Anabolic Steroids and PEDs: Risks and Recovery After Stopping

I see quite a few patients in this group. Some come because their breasts have enlarged. Some come because, after stopping, life feels as if the lights have gone out: no energy, no sex drive. And many come because they want a blood test but are afraid to say what they are using. I want to say this first: you can tell me. Knowing the truth lets me look after you more safely.

What are PEDs?

PEDs (performance-enhancing drugs) are substances used to increase muscle and strength or to lose fat. The ones commonly seen in the fitness world include:

• anabolic-androgenic steroids, both injected and oral, including testosterone at doses above treatment levels
• SARMs, often sold as "safer than steroids", but not approved for human use, and they also suppress hormones
• growth hormone and insulin
• metabolism boosters such as clenbuterol, thyroid hormone and diuretics
• add-on drugs such as oestrogen blockers, hCG or SERMs used without medical supervision

The key difference from TRT is that TRT uses doses that restore normal levels in men whose testosterone is genuinely low, with monitoring. PEDs are usually used at doses many times higher, several at once, and from sources of unknown quality.

Side effects by body system

The Endocrine Society scientific statement (2014) and work by Baggish and colleagues (Circulation, 2017) found that long-term steroid users had clearly weaker heart pumping and more coronary artery plaque than non-users. Many of these risks give no warning until something happens.

Another point that is often overlooked: many underground products contain a different drug from the label, the wrong dose, or contaminants, and some supplements are secretly spiked with undeclared steroids.

Why do I feel so bad after stopping?

While you are using, your brain stops telling your testes to work. When you stop, the hormone from outside disappears but your testes have not yet restarted. This is called anabolic steroid-induced hypogonadism (ASIH).

• Symptoms: no energy, no sex drive, poor erections, low mood, anxiety, muscle loss
• Duration: usually several months, sometimes a year or more, and some men never recover fully, especially after long use at high doses
• Consequences: many go back to using because they cannot cope with the symptoms, and a cycle of dependence develops

Low mood after stopping steroids can be severe. If you have thoughts of harming yourself, call 1323 (Thailand's free mental-health hotline; Thai language, ask for English support) or 1669 (medical emergency) straight away, and read depression or low testosterone: how to tell them apart.

1. 1
   Using PEDsThe brain stops telling the testes to work
2. 2
   StoppingOutside hormone disappears; testes not yet recovered
3. 3
   Low hormone (ASIH)No energy, no desire, low mood, muscle loss
4. 4
   Can't copeMany go back to using

Symptoms can last months to years. If you have thoughts of self-harm, call 1323 (mental-health hotline) or 1669 (emergency).

Recovering after stopping

1. Tell your doctor honestly what you used, the doses, for how long and when you stopped.
2. Have baseline blood tests, such as testosterone, LH, FSH, oestradiol, haematocrit, lipids, liver and kidney function, and screening for blood-borne infections if you have ever shared needles (read HIV: what it is and how it spreads).
3. Have your heart checked: blood pressure, an ECG, and further tests if appropriate.
4. Plan hormone axis recovery as your doctor assesses. Some men wait for natural recovery; others use medicines to stimulate it. DIY "PCT" protocols from the internet are not well supported by evidence and can make things worse.
5. Look after your mental health, because changes in your body image can hit hard. Some men have muscle dysmorphia (a preoccupation with not being muscular enough), which is treatable.
6. Set new, sustainable goals through training, diet and sleep. Read how much TRT helps build muscle, and how to build muscle right.

If testing shows the testes have truly not recovered after an appropriate waiting time, some men may meet the criteria for permanent testosterone deficiency and can consider TRT at replacement doses with monitoring, which is different from going back to PEDs.

1. 1Be honest with your doctorWhat, dose, how long, when stopped
2. 2Blood and heart checksHormones, thick blood, lipids, liver, kidney, pressure, ECG
3. 3Restart the hormone axisAs assessed by your doctor; no DIY PCT from the internet
4. 4Look after your mindBody image, preoccupation with physique
5. 5New goalsSustainable training, diet and sleep

If you are still using, how to reduce harm

I do not support using PEDs, but if you still decide to use them, reducing harm matters more than hiding it.

• Never share needles or equipment; use a new needle every time.
• Have regular blood tests and blood pressure checks.
• Avoid liver-toxic oral types and avoid stacking several substances.
• Do not combine with heavy drinking or other drugs (read chemsex).
• If you plan to have children, talk to your doctor well in advance, because sperm production takes a long time to recover.

Selling controlled drugs without a licence is illegal in Thailand, and no one guarantees the quality of black-market products.

When to see a doctor, and how the clinic can help

Go to hospital or call 1669 straight away if you have chest pain or tightness, a racing heartbeat, breathlessness, swelling of one leg, yellow skin or eyes, or sudden weakness in an arm or leg. Book an appointment if you have breast enlargement, small testes, difficulty conceiving, low mood after stopping, or want a health check while using.

At Dr. Kris Clinic, I offer non-judgemental advice, blood tests and risk assessment, plan hormone recovery as clinically appropriate, and look after your mental and sexual health at the same time. Consultations are available at the clinic or online, in English, and your information is kept confidential.