Muscle for Life with Mike Matthews - Dr. Guillermo Escalante on Using Anabolic Steroids Intelligently

Episode Date: June 9, 2023

The world of anabolic steroids often seems shrouded in mystery and controversy.  In this episode, seasoned sports medicine and exercise scientist Dr. Guillermo Escalante aims to dispel some of those myths and clarify the complex topic of steroid use in bodybuilding and the health and fitness space. Together, we delve deep into understanding anabolic steroids, focusing on their potential implications, responsible usage, and strategies to mitigate associated risks.  Specifically, Dr. Escalante stresses the importance of taking an evidence-based approach to steroid usage. In case you’re not famiiliar with him, Dr. Escalante is a Professor of Kinesiology and Dean Fellow for the College of Natural Sciences at California State University San Bernardino. He has authored over 52 peer-reviewed publications, and regularly presents at regional, national, and international conferences on his research. He has also been a competitive bodybuilder and coach. In this conversation, Dr. Escalante and I discuss . . . - What anabolic steroids are and their role in bodybuilding - How steroids can be used responsibly while minimizing health risks - The "least effective dose" approach to steroid usage - The importance of routine health checks for steroid users - Finding the right time to retire as an enhanced athlete - Balancing effectiveness and safety in steroid use - Common misconceptions and myths surrounding steroid usage - And more . . . Whether you're curious about the science of anabolic steroids or concerned about potential health implications, this interview provides a balanced and informed perspective on responsible usage. Join us as we navigate the world of anabolic steroids with Dr. Guillermo Escalante! Timestamps: (0:00) - Please leave a review of the show wherever you listen to podcasts and make sure to subscribe! (5:10) - What is happening to all these bodybuilders that are suddenly dying? and if someone decides to use anabolic steroids how can we mitigate the risks? (11:42) - Were the deaths of all these athletes due to heart problems? (12:22) - Why is having a bigger heart and thicker ventricular walls are not a good thing? (13:36) - Is this more a correlation than causation? (17:09) - Are risks with steroid use only apparent in high dosage use? (24:52) - Why can you take these testosterone derivatives and use them with testosterone? Why don’t they just take more testosterone? (30:15) - Do lifestyle factors affect the way steroids impact the body? (32:42) - Try Triumph today! Go to https://buylegion.com/triumph and use coupon code MUSCLE to save 20% or get double reward points! (35:05) - Is there a way to monitor your genetics to see if steroids are a risk factor? (40:31) - Is it okay to use steroids temporarily to reach full genetic potential and then stop? (48:39) - What are some other ways to mitigate risk from using anabolic steroids? (57:12) - Should I be monitoring my health if I'm taking exogenous testosterone? (59:16) - Should you start with the lowest dose to mitigate the risks of anabolic steroids? (63:36) - Is it hard to come off these drugs? (01:08:26)- What is post-cycle therapy and how that can mitigate risks? (01:11:05) - What is the point of post-cycle therapy? (01:23:23) - Where can people find you and your work? Mentioned on the Show: Try Triumph today! Go to https://buylegion.com/triumph and use coupon code MUSCLE to save 20% or get double reward points! Guillermo’s website: https://doctorgfit.com/Guillermo’s Instagram: https://www.instagram.com/doctorgfit/

Hello there, I'm Mike Matthews, and this is Muscle for Life. Thank you for joining me today for an interesting episode. I thought it was interesting because it's on steroids, and I have written and spoken a bit about steroids in the past. I've never used anabolic steroids, and I don't generally recommend them. I understand why some people use them, like professional bodybuilders, professional athletes, professional actors who have opportunities to become superstars and make millions of dollars, if they can gain a

lot of muscle, we'll say 30 pounds, in not a lot of time, like three, four, five months. But in the case of your average gym goer, I do not recommend anabolic steroids because I think the risk reward ratio doesn't make sense for that person. They should just be patient because you can get jacked naturally. It just takes longer. Now, if you want to get super duper jacked, super physiologically jacked, then you got to take steroids. But that kind of brings us back to, all right, are you a professional bodybuilder? And are you very passionate about that? Because chances are you are not going to make money. It's going to be a net loss over time.

So it really is a hobby. And so anyway, that's just some context for most of the content that I've created on steroids. Here's how they work. Here's how effective they are. Here's why you probably shouldn't do them. But what if you are somebody who is going to use them maybe because you want to be a competitive or a professional bodybuilder or maybe a professional or high level athlete, or maybe you just want to get super jacked. Maybe you're a guy and the look that you really want requires gaining,

let's say 50 to 60 pounds of muscle from starting as just an average type of guy, an average build. And to do that, you are almost certainly going to have to take steroids. The best a natural man can hope for. Realistically, the rule, there are exceptions, but the rule is probably around 40 pounds of muscle gains. That's total muscle gain over the course of their entire lifting career. So if you are going to use steroids for whatever reason, how do you go about it intelligently? How do you go about it in an evidence-based manner? How do you maximize the benefits and minimize the downsides? You can't eliminate them, but you can minimize them.

And that is what today's discussion is about. And today you are going to be learning from somebody who knows a lot more about steroids and the science of intelligent steroid use than I do. And his name is Dr. Guillermo Escalante, and he is a professor of kinesiology and dean fellow for the College of Natural Sciences at California State University, San Bernardino. And Guillermo is especially unique in that he has one foot in academia. So he has authored over 52 peer reviewed publications. He regularly presents at regional, national and international conferences on his research. But he also has a foot in professional bodybuilding. He has been a competitive bodybuilder and coach for decades now. And that practical experience gives him special insights into the

matter that you simply can't glean from just doing research as a scientist or being a desk researcher, someone like me who reads research. I'm not actively involved in research, although I am contributing to one study actually that is underway with Dr. Bill Campbell, but I don't consider myself a scientist or a researcher. I'm a desk researcher. I read the research that other people do, and then I interpret it for people like you and try to make it easy to understand and try to make it easy to apply. And that's great. But when you have somebody who's actively doing research and has practical first-hand experience, then you often get access to a very deep level of expertise,

a level that is simply not attainable without that practical firsthand experience. And so anyway, that's what today's episode is going to be about. And if you are simply curious about the science of anabolic steroids, or maybe you are concerned about potential health implications because you are using steroids or you plan on using steroids, this interview, I think, will provide you with a balanced and informed perspective on how to use these compounds responsibly. Hey, Guillermo, thanks for taking the time to come on my podcast. Thank you, Mike.

Thanks for having me. I really appreciate you bringing me on. Yeah, yeah. I'm looking forward to today's talk. I'm looking forward to learning a bit myself because this is a topic which, for everyone listening, you probably know by the title, but it is going to be on anabolic steroids. And it's something that I've written and I've spoken a little bit about. I've done an interview or two or three over the years on it, but I like our outline for today's talk because it's different than anything else I've produced on the matter.

And it's going to address some topical issues that and some perennial issues, some perennial questions that I get asked. And so why don't we start with the topical and then we can move into some of the more, I guess, evergreen questions that we want to address here on the podcast. And the topical one that people have been asking me about is bodybuilders dying suddenly. Over the last several years, there have been a number of cases of this, high profile cases for people who pay attention to bodybuilding at all. And so people have reached out to me just for my commentary on it, my thoughts on how dangerous these drugs actually are. Have those dangers been downplayed? And then I think we can go from there into a discussion of

when it might be appropriate to consider using anabolic steroids. And if you're going to do that without necessarily encouraging people to, but if you're going to do that, how do we mitigate some of these risks in an evidence-based way? Yeah, absolutely. I think it's great. And to your point with regards to these bodybuilding deaths in relatively young bodybuilders, it certainly raised a lot of flags in particular when they came about. You know, we saw it in men, we saw it in women. And that actually led to my interest in recently publishing an investigative study looking at autopsy reports of these dead bodybuilders. In fact, our article just published just a few months ago in late 2022. I think it was December or November of 2022. The title was actually

Dead Bodybuilders Speaking from the Heart, an Analysis of Autopsy Reports of Dead Bodybuilders. So what we did is we actually did a search of people that had died in bodybuilding. We wanted to look at specifically males. We wanted to focus on the male demographic and people that had died under the age of 50. And there were actually more that had died between 50 and 60, which is still pretty young to die. But I really kind of wanted to highlight, it's like, these are people that are dying before they're even 50 years old. So we ran through an analysis and we're able to find out causes of death, etc. And the paper dives into the methodology of how we described it. causes of death, et cetera.

And the paper dives into the methodology of how we described it. But ultimately, we only were able to get access to a handful, a little more than a handful, of these autopsy reports. But nonetheless, it was pretty interesting when we actually found. And one thing that I want to mention is we still don't have a direct cause and effect link.

