- 1 HGH (human growth hormone)
- 2 Steroids (DHT and testosterone)
- 3 SARMs (Selective androgen receptor modulators)
- 4 Prohormones (DHEA and A4)
- 5 What’s the difference between them and their effects?
- 6 Can side effects be prevented?
- 7 Other (safer) options to achieve your goals
As a clinic, we receive a lot of requests from healthy people who aim to build muscle and lose fat with products such as growth hormone (HGH) injections.
Despite the fact that the medication is illicit without a prescription, there is an abundance of unreliable information presenting HGH as a safe and easy way to build muscle and lose fat.
In fact, HGH is often misrepresented for being a steroid due to its anabolic properties, the ban by the world anti-doping agency (WADA), and its illegal use in “steroid stacks”.
The reality is that both HGH and steroid abuse can lead to serious but different adverse reactions, such as palumboism, heart and circulatory problems. Thus, it is important to seek health-related information from medical professionals or evidence-based sources only.
Here, we will break down the science on the risks and questionable benefits of the most popular performance-enhancing drugs (PEDs).
In the next lines, you will learn more about the safety and effectiveness of HGH, steroids, prohormones, SARMs and the differences between them.
HGH (human growth hormone)
The human growth hormone is not a steroid. Instead, it is made of 191 amino acids bound in a single chain which forms a “peptide structure”.
Therefore, all hormones made from short chains of amino acids, such as HGH, are called “peptide hormones”.
Growth hormone is produced in pulses by a gland in your brain called the pituitary. If the gland does not function properly, this may lead to growth hormone deficiency (GHD).
GHD is the main medical indication for exogenous growth hormone treatment. Due to its anabolic and muscle-sparing effects, the legal indications for HGH therapy also include wasting due to AIDS and short-bowel syndrome (SBS).
Since the hormone has a peptide structure, the therapy is effective only as HGH injections.
Oral pills and tablets with HGH will be easily deactivated by your gastrointestinal system, while HGH gels or creams won’t get absorbed through your skin.
Legal HGH therapy in GHD patients is generally well-tolerated and has few side effects. That’s because the treatment aims to restore the levels of the hormone in the body back to their normal levels.
However, as a PED, HGH is usually abused in very high doses. According to studies, this can lead to several adverse reactions related to fluid retention, including edemas, headache, carpal tunnel syndrome, etc.
Furthermore, researchers suggest that long-term HGH abuse may lead to acromegaly and type 2 diabetes. Acromegaly is characterized by irreversible bone deformations and an increased risk for premature death due to cardiovascular problems.
Steroids (DHT and testosterone)
Anabolic-androgenic steroids (AAS) include derivatives of the hormones testosterone (T) and dihydrotestosterone (DHT). They have a typical steroid structure made of 4 rings of carbon atoms.
Other steroid hormones such as estrogen, cortisol, and aldosterone lack such anabolic properties
AAS can stimulate muscle growth, increase strength and induce masculinization by triggering specific androgenic receptors in your body’s cells. Due to their effectiveness, steroids are some of the most commonly abused PEDs.
Some AAS such as testosterone esters is available as prescription medications. Legal indications for use in men include hypogonadism, muscle wasting, and osteoporosis.
However, there are AAS that were never intended for medical use but instead used in cattle or discontinued. Nevertheless, they are often abused by athletes and bodybuilders despite the health risks.
Steroid hormones can be taken safely only when prescribed by a medical doctor. If you misuse AAS, there is a risk for both short and long-term adverse reactions. Short-term risks include:
- Oily skin
- Suppressed natural testosterone (T) production
- Psychological problems and symptoms of addiction
- Erectile dysfunction
According to trials, even short-term steroid abuse may lead to psychological effects. These include signs and symptoms of addiction as well as withdrawal after discontinuation.
Long-term adverse reactions occur after prolonged use of high-dose AAS. They include prostate enlargement, gynecomastia, testicular atrophy, high cholesterol, elevated red blood cell count, and increased risk of thrombosis.
Scientists also point out that prolonged AAS use can lead to chronic cardiovascular diseases including hypertension, cardiomyopathy, and heart failure.
AAS come in two main forms – pills and intramuscular injections. Due to the fat-soluble nature of all steroids, they are well absorbed in the digestive system. Yet, they should not be injected intravenously due to a risk of embolism.
Oral forms of AAS are typically modified into 17-α derivates in order to have better bioavailability. Yet, studies reveal that this makes them hepatotoxic and adds liver damage to the list of possible side effects.
SARMs (Selective androgen receptor modulators)
SARMs, as the name suggests, selectively activate some of the receptors triggered by AAS. Therefore they are supposed to carry out the benefits of AAS, such as anabolic stimulus for muscles and bones, without any negative side effects (androgenic effects and masculinization) and health risks.
However, all SARMs are still in the experimental phase and most of them haven’t even reached clinical trials yet
Furthermore, none of the SARMs available are truly selective. Thus, there are still risks for androgenization and suppression of natural testosterone synthesis.
SARMs are legal only when used for research purposes and experiments. Therefore, they are classified as research chemicals that are regulated by the FDA and cannot be sold legally for human use.
The FDA has even issued warning letters to several supplement companies, clearly stating that SARMs are experimental drugs that are still unapproved and their side effects are not fully known.
Some of the possible adverse reactions according to the FDA and unofficial reports may include cardiovascular problems, stroke, liver failure, temporary loss of eyesight, and side effects similar to steroids
Moreover, researchers report that the majority of SARMs sold by supplement companies are wrongly labeled and do not contain the product they claim to offer.
