and jab them deep into your butt muscle at hefty doses of 200–250 mg once every 2–4 weeks. The 1950s logic was solid enough – these long esters were created specifically to keep testosterone hanging around in your system longer so you wouldn’t need to be constantly poking yourself.

But here’s where it all went sideways: this approach created these wild hormone rollercoasters. Your testosterone would absolutely skyrocket right after injection (we’re talking superhuman levels), then slowly crash down, often ending up even lower than when you started by the time your next shot was due. A single 200 mg muscle injection can push your T levels way above normal range in the first week, followed by a miserable dip by week 2.

Patients were basically living the hormone equivalent of a theme park ride – feeling amazing for a few days after getting their shot, then progressively more trash as levels tanked. One clinic describes it perfectly: with typical IM shots given every two weeks or monthly, testosterone peaks within about 24 hours then steadily drops off. By days 10–14, many patients actually have lower T than before they started treatment, creating this brutal yo-yo effect.

So yeah, the old-school approach of massive, infrequent shots made sure you got your testosterone… but at the cost of your hormones going absolutely haywire between injections.

The New Wave: Smaller, More Often, Under the Skin

These days, hormone optimization is all about the “little and often” approach, typically using subcutaneous (SubQ) injections. Instead of stabbing yourself deep in the muscle, SubQ means depositing the testosterone into the fat layer just under your skin (usually in your belly or thigh fat). This approach has blown up for some seriously good reasons:

First, it’s way more DIY-friendly. The needles are tiny (think insulin-sized), it hurts way less, and you don’t need to be a contortionist to inject yourself. But the real game-changer is what it does for your hormone levels – they stay dramatically more stable.

The science is pretty cool: SubQ injections get absorbed more slowly and consistently because fat tissue has fewer blood vessels and relies more on lymphatic absorption. This means the testosterone trickles steadily into your bloodstream rather than flooding it all at once like with muscle injections.

Clinical studies back this up hard. Smaller, more frequent doses (like 50–100 mg weekly given SubQ) can keep your testosterone nicely in the normal range without those crazy spikes you’d get with a massive 200 mg muscle shot. Patients doing twice-weekly or even more frequent micro-doses report way more consistent mood and energy because they’re not dealing with that end-of-week hormone crash anymore.

One legit endocrinology study with hypogonadal men found that weekly SubQ shots of just 50–75 mg testosterone enanthate got everyone’s T levels into the normal range. Doctors could easily fine-tune the dose (50, 75, or 100 mg weekly) based on individual needs. The contrast was stark – the group getting slammed with 200 mg IM all at once had these excessive initial T levels, while the group on split weekly dosing stayed nice and steady. Clear evidence that spreading out your dose is the way to go.

The cutting edge now is using shorter-acting testosterone versions (like propionate) or super-low daily doses. These short-acting forms hit your system faster and clear out quicker, which works perfectly with frequent (sometimes even daily) shots to actually mimic how your body naturally produces testosterone throughout the day. While the longer-acting versions (enanthate/cypionate) still work fine with frequent dosing, some advanced protocols are switching to propionate in tiny daily SubQ shots to get ultra-stable levels without the estrogen spikes that can lead to man-boob development. This approach is gaining serious traction in forward-thinking TRT clinics and among steroid users who are serious about minimizing health risks.

Under the Skin vs. Deep in the Muscle: What Actually Works Better?

These days, many doctors consider under-the-skin (SubQ) testosterone shots to be just as effective as muscle injections, and often way better. The research receipts are clear: SubQ injections reliably get testosterone levels right where they need to be. One study with transgender men found that weekly SubQ shots (50–150 mg) successfully achieved normal male T levels in every single patient, and most strongly preferred the comfort of SubQ over the painful muscle jabs. Similarly, men with low T responded just as well to weekly SubQ testosterone, with the same hormone levels and symptom improvements as the traditional muscle shot approach.

The benefits of going SubQ are pretty massive:

• Way more stable hormone levels: Frequent SubQ dosing eliminates those wild hormone swings, which means your mood, sex drive, and energy stay consistent day-to-day instead of going haywire.