It's very hard to determine that. However, we cannot ignore that there's a smoking gun and we need to investigate this a little bit further. So I always want to highlight that, that, you know, this report even just kind of gives us some insight into things that we need to look at a little bit further and dive into the evidence a little bit more. And it just brings us some, again, a look into the smoking gun. So it begins to for us to analyze critically, because to your point, some of these things have been downplayed. And I think it's important for us to, even though there's no direct cause and effect, doesn't mean that there isn't some, and there's definitely

some linkages there that we need to look into a little bit further. And of course, this research can help with developing more accurate hypotheses that evidence can accumulate for or against over time. And of course, that's the nature of scientific inquiry, right? I mean. Absolutely. And that's a great point is all of these studies are meant, you know, no one study is going to give you the answer to everything. It's just a building block. And then each study builds on each other to help us get to more clear answers to be able to develop these more accurate hypotheses, hopefully, and test these hypotheses over time to develop a better clear understanding of what is going on. So what was interesting about our study was we actually

had six reports were actually available. The average age of the bodybuilders was only 36 years old for these people that died. So, I mean, these are young individuals, the youngest one being in their 20s, the oldest one being in their late 40s. What we also see is the weight of the heart was significantly bigger than the average individual man. Now, I know one caveat to that is naturally when we look at just weightlifters who don't use anabolic steroids compared to the average individual, their heart is going to be larger as well. However, some of these averages were significantly bigger to the tune of 575 grams versus 332

grams for the average man. So we're talking almost 74% bigger in terms of this hypertrophic effect that occurs. We also see some left ventricular myocardium thickness, which is another component that was very similar all across these six different studies. And then a lot of them had different type of abnormalities in there compared to these drug-free bodybuilders. So what we can draw from is, again, we can't draw a direct link cause and effect, but we can say is there's definitely a smoking gun there.

Let's look at this a little bit further and let's look at some of the evidence. And when you look at some of the other evidence that has been published over the years where they've actually looked at, for example, ventricular hypertrophy, they look at blood pressure, they look at LDL, HDL, cholesterol levels over time, you know, again, you start seeing these small pieces of the puzzle that do potentially, I'm going to say, at least there are some associations there. And again, association does not mean causation, but nonetheless, it allows us to look things a little bit further to be able to investigate more. Especially when we're looking to make personal decisions and weigh potential risks with, you could say, known benefits in the case of anabolic steroids. But hopefully a discussion like this can help people make a more evidence-based assessment of these potential risks

and weigh them against, okay, what are the benefits for them personally? Does that make sense? okay, what are the benefits for them personally? Does that make sense? Yeah, absolutely. And of course, these individuals were, you know, if not professional, they were top level type of bodybuilders. We don't know exactly what dosages they were taking. You know, some of the autopsy reports did reveal some of the police report findings of what kind of things they found, but we can't know exactly how much they were taking. But just from working with a lot of these athletes, you know, we do know, and actually, I just published a recent study looking at just amateur bodybuilders and the mean dose for those that we're using in this particular sample. And these are not professional bodybuilders. These were amateur bodybuilders in a local bodybuilding show. You know, these guys are using upwards of

one to two grams a day or not a day per week of anabolic steroids. And this is at the amateur level, those that are using. So you can imagine it's not abnormal for these professional bodybuilders to be using, you know, upwards of two to three grams per week of these anabolic substances in different combinations and iterations. Yeah, I want to get to those details in a moment. But let me just back up and ask about cause of death with these bodybuilders. Were they all related to heart issues or some heart issues? Yeah, so these were particularly related to death, related to some sort of heart issue. And we see a lot of these. So we definitely see these different causes of death.

And we identify what some of these were in particular. So pretty interesting. Again, we see the cardiac hypertrophy in there. We see the enlarged myocardium. We see some atherosclerotic type of changes in the vessels there that obviously can lead to death from a heart issue there. And can you explain to listeners why a bigger heart is not a good thing and why thicker ventricle walls, not a good thing? Yeah, absolutely. So it all kind of boils down to that ejection fraction. So the heart can become so big

that basically it can't pump out as much blood efficiently and effectively out of that left ventricle. So one thing that we actually look at is that the ejection fraction, which is basically how much volume of blood is actually expelled out of that left ventricle in relation to how much is actually goes into that full ventricle. And a healthy heart should be, you know, at the very least 50 percent and actually 50 to 55 percent ejection fraction rate is kind of on the borderline low end of what's considered healthy.

Ideally, you want to be above that 55% threshold, maybe in the 60% to 65% ejection fraction. So those larger hearts usually have relatively lower ejection fractions over time. That's a marker that you should actually look at if you're a bodybuilder. You know, an echocardiogram can go a long way. And that's something that should be done periodically to see, you know, is this affecting you? And if so, how can I mitigate these risks? Makes sense. And I've heard some people claim that this is more of a matter of correlation than causation, just to come back to something you commented on already. And that, and again, this is me kind of parroting some of the things I've heard, that there isn't enough good evidence that anabolic steroids cause this to happen. And

therefore, it's not something you should really be worried about. What are your thoughts? I'm sure you've seen people make the same claims. and often these are people who are using the drugs, but. Yeah, absolutely. Yeah. I think that's kind of a head in the sand approach of just, you know, because I'm using and you want to justify it as like, Hey, you know, there's definitely no risk there, but again, there is some merit to some of that, right? There are no direct links. And when you look at some of the evidence, there are some variations in what we see. However, when you start reading some of these different studies and you start putting them together, you start putting some of these pieces together and you do see a growing evidence that there is a potential risk. Now, that being said, the risk really comes with, of course,

the dosages used, how long you're using them for, and that length of exposure. I mean, those are the two biggest factors that are going to lead to that. You know, obviously, how much are you using? And then what are your other factors? Of course, your genetics are going to play a role. You know, there are some, just like anything else, right? Some individuals may respond very well to weight training, and you're going to have non-responders to weight training that don't respond as well. Well, similarly, some of these drugs may affect people severely negatively, whereas others, they might not impact them as much, or there might be a threshold

as to where it begins to affect them. So some individuals may need, and this is where, again, that genetic component comes in that you touched on. If you're already kind of a genetic freak, you might not need that much to get to that next level and be a pro bodybuilder. Whereas somebody who is not as genetically gifted, they may need more.

At the same token, you may have somebody who it takes very little for them to have deleterious effects and somebody who may be able to handle a large dosage before deleterious effects are seen on them. So these are some of the nuances that you have to kind of look at and the inter-individual differences in interactions with how well you're gonna hypertrophy, how well you're gonna recover, and how you're gonna respond to these drugs.

Yeah, quite a few high-level bodybuilders have commented to me just along those lines that typically the people at the top already were genetic freaks for getting big and strong. And then they had the additional advantage of responding very well to certain anabolic compounds. And so big positive effects and minimal negative side effects. That's really the physiological foundation that's required to make it at a high level in the sport. Yeah, absolutely. And I mean, it's really like any

other sport, right? It's like, you know, looking at Tom Brady, for example, how many Tom Brady's can actually can actually play football at that high of a level for, you know, well into their 40s? The answer is probably not many. Right. And and of course, there's a lot of things that kind of contribute to that. More than genetics, it's going to be, you know, how well he took care of himself. He had resources to be able to do that. So to your point, yeah, I think these are some of the different approaches of what you're doing. Also, how long are you competing for, right?

You know, if you've been competitive for maybe 10 years, 12 years, that's different than somebody that's been competing for 20 or 25 years who's been exposing themselves to high dosages of these drugs for a longer period of time. And that's a good segue for another question that I wanted to ask you. This is also something that I hear people saying in the context of this topic, and that is that the risks, we can focus specifically on the risks related to the heart, but just in general, that the risks associated with steroid use are mostly applicable to people who are using large amounts. And you had mentioned amateur bodybuilders, one to two grams a week, professional bodybuilders bit more about that and even individual drugs and maybe put that in context of TRT, what some people claim is TRT? Because I think a fair amount of people listening, for example, they hear one to two grams, but

they have no context. Is that a lot? Is that little? And many people know about testosterone, of course. Maybe they've heard about D-ball or a couple of other drugs, but I think some details in the context of the research that you recently published and just your knowledge in the topic would be helpful. You know, absolutely.

