What is the rate of adverse events associated with exogenous testosterone (Testosterone) and Human Growth Hormone (HGH) use in bodybuilders?

Adverse Events Associated with Exogenous Testosterone and HGH Use in Bodybuilders

Bodybuilders using exogenous testosterone and human growth hormone (HGH) face significant risks of adverse events including cardiovascular complications, endocrine disruption, psychological effects, and organ damage that can lead to substantial morbidity and mortality.

Testosterone-Related Adverse Events

Cardiovascular Effects

• Cardiovascular risk is one of the most concerning adverse effects of testosterone use in bodybuilders, especially at supraphysiological doses
• In clinical studies with therapeutic doses, cardiovascular events occurred in approximately 2.3% of testosterone users versus 1.5% in placebo groups 1
• The TOM trial was stopped early due to excess cardiovascular adverse events (7% in testosterone group vs 1% in placebo group) 1
• Bodybuilders typically use doses 5-100 times higher than therapeutic doses, significantly increasing cardiovascular risks 2
• Effects include:
  • Unfavorable lipid profile changes (decreased HDL cholesterol)
  • Elevated blood pressure
  • Increased risk of thrombosis
  • Potential direct injury to vessel walls 2

Endocrine System Effects

• Suppression of natural testosterone production and gonadotropins that may persist for months after discontinuation 2
• Oligospermia (reduced sperm count) at high doses 3
• Gynecomastia (breast tissue development in males) 3
• Excessive frequency and duration of penile erections 3

Psychological and Neurological Effects

• Increased aggression and hostility 2
• Mood disturbances including depression, mania, and psychotic features 2
• Risk of dependence and withdrawal effects 2
• Headache, anxiety, and generalized paresthesia 3

Other Physical Effects

• Skin issues: acne, seborrhea, hirsutism, male pattern baldness 3, 2
• Fluid and electrolyte disturbances: retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates 3
• Hematologic: polycythemia (increased red blood cell count), suppression of clotting factors 3
• Hepatic: cholestatic jaundice, alterations in liver function tests, rarely hepatocellular neoplasms and peliosis hepatis 3
• Inflammation and pain at injection sites 3

HGH-Related Adverse Events

Acromegalic Effects

• Long-term use can lead to features of acromegaly, including:
  • Soft tissue swelling
  • Coarsening of facial features
  • Enlargement of hands and feet
  • Joint pain 4

Metabolic Effects

• Insulin resistance and potential development of diabetes
• Fluid retention and edema
• Carpal tunnel syndrome 4

Cardiovascular Effects

• Cardiomegaly (enlarged heart)
• Hypertension
• Potential heart failure with prolonged use 4

Special Considerations for Bodybuilders

Dose-Related Risks

• Bodybuilders often use doses far exceeding therapeutic levels, which significantly increases risk of adverse events 2
• Clinical studies typically use much lower doses than those used illicitly, meaning actual adverse event rates in bodybuilders are likely higher than reported in medical literature 2

Polypharmacy Risks

• Bodybuilders often combine multiple performance-enhancing substances, creating unpredictable drug interactions
• "Stacking" testosterone with other anabolic steroids may amplify adverse effects 2

Long-Term Consequences

• Habituation and psychological dependence can lead to prolonged use despite adverse effects 4
• Improvements gained with steroids generally disappear after discontinuation 4
• Long-term cardiovascular and organ damage may be irreversible

Risk Mitigation

• The American Urological Association recommends against continuing high-dose testosterone therapy, as supraphysiological levels increase adverse effects without additional benefits 5
• Monitoring for cardiovascular effects is crucial with supraphysiological testosterone levels 5
• Avoiding compounded testosterone products with inconsistent potency and quality 5
• Avoiding alkylated oral testosterone due to liver toxicity 5

Conclusion

The adverse event profile of exogenous testosterone and HGH use in bodybuilders is substantial, with risks that far exceed those seen in therapeutic settings due to much higher doses and longer duration of use. While clinical trials show relatively modest adverse event rates with therapeutic testosterone use, these studies do not reflect the reality of illicit use patterns in bodybuilding communities, where adverse event rates are likely significantly higher.