• Dramatically less painful and easier to DIY: SubQ uses those tiny insulin needles into belly fat, which is night-and-day less painful than jabbing deep into muscle. You also don’t have to worry about hitting a nerve or blood vessel like you do with muscle shots. In real life, this means patients can easily self-inject at home without contorting themselves into weird positions or needing someone else to do it.

• Fewer man-boob risks and side effects: By keeping testosterone levels steady and using smaller per-dose amounts, your body likely converts less to estrogen all at once, potentially reducing side effects like mood swings or gynecomastia (though you still need to keep an eye on your estrogen levels).

• Works better with fast-acting testosterone: The shift toward frequent dosing has made shorter-acting testosterone types (like propionate) actually practical now, whereas before they were a pain since they required shots every other day. These days, advanced users are fine with an every-other-day or even daily schedule to get the stability benefits of these faster-acting forms.

That said, the old-school muscle injection approach did have one advantage – convenience. One shot could last you weeks, which was perfect for making sure patients actually stuck with their treatment.

Some people still prefer a once-weekly muscle injection if they don’t mind some minor hormone fluctuations or if they struggled to remember multiple doses throughout the week.

The most important thing to remember? Whether you go muscle or under-the-skin, getting the right total weekly dose is what matters most. Many TRT providers simply took a weekly muscle dose and split it into two or more smaller injections.

For example, instead of a brutal 200 mg muscle shot every 2 weeks, a modern approach might use ~50–100 mg SubQ twice a week. Your total weekly amount gets personalized based on your blood work and symptoms, but splitting it makes everything more stable.

How to Actually Do This Safely

There are tons of legit resources out there on proper injection technique for both muscle and SubQ methods (without encouraging misuse).

Official medical sources like Mayo Clinic and endocrine society guidelines provide step-by-step instructions for patients on DIY testosterone injections.

These cover everything from sterilizing the injection site to choosing the right needle size to figuring out how deep to go.

Harm-reduction focused organizations also publish detailed guides and videos on proper technique. They emphasized crucial safety practices like rotating where you inject and proper needle disposal to avoid infections or injection-site injuries.

While we won’t spell out the exact procedures here, if you’re considering self-injection, definitely consult professional guidelines to make sure you’re doing it safely.

hCG: The Gold Standard Ball-Saver

Human Chorionic Gonadotropin (hCG) is the MVP when it comes to preserving testicular function. It’s basically the cornerstone medication for this purpose.

hCG is an analog of LH – it mimics the signal that your brain normally sends to your testicles. It binds to LH receptors in your testes (particularly the Leydig cells) and tells them “keep working, boys!” even though your brain stopped sending that message.

In simple terms, using hCG alongside testosterone replaces the missing signals from your brain. Both clinical sources and harm-reduction communities recognize that hCG prevents your testicles from shrinking and keeps them functioning during steroid use.

hCG has been used for decades in fertility medicine and by athletes coming off steroid cycles. Typical dosing when on TRT or low-dose steroids is in the hundreds of IU (International Units) per injection, given a few times weekly.

Studies show that even low-dose hCG – as little as 500 IU under the skin 3x per week – is enough to maintain normal testosterone levels inside your testicles while you’re on external testosterone.

One landmark study found that just 250 IU hCG every other day kept testicular testosterone production nearly unchanged during a testosterone suppression experiment. Higher doses (like 500 IU every other day or 1500 IU weekly) can actually push your testicular hormone levels even higher than normal. For practical TRT purposes, doctors often prescribed hCG at 500 IU 2–3 times weekly alongside testosterone, adjusting as needed.

This approach has been shown to maintain sperm production, prevent testicular shrinkage, and even improve fertility compared to testosterone alone.

The big advantage of hCG is that it works even when your pituitary is completely suppressed, since it bypasses your brain and directly stimulates your testicles.

Men taking hCG with their testosterone typically reported that their testicles maintain normal size and their ejaculate volume and fertility markers stay much closer to normal.

Many endocrinologists now routinely included hCG in TRT protocols for younger men who might want kids in the future. One harm-reduction review states it plainly: “Human chorionic gonadotropin is used to prevent testicular atrophy and preserve testicular function” during steroid use.

The downsides? hCG requires injections (usually SubQ) and can raise estrogen levels since the increased testicular testosterone can convert to estradiol.