That's a good point. So androgenic anabolic steroids are essentially derivatives of the hormone testosterone. So you can get straight testosterone, which is in its own right going to have anabolic properties. And then you basically have, you know, different trees that come from that. So you have some that are oral, which are going to be typically alkylated at the 17th carbon atom, which allow you to basically bypass the digestive system. And then your liver is going to process those. So sometimes people at the beginning, they say, oh, well, it's easier to take a pill than it is to put an injection.

But actually that route of delivery is actually more deleterious and can have more consequences than the injection, which is why most physicians, when they're going to prescribe hormone replacement therapy, it's usually an injection that's done, you know, maybe two or three times a week, maybe once a week, or they maybe do a pellet that they'll put in and it's a slow release hormone where they're doing it. Or they may do a topical cream, which is effective as well. So among those different testosterone derivatives, you also have basically the 19-nor type of steroids and then the DHT derivatives, which are basically kind of two trees, which is

basically just a chemical manipulation of that testosterone backbone and how the drugs are essentially done. And there's different uses, but essentially the goal of all of these is to basically increase testosterone levels over time and to create increased anabolic signaling in the body to help to create more muscle tissue over time and obviously increase strength and all of the other benefits that could be associated with it. Now, that being said, there are potential side effects with those as well, because it targets more than just muscle tissue.

Essentially, to make it simple, when testosterone is administered, it's going to bind to the androgen receptor, and then the androgen receptor is actually going to bring it in. But there's androgen receptors in more than just muscle tissue. There's going to be androgen receptors in other tissues in the body, which is why it's going to affect other tissues in the body as well, in addition to that muscle tissue, there's going to be androgen receptors in other tissues in the body, which is why it's going to affect other tissues in the body as well, in addition to that muscle tissue. And some of those may not necessarily be favorable, particularly when you're doing it in larger dosages.

To put it in context in terms of dosing and what is considered medicinal dose for testosterone replacement there, because I think that term gets thrown around a lot. for testosterone replacement therapy, because I think that term gets thrown around a lot. I joke that it's a red flag online when you have some dude who's huge, strong, shredded, and then they mention, well, I'm on TRT. Joke, that's a red flag. That often means something else.

Yeah, absolutely. And TRT is very specific. So if you're on TRT, number one, unless you have some weird medical condition, if you're on TRT, number one, you know, unless you have some weird medical condition, if you're under 30, 40 years old, you're probably not on TRT because number one, there's no medical need for it unless you have, again, some other underlying medical condition because it's meant to treat hypokinatism, which means your testosterone levels are suboptimal at that point in time in a reference range that is well below what's

considered normal. And in terms of normal levels of testosterone, typically, 300 is kind of on the low end of considered normal. So three, four, 500, I still kind of consider that. Maybe 500 is probably not quite abnormal, but maybe on the lower end. But if you're in the 500 to maybe 1,100 nanograms per deciliter of blood, you're going to be in the normal range. And there's really no necessary benefit if your levels are, say, 600 or 700 or 800 in that normal physiological range. You do start seeing some potential deleterious effects once you kind of start dropping below that threshold. And if you're dropping in that 400, 300, 200 level,

now you're gonna be seeing some potential side effects. And that's the other thing that's associated with some of these symptoms. If it's medically indicated, your levels alone aren't enough to tell you that you need testosterone replacement therapies. What other symptoms do you have? Do you have, are you tired?

Are you unable to recover? Do your muscles hurt? What's your sexual desire like? What's your anxiety, your fatigue? All of those things are going to be put together, which again, a medical provider should be the one that's making that diagnosis. So when a medical provider takes that blood and looks at all of your symptoms and does a full examination, and then they diagnose you as a candidate for testosterone replacement

therapy, they're going to typically provide you as a candidate for testosterone replacement therapy, they're going to typically provide you with a dosage that's going to bring your levels up to that normal physiological range. So again, the goal for that physician is going to be to get your levels up in that 600 to 1,100 nanograms per deciliter range. If they're aggressive, they might go on the high end of that normal, closer to that 900 or 1,000. But really, that's what TRT is meant for. Now, what dosages do they prescribe to do that? So the dosages are actually quite low. Typically, it may be as little as 25 to 50 milligrams a week, up at the very most to maybe 200 to 250 milligrams a week, depending on the individual and how you're responding to that drug and what type of drug they're going to be prescribing to that particular individual. So that said, even if we use the high

end of 200 to 250 milligrams a week, that is high end prescribed TRT dosages by a physician, absolutely high end. When bodybuilders say TRT, they're very typically doing much more than that, typically double to triple that, which is again, two to three times what is considered prescribed. Because again, if you're normally taking 2,000 or 3,000 milligrams a week, coming down to 500 milligrams a week, you're definitely way reduced your dosage, but you're still far above TRT dosages. So I think that's a really good nuance to identify.

And I'm glad that you brought it up because it's very important to understand when somebody says they're on TRT, a lot of times how they define TRT is still two to three times the dosage that is prescribed by a medical physician. And that would just be the testosterone. There might be other things, as you've mentioned as well, that could bring it up to one, two grams a week or more. Absolutely. Yeah. And because we're talking about right now, anabolic steroids, but they may be utilizing other PEDs or other anabolic steroids, which again, could actually definitely bring it to higher levels. The other component that we also want to look at is, again, the combination of some of these compounds, you know, because they're going to have compounding effects. So just because you're taking testosterone as a backbone, you know, you may be adding

one of these 19-nore testosterone, like a decadribolin, or you might add a DHT derivative, like a primobolindipo. And then those are also going to have, and they can also raise your levels to higher levels. So really important to kind of keep in mind, you know, what's going on and what's going on with the body in regard to that. So I think people need to realize when they say TRT, what they really mean. And just for people who are curious, why can you take these testosterone derivatives and

use them together with testosterone to achieve even higher levels of anabolism or higher levels of testosterone. For people who don't know the details, it sounds kind of strange. It sounds like, wouldn't you just keep taking more testosterone? Why do you take these other things that come from testosterone? Yeah, well, I think typically after you get to a certain dosage of testosterone levels, the side effects are going to tend to accumulate a little bit more. Things like gynecomastia that are going to creep up over time. So you may actually want to utilize some of these other ones that maybe they don't aromatize

as much, and then you're going to be able to see some of these other potential benefits. And also, again, if you're competing, you may also kind of figure out, and you're going to be tested, for example, there are certain drugs, there are certain clearance rates for certain drugs. So you need to kind of keep that in the back of your mind because there are like fast acting testosterone compounds, slower acting ones that have different half lives, which can stay in the system a little bit longer. And again, if you're playing the you need to do a drug test game, you know, it's not hard to pass a drug test if you know what you're doing and how to utilize some of these compounds. Of course, the science of that is evolving as well, but the science of how to beat those tests is also evolving at a faster rate. It's not something that

I'm an expert in, but I definitely know if you just know some basic organic chemistry and you understand what the testing is like, you can actually play around and modify with some of these compounds or not even use anabolics altogether. You can use things that are not necessarily detectable, that are still performance enhancement drugs that are not necessarily androgenic anabolic steroids. To this point, I wanted to also highlight this other thing is because people always say,

well, there's no good studies with direct cause and effect of some of these compounds. But you also have to understand that as a scientist, I can't necessarily prescribe somebody extremely high dosages of something that are going to have deleterious effect on that individual. So no institutional review board is going to allow that for me to do that type of testing on an individual. So no institutional reward is going to do, because we know that if I put you on two to three grams of anabolic steroids for a period of eight weeks, 10 weeks, 12 weeks, it's going to have some potential deleterious effects. So as a result, when we see the literature, the highest dosages used in terms of anabolic

steroid use, or in terms of testosterone testosterone use is only 600 milligrams a week. So that's still three times the physiological dose. And that experiment was carried out for, I think, 20 weeks. So we basically have a couple of confounding variables there is when you're actually trying to look, when you're looking for real evidence, well, you know, nobody's going to be able to do an experiment where they can give somebody two grams of something a week for a period of 10 years or five years. So what we're left with is we have to basically study what people are already doing. So in other words, we're going to recruit individuals who are voluntarily doing whatever it is they're doing.