Prohormones (DHEA and A4)
Prohormones are compounds produced in the male and the female body as a part of the natural synthesis of testosterone and estrogen. They include dehydroepiandrosterone (DHEA) and its metabolite, called 4-Androstenedione (A4).
DHEA is available as a dietary supplement that is not regulated by the FDA and therefore it is legal for over-the-counter (OTC) use.
Studies suggest that DHEA may lead to an increase in the natural T synthesis. Yet, the increase in testosterone also leads to an increase in estrogen levels and a negative feedback effect on natural testosterone production.
Thus, your T levels may increase but won’t exceed the normal reference ranges and you won’t experience any noticeable benefits for your performance or body composition. Besides, trials report that men with hypogonadism will not benefit from DHEA.
A4 on the other hand is a regulated substance and its possession is illegal. However, studies reveal that supplementation is also ineffective increasing muscle mass or athletic performance. A4 may cause side effects such as worsened cholesterol levels.
What’s the difference between them and their effects?
Compared to the rest, AAS are by far the most effective PED for improving body composition and strength.
The use of supraphysiological doses leads to quick effects which occur as soon as the first couple of weeks. For the same reason, they also have some of the most serious adverse reactions.
Oral forms of AAS are usually taken daily or several times per day, while most injections are taken once per week.
In comparison, the anabolic effects of HGH are significantly weaker, while the fat-burning benefits are moderate.
Furthermore, it takes at least a month until there is noticeable fat loss. The use of HGH involves daily subcutaneous injections.
SARMs have largely unknown benefits. So far, only some compounds are clinically tested and show significant benefits for muscle mass and bone density.
All SARMs are designed for daily oral use. The severity of their side effects is yet to be studied extensively.
According to the available evidence, prohormones lack any significant benefits. Nevertheless, some side effects are still possible, albeit less severe than other PEDs. DHEA and A4 come in the form of oral supplements which should be taken daily.
Can side effects be prevented?
The best option to prevent side effects from HGH or steroids is to first consult with a medical doctor and take the medications as prescribed. Your physician will offer you a prescription only if you have the medical indications for hormonal therapy.
Keep in mind that purchasing illegal substances also hides a risk that they may contain chemical and biological contaminants.
The only way to be certain that you are purchasing a genuine product is to buy it from a licensed pharmacy that requires a prescription.
Reducing the dosage of the PEDs may lower the risk of adverse reactions. The side-effects of HGH are transitory, and the main one – water retention goes away as soon as you discontinue the medications.
If you have taken AAS for a prolonged period of time, it is best to taper off the drugs rather than stop “cold turkey”. The process may lead to symptoms of withdrawal and it takes several months for your natural T production to recover.
According to studies, it may take longer than 6 months until the testosterone production in your testes is restored back to physiological levels.
Recovery in 90% of individuals occurs after at least 12 months
Another option to prevent some of the risks is taking prescription medications such as selective estrogen receptor modulators (SERMs).
They may lower the risk of gynecomastia, natural testosterone suppression, and testicular atrophy by preventing the action of estrogen on your breast tissue and the pituitary gland.
Yet, there is insufficient evidence on whether OTC supplements such as Tribulus terrestris are effective in increasing recovery after the use of AAS.
Other (safer) options to achieve your goals
There are significant differences between HGH and steroids in their magnitude of effects and adverse reactions. Yet, both can have negative consequences for your health when misused as PEDs.
Therefore, it is much safer to focus on your diet and training, as the two most important and natural factors that can help you build muscle and lose fat.
First of all, your nutrition should include a sufficient amount of protein, in order to support muscle growth and help you preserve muscle mass. Yet, the amount of protein required for optimal results is largely overestimated.
Studies reveal that 0.7-0.8g/lbs (1.6 – 1.7g/kg) of protein intake is sufficient to provide an optimal anabolic environment for your muscles in both bulking and cutting phases.
Unless you are severely overweight or obese, it is best to avoid dramatic changes in your total energy intake. For example, a slight energy surplus will help you gain more muscle without gaining too much fat in the process.
On the other hand, a slight energy deficit will help you lose weight in a controlled manner while preserving your muscle mass.
In terms of training, it does not matter whether your goal is bulking or cutting – you should focus on training with weights instead of cardio.
Aerobic exercise may induce a modest weight loss but generally, it is not an effective method for weight management on its own. Dietary intervention alone seems to provide similar results.
Adding cardio to your weight training is also not optimal as it reduces the benefits of resistance training for muscle growth
On the other hand, resistance training will help you preserve your muscles when cutting and build more mass during a bulk.
Why is natural bodybuilding better than steroids?
AAS are highly effective in increasing muscle mass and reducing body fat. However, the wide range of side effects far outweighs their benefits.
Besides, most people tend to lose their progress once they discontinue steroid use since their nutrition and training regimes are often less than optimal.
Natural bodybuilding may take much more time and dedication before achieving substantial results, but it will help you build a routine, that will keep you on track towards your goals for the long term.
Besides, you will have more time to find the most optimal approach in your diet and training. For example, here are several tips to keep in mind when creating your weight training routine to maximize muscle gains:
- Progressive microoverloading is the key to muscle hypertrophy. This means you should slightly increase your training volume every week or every few weeks by either increasing the weight you lift or adding an extra rep.
- Combine different exercises – a mix between compound exercise and isolation exercises works best. Do not focus on using machines only!
- Don’t focus on just one rep range. Researchers report that varying your rep ranges works best for muscle growth.
- Train through a full range of motion. Trials suggest that this is better for muscle hypertrophy and strength.
- Target each muscle group at least 2 times per week. Studies reveal that this is more optimal for muscle growth. Keep in mind that this does not mean to double your workload for every muscle, but more like splitting it throughout the week.