High doses of hCG might also desensitize your testicles over time or cause excess LH-like stimulation leading to gynecomastia (man boobs). This is why the goal is to use the lowest effective dose to keep your testicles functioning.

Recent changes in U.S. regulation have made hCG harder to get (it was reclassified as a biologic drug, so compounded hCG is no longer available), but it remains the standard option for fertility preservation during TRT.

Enclomiphene: The New Kid on the Block

Enclomiphene is an emerging alternative to hCG for keeping your fertility intact while on testosterone. It’s essentially one component of clomiphene (Clomid) – specifically the trans-isomer that blocks estrogen receptors without the mixed effects of regular Clomid.

Enclomiphene acts as a selective estrogen receptor modulator (SERM) in your brain’s hormone control centers, blocking estrogen’s feedback signals.

By doing this, it tricks your body into thinking estrogen (and thus testosterone) levels are low, which causes your pituitary to pump out more LH and FSH. In other words, enclomiphene stimulates your body to produce its own fertility hormones.

Unlike hCG, which bypasses your pituitary completely, enclomiphene needs your HPT axis to be at least somewhat functional (your pituitary and hypothalamus must still be capable of producing LH/FSH).

For guys on moderate TRT doses, enclomiphene can keep the pituitary partially active despite the external testosterone, maintaining some sperm and testosterone production naturally.

A recent study comparing enclomiphene to regular clomiphene showed that enclomiphene significantly increased LH and FSH levels and improved sperm counts in men, while boosting testosterone just as effectively as clomiphene.

Because enclomiphene more selectively blocks estrogen without the mixed effects of clomiphene, it typically has fewer side effects (guys on regular Clomid sometimes reported mood swings or visual issues due to its mixed activity).

Some rejuvenation clinics have started prescribing enclomiphene for men on TRT as a fertility-preserving agent, especially since the hCG availability issues. Clinically, enclomiphene is typically given orally, around 12.5 to 25 mg per day or a few times a week, adjusted per hormone levels. Early evidence suggests it can maintain sperm production and even raise testosterone slightly during TRT, essentially acting like an “oral gonadotropin” stimulant. For example, enclomiphene has been shown to maintain normal sperm parameters in hypogonadal men while increasing their testosterone, something that exogenous testosterone alone would not allow. A key point is that enclomiphene will not be effective if the dose of anabolic steroids is so high that the pituitary is completely shut down despite SERM signals. In mild to moderate suppression, though, it can help preserve fertility without injections. Enclomiphene is not yet as widely used or studied as hCG in this context, but it’s a promising tool and is legal in the UK (and available via private prescription) for TRT-related use. In the US, enclomiphene is still in a gray area (not FDA-approved specifically for TRT support, but doctors might prescribe off-label or patients obtain it through compounding pharmacies).

Other Options Worth Knowing About

There are a few other strategies for keeping your testicles functioning. One approach uses a GnRH analogue called Gonadorelin in carefully timed pulses.

Gonadorelin is synthetic GnRH – the hormone from your hypothalamus that tells your pituitary to release LH/FSH. If given in small pulses or daily, it can prompt your pituitary to release fertility hormones even when testosterone levels are high.

The downside? It requires very frequent dosing (often daily SubQ shots), and researchers are still figuring out how effective it really is for maintaining fertility during steroid use.

Some clinics recommended gonadorelin as an hCG alternative (usually as nightly injections) for men on TRT who want to prevent testicular shrinkage.

While the concept makes sense, the hassle of daily injections and higher cost makes it less popular than hCG or enclomiphene.

Additionally, regular Clomiphene Citrate (Clomid), the older SERM, is still used by some either during a cycle or as part of post-cycle therapy (PCT) to restart the HPT axis.

Clomid can maintain some LH/FSH production during a cycle, but with more side effects and less targeted action than enclomiphene, many now prefer enclomiphene (which is essentially Clomid’s active component without the problematic parts).

TL;DR: Your Fertility Preservation Options

Both approaches can work well. Sometimes doctors might even combine them for guys who are seriously prioritizing fertility: for example, a low dose of hCG weekly plus enclomiphene a couple times a week.

Researchers are exploring even newer options like kisspeptin analogues (which work higher up on the hormone chain) or refined GnRH protocols to maintain fertility during TRT.