I'm not prescribing it for nobody's going to prescribe. No doctor would ever prescribe that to them. It's whatever they're doing, which brings a few other kinks into the cause and effect equation, because now you have to figure out they're not taking the same things necessarily. They're going to be taking different compounds at different dosages. And because they are not legal compounds, they're going to have to be getting them from underground sources, more than likely from different underground sources, which now you question the purity of these compounds and the quality of these compounds. So realistically, you have a lot

of confounding variables to really look at a direct cause and effect link. So unless you really know that evidence and know the nuances of scientific research, you're never going to find a direct cause. You have to draw some inferences from the methodologies that are available with the limitations that are available or that are there and that are present to be able to do this. So the best thing we can really do now is look at individuals, for example, who have self-reported to have been using these compounds for maybe five years,

10 years, 15 years, bring them into the lab. And then that's the other thing you have to rely on. They're self-reporting. So are they actually being truthful in what they're reporting? Did they take more? Did they take less? What kind of compounds were they taking? What kind of combinations? What other lifestyle factors did they have? Did they drink? Did they smoke? Did they do cocaine? What was their diet? Their diets are going to be different. Their training is going to be different. So you have a lot of these different variables that are hard, but that's the best we can

do. Take a group of, you know, recruit people who have been self-reported using anabolic steroids for the last 10 years on a regular basis, and then bring them into the lab. And then maybe take another group of 10 individuals who have been self-reported, lifetime drug free, and bring them into the lab and then maybe take another group of 10 individuals who have been self-reported, lifetime drug-free, and bring them into the lab. And then let's do some tests. And that's what we kind of start to see now is some of these tests have been done, and we actually do see some differences in things like ejection fraction. We do see some differences, for example, cholesterol levels in terms of LDL levels and HDL levels.

We do see some things in things like blood pressure. So we do see some of these differences with the nuance that we know that there are limitations into the methodologies there. And I'm glad you mentioned lifestyle factors because that's a question I wanted to follow up with because that is also something that I've seen many people claim is that the people who have had the biggest problems with these drugs either were using huge amounts, way too much, way too many, like we're doing it wrong, or they were using what would be quote unquote appropriate for bodybuilding, which is large amounts, but they had unhealthy lifestyles, alcohol use, recreational drug use, didn't eat well, didn't get enough sleep. And because they didn't take care of themselves, that exacerbated

the deleterious effects from the steroids to such degree that people who take care of themselves don't need to worry about it nearly as much, if at all. What are your thoughts about that type of argument? Because I'm sure you've seen that and heard that. Yeah, I think lifestyle factors definitely do play a factor in addition to the genetic factor, combining them together, right? But I think it's not a strong enough argument really to say that it's only those lifestyle factors that are going to do it. Because when we see some of these bodybuilders, actually, I didn't disclose the names of the bodybuilders in the autopsy reports that we do, but I actually knew a handful of those

individuals, less than a handful, but a few of those individuals personally on a personal level that unfortunately I had met over the years in the bodybuilding circuits. And I know their lifestyles. And they were not utilizing other substances or drinking alcohol. They were people that were very much taking, I mean, their body was their income in a sense, right? So they were personal trainers. So that meant marketing was something

that they utilized their bodies for, photo shoots, sponsors, et cetera. I mean, their body was the way to make a living. So they took care of their body quite well. You know, they slept well. They didn't abuse alcohol. They were not using some of these particular, and again, these are individuals that are,

not to say that everybody does that, but you see that there are people who do take care of themselves and all of those things. And yet they're still potentially going to die at an early age because of the quantities that they're using over time. In addition to, of course, their genetics themselves that are going to make me predispose them to have deleterious effects due to dosages that they utilize. Many people think that if they just eat well, if they eat enough nutritious foods,

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No forms, no return is even necessary. You really can't lose. So go to buylegion.com slash Triumph now. Use the coupon code MUSCLE at checkout and save 20% or get your 6% cash back. Try Triumph risk free and see what you think. Try Triumph Risk-Free and see what you think. And we can tee that up, I think, appropriately. So we're not necessarily encouraging people to do it. But some of these genetic factors, unless you are monitoring your body in the right ways, you really will have no idea, right? Yeah. And I think that's actually a perfect tee up almost to what we're talking about, which

is really the biggest thing you need to do is, you know, be mindful of when you're starting a protocol, if this is something that you decide to do, and again, I in no way encourage it. And in fact, before you even consider it, I kind of want to touch on all those lifestyle factors that you touched about, right? So number one, are you training enough? Have you been training long enough? Are you eating right? Are you getting enough protein? Are you getting enough fruits and vegetables into your diet? Are you sleeping enough? Are you training right? They're either over-training or under-training, and they're not really maximizing. I see that all the time in the gym. I mean, all the time I see guys usually, at least the ones who just openly talk about it and young guys

using various anabolic steroids. And because often I can think of one guy in particular, I just had this conversation semi-recently. he just felt like he plateaued at a certain point, and he couldn't really make any more progress. And so he then got on a number of drugs. And then now he considers it TRT to what you're saying. But I think he keeps his testosterone around 2000 and GDL. So this guy's like 25. I'm like, all right, that's not TRT. But ironically, just because of how he trains, I don't need to know anything else. He might not eat well, he might not sleep well, but I can tell you just by how he trains and he makes a number of mistakes, I am more muscular than he is. And I recently, it was a saliva test.

So they actually, they just gave my free tea and it was just in the middle of normal. So if we extrapolate that, you know, it's probably if I have a normal conversion of testosterone free tea, probably my total testosterone is probably also just going to be right in the middle of normal. Despite that though, you know, he, again, not to knock him like personally, but it's just kind of ironic. Yeah. And you bring a very good point. People, when they talk about supplements, I mean, the first two questions that I usually get from people is, you know, what supplements are you using?

And, you know, hey, like, what stack are you on, bro? Instead of thinking about how about like, how long have I been training? You know, how do I train? How do I eat? How consistent am I in doing those things on a regular? What's my sleep pattern like? What's my recovery like? And then when you add all of those things together, you know, and then, of course, your

genetic starting point to begin with, right? If you have a bad genetic starting point and you're doing all those things wrong, now you're going to try to make up by, you know, putting all this extra stuff in you, whether it's dietary supplements or these anabolic steroids, you're probably going to still be not making as many gains as you can. And this is where you see people where you really use that much stuff and they look like a normal Joe or worse than a normal Joe. And it's sad because before you even cross that bridge to consider utilizing, it breaks my heart when I see young kids doing this. You know, if you're a teenager, you know, even if you're under 25 years old and you've

only been weight training for, you know, one or two years before you even consider any of that, you know, maximize your genetic potential by doing all these other invest money and time and energy and education and doing all the other things correctly, you know, training appropriately, loading appropriately, deloading when needed, getting enough protein intake, getting a regular diet with enough calories that are going to, it's going to support muscle growth, doing that for a regular basis for a two or three year period over time where your training's consistent, your diet's consistency, then and only then, and you maybe want to compete at a higher level, and you think that you see

yourself maybe doing that, that may be now a conversation where you have, and you have the money and resources to be able to do that. And by that, I mean, not just money and resources to buy the substances that you're going to need to buy, but also have the money and resources and insurance policy, for example, health insurance, to be able to see a medical provider, to pay for all these medical tests and the blood work that you're going to need to do, because that is the responsible approach. And again, I don't advocate people to do it, but if they choose to do it, then those are kind of the main things that I kind of want to make sure. Are you doing all these other things first? Yes. Okay. Do you have money and resources to be

able to, do you have a medical provider that you can go see, that you can talk to, that you can trust, that you have rapport with, that you can get these tests on a regular basis? Because you need to see the doctor more than once a year. You should see them probably minimum two, probably three or four times a year to get regular blood work done on a regular basis. And then you can actually start monitoring from there, you know, and you don't need to go crazy in terms of quantity. So you probably want to start with a what you want to do is the least effective dosage possible is should be your starting point, right? So sorry to interject, but I want to hear all of this, but I want to offer a quick counterpoint

that I hear from guys in the gym. And then I would love to, again, talk more about some practical strategies for mitigating downsides and maximizing efficacy and so forth. But here it is. Some guys, their line of thinking is, and maybe some women as well, but I've only heard it from guys. It is, well, yeah, okay. I'm new to this and my body's very responsive, or maybe I have a year of training. So like my newbie gains are kind of gone. Why don't I use steroids for a period of time, let's say one, two, three years, and I'll try to go about it intelligently. And in those few years, I can gain what will take two or three times as long naturally in the way of muscle and strength. And then I'll just come off. I don't have to wait eight years, seven years, six years to achieve at least 80% of my genetic potential.

What are your thoughts about that? Yeah, well, I mean, there's definitely a dose response relationship to the drugs. That being said, you know, I can see where that mindset kind of goes in. I'm just going to use more and blast and get the gains or even not necessarily use more, just start. So I'm going to be natural. I'm natural for a year. I'm I got my newbie gains. I like this. I'm impatient. I don't want to wait. And so I'm not this is not somebody who's looking at being a competitive bodybuilder athlete, just a gym goer, probably a guy who wants to get girls until he realizes that we care far more about our muscles than girls ever will. And the only people who care as much as us are other dudes in the gym, but they haven't realized that yet. And so their thinking is, all right, I'll just get on some

steroids. I'll do it intelligently again for just a couple of years. And then I can be jacked at the end of that period and not have to wait six years naturally or whatever. Yeah. And I think that's definitely the wrong approach is number one, like you said, one year of weight training, you're still maybe you're not you're out of your newbie gain stuff, but there's still a lot of gains to be made over that period of time when you're programming correctly. But you also have to remember the risk to benefit ratio, which we kind of talked about. Right. So if you're not going to compete, if you're not going to be making a living doing this stuff, realistically, you know, why would you want to expose yourself to these compounds? And if you do, then make sure that you've been training long enough to do these other things,

because most of those guys haven't checked all the boxes yet before they even need to consider it. And as we just mentioned, there are a lot of guys in gyms and I've seen this in papers I've read and it checks out with my anecdotal experience as well. There are probably more people for people listening, more people, and it tends to be men in my experience, in your gym using drugs than you realize. And if you knew and you looked at a lot of these guys, you would be a little bit puzzled because they don't look like jacked bodybuilders. Yeah, you can't tell. You absolutely can't tell. And to your point, there was a paper that my colleague Rick Collins co-authored a few years ago, and they actually looked at, you know, who is the primary user? And there's been a few papers, but his paper rings a bell because I've cited it quite a few times. But they basically interviewed close to 2,000 gym goers, and they were trying to kind of figure out the demographic of who's using. And it was not actually the adolescent in sports.

It was not the athlete or the pro bodybuilder. It was not the, it was basically a 29-year-old man, or maybe a 30-year-old man, white guy, who paid a higher than average income. And his goal was exactly what you said, to basically look better naked. That was basically who the demographic of the stereotypical user is. That aligns perfectly with the TRT craze that we're seeing right now, by the way. Absolutely.

Absolutely. And really, they're not they're not going to compete. They're not going to make money on it. They just basically want to look better. And to your point, they're thinking that, you know, it's going to attract more females. But yeah, realistically, what you'll realize, you know, even when entire, all the time you're going to spend in the gym for the rest of your life. You actually may never get one random compliment from a woman. Exactly. They really don't care. Yeah. For the majority of part, they really don't. Yeah. So it's funny. So I definitely advocate against that mentality and, you know, encourage to look inward. And again, there's nothing

wrong with vanity. I mean, if we want to look better and you want to do it, that's fine. But if that's the case, then again, now your reward to risk ratio is even more important because what dosages do you want to utilize? And, you know, what kind of risk are you willing to tolerate? Or do you want to tolerate? Because you're not going to make any more money on it. You're not going to get any fame from it. You're not going to transform into Brad Pitt. It's just not. Even if you have his Troy body, unfortunately, we're still just not Brad Pitt. It doesn't work like that. Exactly. Exactly. Yes. So it's very true. And I definitely I'm glad that you pointed that out because I think it's not necessarily

the best mentality to go forward. And that being said, I think even if you are utilizing, you know, let's say that you are considering competing, you've been doing things right for five years, you've checked all the boxes, you're gonna say, you know, maybe you've done a natural show or two and you say, I really like this.

This is something that I can see myself doing. Maybe you're, you know, genetically gifted where you've done well in these competitions and you look better than the average individual, you know, just naturally with hard training and hard work. You know, I'm thinking the person that comes to mind is Kai Greene, right? If you look at Kai Greene, I mean, Kai Greene turned pro as a natural bodybuilder. He won the universe, which was tested. And when you look at Kai Greene as a natural, he looks better than 99% of the people that are utilizing.

Ronnie Coleman, too. Have you seen the picture of him at 23 or so when he said that's when he started to use? And anybody listening, if you find that picture online, you can find it just by poking around a little bit. There are many forum threads and so forth where this is the discussion. So at 23, which again, by Ronnie's own admission, I don't know why it'd be weird for him to lie about when he started using steroids. He openly said he started using them at about 23. And you can see pictures of him then at 12, 13, jacked, absolutely jacked, the most jacked 13 year old you will ever see. He played high school football. He looked like

a college linebacker. He looked ridiculous in high school. And then at 23, before he started using steroids, there's, I can see the picture. I don't know if you've seen it. He's shirtless and he's posing, but he looks, he would be the most jacked person, probably top three to five that I've ever seen. If he were in a gym, that would be in the top three to five that I would ever have seen up until this point in my life. And that was before he started using trucks. Yeah, absolutely. And to that point, I actually competed against Phil Heath at the 2005 USA Championships. It was the day he turned pro was at that show. Phil Heath, you know, they call him the gift for a reason because he had extremely gifted

genetics. And, you know, here he was, you know, he was a basketball player, had only been lifting really for basketball and then kind of had just been bodybuilding for about a year. I mean, I had four years in, five years in, and I looked nothing like Phil Heath in his first USA show. I mean, I had done two or three USA bodybuilding championships and some junior national championships under my belt. And then Phil Heath comes in and everybody was weighing in and very cockily. He said, you know, I don't know why I'm even here. They should have just mailed me the trophy. And everybody in there was like, really, who is this guy? And then he took off his stuff and you're like, well, you know, he's right. I mean, like we can compete. And of course he won

the overall, turned pro and then Phil Heath became Phil Heath, right? And those are the genetics that are there, you know? So after, you know, realistically less than a couple of years of true bodybuilding exposure, less than a couple of years of probably, I'm going to guess minimal dosages of utilizing compounds, you have the USA champion beating guys that have been competing for years and unanimously winning, you know, hands down, best amateur bodybuilder in the country that became Mr. Olympia, obviously, a few years later. Let's get back to then, or let's, I guess, kind of shift gears back to what we were talking about, which is, okay, so you have somebody that's been training for a period of time, they're eating well, they know what they're doing, and they want to pursue bodybuilding seriously. require it simply because so many other people are using things that allow them to perform and recover. And the only way to really compete at that level, depending on what it is to use

steroids, you can start wherever you want with this. You gave a good overview of some of the things that you should keep in mind to mitigate the risks. And if I'm hearing you correctly, you can never completely eliminate them, but you can mitigate them. You can avoid blunders that will almost certainly cause major problems. At least you can do those things. Yeah, absolutely. And the biggest thing is just, I kind of do the analogy of like a car, right? You want to look under the hood, right? You don't just want to look at the outside of the car. You want to look at what's going on under the hood. So with that, you should know what your baseline levels are. So number one, work with a physician and a healthcare provider that you trust that you can communicate

with. And with that individual, of course, they're going to try to discourage you. That's their job from utilizing it, but be upfront with them and then do specific tests that you can actually monitor, right? So of course, on a regular basis, you would want to check your blood pressure. I recommend that at least once a week. Maybe you want to check your starting blood glucose levels at the beginning, do that at least two, three times a month, so you can kind of have those baseline. What's your resting heart rate?

All of those things are things that you want to kind of start considering and keeping documentation of on a regular basis. Because if any of those variables are things that you want to kind of start considering and keeping documentation of on a regular basis. Because if any of those variables start to escalate or go off track, then you can intervene on a regular basis. Your blood work should definitely consist of complete metabolic panels. So you want to look at specifically like your hematocrit levels. Those are very important.

Your red blood cell count, that's very important because typically those levels are going to increase to a point that you can have deleterious effect on those. So your blood cell count can increase. Your blood can become so thick that it can now potentially cause other problems. So those are things that you want to, again, look at what the dose response relationship is to those levels. You want to look at things like your cholesterol levels, your LDL, your HDL, your total cholesterol, your triglycerides, and making sure that those are staying, you know, somewhat within normal reason. Because typically what happens, we typically see the LDL levels start to rise. We see the HDL levels start to drop. Which is bad for everybody listening. Please don't listen to the carnivore crowd who

says that, no, that's good. You want high LDL. No, you do not want high LDL. No, you do not, especially in combination with the low HDL. And again, there's a lot of literature which kind of talks about, well, you know, if it's low, it's not too bad. But I'm not talking about just marginally low, you know, because typically it's recommended for that to be at 40 nanograms per deciliter of blood, ideally over 60, right? So 40 to 60 is considered normal, but if it's over 60, that's actually a positive health risk factor or something good. But what happens with genetically, you may already be on the low end. Like personally, I am very low on my HDL levels naturally.