For now, hCG remains the gold standard for preserving testicular function during testosterone use, with enclomiphene emerging as a promising alternative.

The Health Equation: Benefits vs. Risks

Low-dose testosterone (medically supervised TRT) can genuinely improve health for guys with deficiency – better mood, more muscle, stronger bones, the works.

But non-medical use and high-dose steroid abuse can lead to significant health problems. We’re talking cardiovascular strain (high blood pressure, cholesterol issues, heart changes), liver damage (especially with oral steroids), and hormone disruptions (acne, hair loss, man boobs, shrinking testicles).

Psychological effects like aggression, mood swings, or even dependence can hit susceptible individuals hard. Long-term steroid abuse has been linked to early heart attacks, permanent heart changes, and even cognitive problems or mood disorders in some cases.

From an ethical standpoint, using steroids purely for performance enhancement means knowingly risking these health consequences for non-medical reasons.

If you do choose to use, harm reduction principles suggest regular health monitoring (blood pressure checks, blood tests for liver and lipid profiles) and using the lowest effective doses for the shortest time possible to minimize risks.

The Ethics Conversation

In sports and competitive contexts, using anabolic steroids without a prescription is considered cheating and banned by virtually all sports organizations.

Using steroids for performance or physique enhancement undermines the principle of fair play in competitive settings.

Even outside pro sports, there are legitimate ethical questions about the social pressure to use these substances (gym culture, body image issues) and whether it’s appropriate to risk your health just for cosmetic or strength gains.

Doctors face ethical dilemmas too. Prescribing testosterone purely for age-related enhancement or athletic improvement (without a genuine medical need) enters a gray area.

Most medical guidelines stress that testosterone should only be prescribed for actual hypogonadism. However, there’s a growing “anti-aging” industry marketing TRT to older men with borderline levels to improve quality of life.

Making sure patients fully understood the risks and had realistic expectations is essential. At the same time, refusing TRT for someone who genuinely needed it (due to stigma about steroids) was also an ethical concern – so doctors needed to find the right balance.

The Law: US vs UK

Legally, testosterone and most anabolic steroids are classified as controlled substances in many countries, but laws varied significantly.

United States: It’s straight-up illegal to use or possess anabolic steroids without a valid prescription in the US. They were added to the Schedule III controlled substances list in 1990.

This meant any non-prescribed use (bodybuilding, performance enhancement, etc.) was against federal law. People caught distributing or possessing illicit steroids could face criminal charges.

In practice, personal users with small amounts rarely got prosecuted, but the law was clear – non-prescription use was illegal.

United Kingdom: The UK took a notably different approach. Anabolic steroids are Class C drugs, which meant they’re illegal to supply or sell, but personal possession for self-use was legal under certain conditions.

In the UK, you could legally possess steroids for your own use, and you’re even allowed to import/export them as long as you did it in person (like carrying them in your luggage).

However, it was illegal in the UK to supply steroids to others or import them by mail. Penalties for supplying were serious – up to 14 years in prison.

Testosterone was still a prescription-only medicine in the UK, so while having it wasn’t an offense, getting it should be through a prescription or personal import. Buying on the black market wasn’t a legal route.

This nuanced legal approach tried to avoid criminalizing users who were often just trying to improve their own bodies, while still discouraging trafficking and misuse.

Medical Supervision: The Smart Approach

In both the US and UK, testosterone was available through prescription for legitimate medical purposes (diagnosed low testosterone, certain anemias, gender dysphoria, etc.).

Under a doctor’s care, you got crucial benefits: proper dosing, regular lab monitoring, and management of side effects.

Ethical medical practice dictated that doctors shouldn’t prescribe steroids purely for performance enhancement or cosmetic goals.

Some countries had specific anti-doping laws targeting athlete use, while others focused more on distribution. Several US states had laws against “body brokering” or coaching steroid use in gyms.

Harm reduction organizations encouraged users who chose to self-administer to do so as safely as possible: get regular blood tests, never share needles, and use pharmaceutical-grade products rather than sketchy underground lab concoctions to avoid contamination or dosing errors.

It was also critical to have an exit strategy (post-cycle therapy or medical help) to restore normal hormone function after a cycle, reducing long-term harm.