Personally, I am very low on my HDL levels naturally. So if I were to use these compounds, it would drop significantly lower to maybe even single digit levels. And that's when you see some of these potential deleterious effects. So you want to monitor what these ratios are looking like over time. And then, of course, you may be, depending on how long you're using, you probably want to do eventually, especially as you're aging, you want to do things like an echocardiogram, calcium score for your heart. And then you can actually see, are there any of these deposits going on? And then keeping a record of all of these things. So, you know, I have a file of, I don't know how many years back

of every blood work that I've done. And I literally track some of these particular metrics that I'm looking at to see what's going on. And then as you're using things, you can actually say, that's the other thing that I want to emphasize. Don't just test when you're off. You want to test when you're on, right? If you're on eight months out of the year and off for four, then, and you're only looking in the window of the four months, you're missing the boat, right? So you want to utilize like, what am I when I'm on nothing? What am I on when I'm on minimal stuff? What am I on when I'm on higher dosages stuff? And how long does it take those levels to come down?

Do they come down? Do they stay elevated? Because that's going to give you a bigger picture of what's going on. And then over time, this is where you can catch a lot of these things. Whatever protocol you're utilizing, and you see that you're redlining all the time on all of these things. Your hematocrit levels are high. Your blood pressure is high.

Your HDL levels are low. Your LDL levels are high. And then maybe over time, you're looking at ejection fraction, and your ejection fraction went from 60% to 58% to 56% to 49%. You should probably be looking out at what you're doing, right? And pay attention. And that's where it's really important where you're just not sticking your head in the sand and say, I feel good.

Because the reality is, is a lot of times if you have just borderline hypertensive, you probably don't feel it. If your HDL levels are low, you're probably not going to feel it. If your hematocrit levels are high, you're probably not going to feel it until it's finally a problem and it's too late. Yep. And to your point, you might generally feel pretty good on these substances. So how you feel, energy levels, and I often I've heard from people who have been open

to me about cycles and on and off and just how much better and really, quite frankly, how great they feel, at least for short periods of time when they're on a number of these compounds and they feel like they don't, it's not smart to not sleep much, but they quote unquote don't need to sleep as much and they have high energy all the time and their workouts are great, big pumps, they feel unstoppable. It can be counterintuitive for them to consider that they might be actually on the road to dying, even though they feel great, quote unquote. Exactly. And that road is actually quite slow because that's one thing that I want to emphasize is a lot of these things, you know, That's one thing that I want to emphasize is a lot of these things, you know, one cycle for 12 weeks is going to maybe get you a little bit to the outside barriers.

But, you know, when you come off more than likely things and we see that it's going to come off. So the problem is when you're taking high dosages for a long period of time over and over again, and that's when we see these issues build up over time where and those people are sticking their head in the sand. And to your point, when you're on these high dosages, I mean, in the gym, you're like a beast, right? You're going to be super strong. You're going to be recovering. You know, you're going to be alert. You're going to have energy. A lot of things kind of feel good, but internally, they're not necessarily looking good. And I didn't mention some other important things. I kind of

focus on related to the heart, but you still want to look at your liver enzymes. You want to look at your kidney function. These are all different blood biomarkers that, again, you should work with your healthcare professional to evaluate these on a regular basis. You know, I spent a lot of time with my, especially, you know, I'm 46 going on 47 this year. So, you know, especially over the last six, seven years, it's something that I have done on a regular basis. And we're going over all of these biomarkers, you know, to be utilizing them. And this goes for people on TRT as well, right? If you're working with a physician on TRT, they should be monitoring these things closely as well, because again, you're taking a drug just like any other drug. If you're on a hypertension drug or a cholesterol

drug, you should be monitoring all of these levels accordingly on a regular basis and then working with your doctor to see it's like, okay, these levels look good. You're not seeing any changes. But if you see something occurring going up or down, that's going to be a road to potentially major deleterious effects, not necessarily right away. It's going to be five years, 10 years, 15 years down the line that if you don't catch it early, you're going to have problems, which is why I like the regular blood pressure checks, because if your blood pressure's out of control, I see that all the

time. I have guys that come into my lab that are using stuff. And first thing I check is their blood pressure as part of one of the biomarkers that I look at. And sure enough, their blood pressure is often elevated. These are guys in their 20s and early 30s who should not have elevated blood pressure levels on a regular basis. And coming back to dosage, I'm glad you mentioned that with TRT because that's another thing, another comment that I will hear now and then is that, well, a lot of what you're describing here applies to bodybuilders using a lot of drugs, different types of drugs. I'm only using, well, they might say TRT. Let's just say I'm only using testosterone. Therefore, it doesn't require as much diligence and vigilance. So if I'm hearing you correctly, you disagree with that point that if you are introducing exogenous testosterone in your body, depending on how

your body responds to it, there could be causes for concern and you do want to start paying attention to these things more closely than you would if you were not using even just testosterone? Yeah, absolutely. I think anytime you introduce any drug, even if it's prescribed by your doctor, it's your doctor's duty to do some periodic checks. Now, depending on what it is you're taking, you know, that might require a once a year check, maybe once every two years, maybe every six months, maybe every three months. You know, it depends on where you are and what it is, right? So if your doctor prescribes you thyroid medication for hypothyroidism, initially, you're going to probably need to go every two to three months to check your thyroid levels to get

the right dosage. And then once you're on that appropriate dosage and they stabilize, maybe you need to go every six months to every year to make sure that that dosage is doing what it's supposed to do. No different than testosterone. Your healthcare provider that is providing and prescribing that to you. Initially, you should probably go get tested maybe every two to three months initially to make sure that the dosage used is going to get you to those normal levels. And then maybe every six months to every year, you're doing periodic blood work and physical

work where you actually go see the individual. At the very least, they order lab work for you, and then you do a telemedicine call and you review the lab results on a regular basis. They ask about your symptoms, your health. Maybe they'll ask you to measure your blood pressure, and then you can give that information to them. You mentioned earlier also coming back to mitigating the negative effects, the potential negative effects in the case of using these drugs that you want to, you might've said, start with, or just generally use the minimum effective dose. Can you talk a little bit about that? Because that's a mistake I know that a lot

of guys make. I mean, I've seen guys talk to other guys in the gym and get their stack, so to speak, and just jump right into that. Oh, a bunch of testosterone and some Trenbolone and this and that. Sure, let's do it. Yeah. And I think that's something that is important to emphasize because, I mean, again, I've said this before, there's a dose response relationship where 200 milligrams is better than 50 and 400 milligrams is better than 200 and 400 milligrams better than 200 and 600 is better than than 400 but that curve is not it's not a straight line right there's gonna it's more of a there's gonna reach a point of diminishing return so yes there's a dose response relationship but it starts to kind of plateau at a certain level and then and that's where you kind of want

to be at that sweet spot where and the sweet spot spot for that is, is how much can you tolerate and get the maximum benefit with the least deleterious effects, right? So if you have that sweet spot where, you know, you're not getting gynecomastia, you're not getting elevated blood pressure, you're not getting, and you're having no symptoms, but you're still making gains, then that would be an ideal spot. Now, of course, if you're a competitive bodybuilder and you're making a living on this stuff, you're gonna have to, you know,

I'm gonna say redline it a little bit more. You're gonna have to go to points where you're gonna go, you know, redline it for a time being. But even then, you can still probably mitigate some symptoms. And again, this is why it's important to work with your physician because there are other drugs that can actually be utilized to help mitigate some of those symptoms. And again, this is why it's important to work with your physician, because there are other drugs that can actually be utilized to help mitigate some of those symptoms,

but you can't self-prescribe this stuff. So there's things like Telmisartan, there's things like maybe cholesterol medication that you can go on that you can actually utilize that can actually help mitigate some of these risk factors. But again, it's not something you just want to blindly self-prescribe because you're not a pharmacist, you're not a physician, you have no medical training and neither does your coach, by the way. So I'm going to say,

you know, talk to your doctor, even though there are some very well-educated coaches that advocate safer use models. And I would say that they've probably taught some physicians some things as well. But again, having that relationship

with the doctor and then letting them know, it's like, hey, here's an article related to this. And then now you can, they can put the pieces together and then they can actually give appropriate dosages and then monitor your health biomarkers. And then now you actually have a prescription for these certain things to help mitigate some of these risk factors. That's the smartest approach to do it. I'm assuming, though, it's probably difficult to find a doctor who knows enough or wants to know enough about this to be able to manage it in this fashion, or am I wrong there? No, it definitely is. You need to do your research into which providers are actually going to,

you know, provide the best service for you. You know, your general practitioner is probably not necessarily trained in this. You know, even if you work with a cardiologist, you know, this is why you have to have that open line relationship. And it's probably important, you know, if you're gonna be talking about certain things, you know, investigate some things yourself,

provide them some medical literature, not some website that you read this from, you know, some peer-reviewed medical literature that they can actually glean is maybe bring the paper with you and say, hey, I read this, you know, then you can help have that conversation with them. They're going to be open to that. And if they're not, find a new doctor. If they're judging you, find a new doctor. And this is why I mean, it's important to have the financial resources and stability to be able to do that. Because if you can't do that, then you're doing yourself a disservice and you're not going to

have that accountability factor on yourself to look at these particular health markers. So, you know, I invest a lot of money in my health and I know I have a concierge. You know, there's three or four different doctors that I work with and they all work together. And some of them are concierge doctors that don't even accept insurance where I'm paying out of pocket for me to see them. But they are there to kind of coordinate all of this stuff and to be able to do that. How important is it to come off all together? I know I've heard debate around that. I know I've heard debate around that, and it seems like the conversation has with the idea that when they're not using the more aggressive compounds, their body is recovering in some way. What are your thoughts on that? Well, I think, again, it becomes an individualized approach at

that time, because if you're able to utilize, you know, lower dosages and still maybe have, maybe your testosterone levels are double of normal physiological range, right? And you're working with your healthcare provider with, and again, no healthcare provider is going to prescribe that much to you. They're going to advocate for you to be on the lower end. But nonetheless, maybe you're managing, you have no symptoms, right? So you have your blood pressure is under control, your cholesterol is under control,

your hematocrit levels are under control. If you're able to control those variables for a prolonged period of time, then I think no harm, no foul at that point in time. But for more often than not, you're not gonna be able to have your cake and eat it too. You're gonna typically have some issues with that, which is important again to, if that is the the case for you to have some time off.

And this is another time when guys often, especially nowadays, the time off is often such a small window that it's not really enough off time, right? Because, you know, if you finish a bodybuilding show, you've been blasting for five months, right, to finish. You took your last dosage of things, say, you know, three, four or five days before your show, a week before your show to make the date easy. Let's say you finished competing on July 1st, right, of this year. And then now you're gonna be off for two months,

but you did your last shot on June 25th, right? So the half-life of that, depending on what you took, is going to be in your system for a while. So even though you're off, you know, those first three to four weeks, you're actually not really off. That stuff's still in your, a lot of these things are still in your system and they're working. So realistically, it's about three to six weeks after that last dose that you're really off, right? Because that's when your levels are going to start to come down. A lot of people are only off maybe for two or three months, which is not nearly enough time to let your body recover. To really kind of feel that and let your body go

into a full recovery mode, you're probably going to need to be off for maybe four or five months. And then depending on what you took and other different factors, your levels are probably going to crash down significantly, right? Like, and that's the issue with a lot of people that have been dosaging for long periods of time is their normal is not normal anymore, right? So when they come off of this stuff, their normal testosterone levels are hypogonadal levels. And you're going to have the symptoms and issues, you know, with erectile

dysfunction, with anxiety, with fatigue, with loss of muscle mass, with loss of strength. Those are all going to come to me down. And that's very hard psychologically and mentally to deal with. So this is where I think there's not necessarily a physiological addiction to it, but there's definitely a psychological component to it. Because if you've been in that high and then you come off for four, five, six months, and you've been on for a while, and then now this is where you have a lot of struggles. And there's a lot of physicians that specialize in that. Sometimes that stuff doesn't even come back. You might need to be on TRT literally forever at that point in time. And the longer you're on, the higher the chances of that.

One other thing I wanted to mention, too, that some of the young guys aren't careful with is this can cause infertility as well. Right. So you need to be careful with this. If you aspire to have children and you're maybe in your late 20s, you know, or early 20s, you want to be a dad when you're 30, 35. You need to be careful because these things do have consequences if you're not careful. And just to be clear with that and consequences that can be irreversible. They can be or very difficult to overcome over time. Some of these, you know, the typical post-psychotherapy type of protocols that can work short term. If you've been on stuff for a long period of time, no post-psychotherapy stuff for most people is gonna typically bring levels back up to normal over time. And again, there's a lot of physicians

that actually work with athletes with this. And what they usually end up doing is they have to put them on long-term lifetime testosterone replacement therapy at true physiological dosages, because that's the only way that their body's gonna be able to do that. And I wanted to ask you about post-psychotherapy because that's also something that people looking into this should know about and they wonder about.

So how does that fit into responsible and intelligent use of these drugs? You mentioned, for example, coming off for several months at a time to allow your body to recover. Is a post-psychotherapy often included in that off time or it depends on circumstances? Yeah. And that's, and that's a good point. So, I mean, ideally if you're, again, I'm going to use that example of you finish your show July 1st. So now you're going to need to be off everything for at least probably four weeks, six weeks, maybe eight weeks, depending on what compounds you were taking before your body starts to kind of start spilling some of the things of not being, that's being out of your system,

essentially. At that point in time, that is when you would be appropriate to start the post-cycle therapies. If you're starting post-cycle therapy, you know, one or two weeks after you finish your show, that's the wrong time to start it, right? So you probably need to wait again, at least probably four weeks, maybe six or eight weeks after you finish your show to actually start it. And then that process may take anywhere from four to eight weeks, typically, maybe even 12 weeks. So realistically, if you're off for two months, minimum off time would be four months, probably more like five to eight months is really the amount of off time. But some of that off time is going to be part of that post-cycle therapy.

And then after that, if you just jump right in to another blast cycle, my question is, is why did you even do the post-cycle therapy to begin with, right? Because you're never letting your body be at normal physiological levels. And this is the case for most bodybuilders today. That's why they don't come off is they basically just kind of stay on lower dosages, mitigate those risks because it's kind of pointless to come off. And again, if your paycheck and your living is dependent on you competing and you're doing two shows a year, there's no way that you can come off for prolonged periods. You're just basically taking smaller quantities or larger quantities and mitigating the risk as much as you can,

which is where the health concerns come into picture. Because PCT is just not enough to give the effects required to do what you need to do in the case of shows and photo shoots and the rest of it? Yeah. And you're also the time required, right? So let's say you do the Olympia in December, you do well, you want to compete in next year's Olympia, you're going to make progress in the off season, right? And there, so, and during that time, you're not going to be using, you're going to make no progress. So by the time you show up to the next Olympia, you're not going to look at, you're not going to be using, you're going to make no progress. So by the time you show up to the next Olympia, you're not going to look good. You're not going to win. And just so people can understand then what is the purpose of post-psychotherapy then? What's its ideal use?

So its ideal use would be, in my opinion, is to bring your hormone levels back to normal level and leave them there and leave them there and not mess with it, right? If you're going to be continuing to mess with it, then there's really no need or benefit to utilizing it, in my opinion. That makes sense. And you've mentioned duration a few times in our talk. And I think before we wrap up, we should talk about that, as well as any other points you want to mention, again, about the healthiest and most responsible way to go about this.

So on this point of duration, though, you had mentioned that the longer you use larger amounts of these drugs, the greater the risk. And so I wanted to hear more of your thoughts regarding that just to help people understand in their own circumstances, then how they should be thinking about the duration and at what point maybe is it time to stop? Right. Yeah, I think it's all definitely dependent on your goals. You know, if you're a bodybuilder and you're gonna, again,

you're gonna make a living doing this, then you're gonna need to redline it for a period of time. And that may be the time of your competitive career. If that's the case, hopefully you get to the point where you're good enough, where you have the luxury to maybe take a year off competing. But the reality is, is sponsors that pay your bills are going to want photo shoots and appearances and all of this stuff. And they're going to want you on stage because if you're not on stage, people forget you. And then now you're essentially worthless for that sponsor. So the reality is, is the guys that are that are making a decent living doing bodybuilding. Remember, even the best in the world only wins four hundred thousand dollars and that's only

one person. So, I mean, that's pretty good money, but that's only one person. If you're 10th in the Olympia, you want 10 grand. You can't even pay for what it takes to compete on stage, basically. So you need to make your living otherwise, and that's going to be with sponsors, right? So you can make a decent living at that point in time, but that's going to require you to be competing regularly, showing up, flying, and looking good. showing up, flying and looking good. So for those guys or women, you're going to have to be redlining pretty much all the time responsibly. You're going to either be, you know, blasting to peak for a particular show or you're going to maybe be, you know,

just cruising for a short period of time. And this is why the people that are competing like at the Arnold and the Olympia, like at two different times of the year, it's like they're basically on blast almost the whole time. And, you know, I often wonder what does their health look like? Because I don't think there's enough you,

enough other things you can do to mitigate the health risks that are there. I think it's inevitable, but that's the game that they choose to play. So that individual aside, because that's not the majority of people, right? I'm going to say the other individual, I'm going to say maybe you do want to make some short-term gains for yourself and you want to look good. Or maybe just do bodybuilding as a hobby, but it's a hobby you really enjoy and it's not going to make you any money per se, but you do want to do it competitively for a period

of time simply because you really like it. And maybe we can even assume this person wants to do it as long as they can while still maintaining their health. But at the point where they can no longer maintain their health, that's when they would walk away from it. Yeah. And I think that's where it's important to, again, using that least effective dose, kind of finding that sweet spot to be able to do it. Or if you do do it, maybe you're going to say at that point in time, maybe you have the luxury to compete because you're not making a living on it. Maybe you compete every other year, right? And then you would maybe do a blast for, you know, four or six months, and then you can maybe take a little bit of time, or maybe you do one blast a year, and then you're kind of cruising the rest

of the time to be able to kind of make the gains possible while still making, doing all those particular health checks to make sure you're not, that things are kind of coming back to normal and they're not necessarily drifting into potential deleterious long-term effects over time. And then of course, when is it time to retire? You know, well, when it's no longer fun and you don't, you no longer want to do it, you can still tire, you know, well, when it's no longer fun and you no longer want to do it, you can still live the lifestyle. And then in terms of, you know, utilizing stuff, there are going to be individuals that are going to choose to utilize stuff, you know, for long term. And that's OK. But if that's the case, find that sweet spot where it's that least effective dosage and you're not

having these other potential health consequences there. Or the alternative is, is just stop and then let your normal levels come up to normal. But that's the hard is, is just stop and then let your normal levels come up to normal. But that's the hard part, I think, for a lot of individuals, because once they've seen what it's like to be on there and you feel really good and you see the results on that, it is often hard to revert back to not. But it's definitely possible and it's definitely something that can be done. So if I'm hearing you correctly, then the risks, if as long as you do a lot of what you've shared here and you're mitigating the risks, there's not necessarily a cumulative effect over time, whether you're doing it for five years,

10 years, 15 years, 20 years, if you go about it responsibly and you don't make any major mistakes, then you should be able to maintain your health regardless of the total duration. Yeah, I think as long as as long as all those biomarkers are in check, there's a possibility. I'm not saying that it won't because everybody's going to be different. And that's why it's important to monitor those if those things are not going out of balance. So if your blood pressure is healthy, you know, all your blood work looks good, your ejection fraction looks good, etc., etc. You know, your liver function looks good. If all of those things are in line and you're able to find that least effective, minimum effective dose, and you're seeing the results, then you may be able to do that. Some people may not be able to do that. And the reality is,

then you may be able to do that. Some people may not be able to do that. And the reality is, is most people that are utilizing any that's beyond super physiological dosages, you're probably going to run into problems. I mean, that's just the reality. And that's where you have to kind of make that decision. That makes sense. And so are there any other key issues that you want to mention, again, regarding going about this in a healthy evidence-based manner? Yeah, well, I'm going to kind of state the obvious that obviously if you're, a lot of things work, right? So, you know, but it's not about what works,

it's about what's safe. And I think finding that combination of works and safe and meeting somewhere in the middle is where what's effective because you can blast a ton of stuff for a long period of time. And yes, you will look, especially if you have good genetics and you're doing all the other things right, you're probably going to look pretty amazing, but it's going to come at a

consequence of health issues over time. And again, it doesn't creep up in necessarily three months or six months. It's going to creep up typically over years and years and years where now, you know, you started when you were 25 and then now you're 40, 45, 50. And then now you start seeing all of these major effects, especially if you've never checked those things to begin with. That's when you're going to have major issues. And ironically, it requires the same patience really to do everything that you're talking about as it does to just accept a slower rate of progress as a natural weightlifter because i'm sure psychologically and even physiologically it's kind of like probably similar to newbie gains you start lifting your body's hyper responsive it's fun and then things slow down and you have to recalibrate your expectations or it's not so fun because you don't know what happened. I'm assuming it's similar with

steroid use in the beginning. Your body's hyper-responsive, it's new and it's fun, but to progress past the newbie gains phase, so to speak, of steroid use, then it requires the same self-control really to understand that while you can just double your doses and add these other things, chasing what you experienced in the beginning, that is going to have negative consequences. And so as far as the personality that's required to go about this intelligently, that is the same person who could stay natural and accept that you got to work really hard for not a lot of muscle and strength after a few years. Yeah.

And I think that's a great point because there is a point of diminishing returns, you know, even if you do go the path of utilizing the anabolic steroids where you're right. I mean, your first, you know, cycle or two, you're going to experience similar newbie gains over time. And those definitely diminish. And if that wasn't the case, you know, we would have 600 pound monsters, not 280 pound monsters, right?

And these are individuals with extremely good genetics already. I mean, realistically, most people, if you can with extremely good genetics already. I mean, realistically, most people, if you can add 50 pounds of muscle to your frame, enhance. There's very few people that I think are going to be able to gain much more than that with or without drugs, right? Well, probably without drugs. There are a few anomalies where maybe they're kind of getting a little bit beyond that, but about 50 or 60 pounds of muscle, if you can add that, enhance over time, right? You bit beyond that, but about 50 or 60 pounds of muscle, if you can add that enhanced over time, right? You're probably not gonna add 50 to 60 pounds

of quality tissue unenhanced, right? No matter what kind of genetics you have. But if you're enhanced, you may be able to maximize that. And we see that in a lot of these great bodybuilders, right? And I mean, you look at Jay Cutler, you look at Dexter Jackson, where, you know, now you see them now they are legitimately more on TRT type dosages. But Jay Cutler is still an amazing physique, even at 50 years old, you know, utilizing,

you know, significantly lower dosages, even if he's not at a TRT dose, even if he's, it's significantly lower than it was, you know, he's a 50 some year old man. Obviously he still trains well. He still eats well, takes all the boxes and he's genetically gifted, but he's definitely not, you know, the Jay Cutler when he was Mr. Olympia, he's probably 40 pounds less than that. 30 pounds less than that. Dexter Jackson kind of on the same boat where he was probably a 230 pound individual. You know, he might be about 200 pounds now. Still looks great. Great structure, great physique, still lean, but not the Dexter of when he won the Olympia

in 2008. Of course. Yeah. Yeah. And that is a good point just for people to understand that. And, you know, I've heard from people who have just shared their experience with me of when you do eventually, or if you are going to be using a lot less, you need to understand that that is going to happen. And you just have to be psychologically, you have to accept that you are not going to look the same. You're not going to perform the same to expect otherwise is to set yourself up for disappointment. And that then can, and people

have shared with me that that psychological component has driven them back to using more drugs and larger amounts of drugs, even when they knew that they should, that that period of their life should be over. They should be more on the TRT now and accept that they can still look great and by normal standards, let's say, and have great workouts and so forth, but it's just not going to be the glory days forever. Exactly.

And for me, you know, I mentioned a few guys, but one guy that really sticks out to me is Lee Labrada, who he's in his 60s now. He was one of my favorite bodybuilders from back in the day. And I mean, you look at him at 60 some years old, and I mean, the guy's still chiseled, great muscle bellies. And again, I don't know him personally, but you know, he looks healthy. I don't imagine he's, you know, blasting on a ton of stuff, probably on TRT type stuff. But again, somebody with good genetics, good work ethic, knows how to train, takes care of his body. And

even though he's 60 or in his 60s i should say you know that physique is still amazing totally agree well i i've kept you 30 minutes longer than i originally planned i i actually just noticed it now and so i want to be i want to be respectful of your time and just ask us anything else that you want to mention before we quickly wrap up here no i just wanted to say thanks for bringing me on. And I appreciate you having me here. If you want to follow me on Instagram, I'm at DrGFit. And you can follow my research on that.

Or you can go to my university website, csusb.edu. And you can find my name there. And hopefully, I'd love to hear from you as well. Yeah. And thanks again for taking the time. This was a great discussion. Thank you for having me. Well, I hope you liked this episode. I hope you found it helpful. And if you did subscribe to the show because it makes sure that you don't miss new episodes. And it also helps me because it increases the rankings of the show a little bit,

which of course then makes it a little bit more easily found by other people who may like it just as much as you. And if you didn't like something about this episode or about the show in general, or if you have ideas or suggestions or just feedback to share, shoot me an email, mike at muscleforlife.com, muscleforlife.com, and let me know what I could do better or just what your thoughts are about maybe what you'd like to see me do in the future. I read everything myself. I'm always looking for new ideas and constructive feedback. So thanks again for listening to this episode and I hope to hear from you soon.