TRT compared with anabolic steroid use

Side by side

The monographs' dosing wording is quoted here to explain the difference, not as advice. A prescriber sets and adjusts the dose from blood tests. The same monographs warn that testosterone "has been subject to abuse, typically at doses higher than recommended".

Documented harms of non-medical use

• Heart muscle. In US weightlifters aged 34 to 54, long-term users had a heart pumping fraction (ejection fraction) of 52%, compared with 63% in non-users, and more coronary plaque (Baggish 2017). In a Danish registry of 1,189 men sanctioned for steroid use, cardiomyopathy was about nine times as common as in matched men, and heart failure about 3.6 times (Windfeld-Mathiasen 2025).
• Death. Two Danish registry studies found a death rate about three times that of non-users (Horwitz 2019; Windfeld-Mathiasen 2024).
• Natural testosterone production. Years after stopping, 27% of former users in one Danish study had testosterone below the reference range (Rasmussen 2016), and a US study describes steroid-withdrawal hypogonadism as common and often prolonged (Kanayama 2015).
• Dependence. Pooled data from ten studies put steroid dependence at about 30% of users (Pope 2014).
• Blood and liver. A higher red blood cell count is common, even at replacement doses; liver damage is mainly linked to oral steroids of a particular chemical class (Bond 2022).
• Injection injuries. Among 366 men in the UK who injected, 42% had ever had redness, swelling and tenderness at a site, and 6.8% an abscess or open wound (Hope 2015).

Unlicensed products add their own risk. On 24 December 2025 Health Canada reported a testosterone cypionate product labelled 250 mg/mL, a strength no Canadian product has, sold online and seized at a Vancouver gym, and warned that unauthorized injectables carry risks of infection and contamination.

Risks that apply at replacement doses too

• Fertility. The Canadian Urological Association says testosterone "can serve as a contraceptive", lowering sperm production, and advises men who want children against using it on its own.
• Red blood cells. Polycythemia is a common side effect; the Canadian guideline acts at a hematocrit of 55% or more.
• Testicle size. Outside testosterone suppresses the signals that drive the testes. More is on the risks and monitoring page.

What the dose does to muscle

Muscle gain rises with dose. In healthy young men whose own testosterone was switched off, weekly doses of 125, 300 and 600 mg added about 3.4, 5.2 and 7.9 kg of fat-free mass over 20 weeks, while red blood cell counts rose and HDL cholesterol fell with the dose (Bhasin 2001). At replacement doses in older men, a 2025 Canadian Family Physician review found testosterone may add about 1.6 kg of lean mass, with no consistent effect on strength. Replacement therapy is not a muscle-building treatment, and the Canadian labels do not approve it as one.

The legal difference in Canada

• Same schedule. Testosterone and the other anabolic steroids are in Schedule IV of the Controlled Drugs and Substances Act.
• On prescription: legal, dispensed by a licensed pharmacy.
• Possession for your own use: not an offence under the Act for Schedule IV.
• Selling, giving or sharing: "traffic" in the Act includes to give, transfer or send, and trafficking a Schedule IV substance carries up to three years on indictment. Importing without authorization carries the same maximum.
• In sport: Sport Integrity Canada (formerly the Canadian Centre for Ethics in Sport) lists anabolic steroids as prohibited at all times; an athlete on prescribed treatment may need a therapeutic use exemption.

The full legal summary, including travel rules, is on the Is TRT legal in Canada? page.

Common questions

Is TRT the same as taking steroids?

Testosterone is an anabolic steroid, so in that sense yes. The difference is dose, goal and supervision. Replacement therapy aims to bring a confirmed low level back into the normal range under monitoring. Non-medical use aims for levels well above normal, often by combining several steroids, usually without medical monitoring.

Is TRT safer than steroids?

Replacement doses carry known risks, such as a higher red blood cell count and reduced sperm production, which is why treatment is monitored. Non-medical use at much higher doses is linked in studies to heart muscle damage, prolonged loss of natural testosterone production after stopping, dependence in about three in ten users, and a death rate about three times that of non-users in Danish registry studies.

Is 200 mg of testosterone a week a lot?

Compared with the Canadian product monographs, yes. The testosterone cypionate monograph gives 200 mg every two weeks for replacement, with a maximum of 400 mg a month; 200 mg every week is twice that dose and above the monthly maximum. Your own dose is set by your prescriber and adjusted to blood tests.

Is it illegal to have steroids in Canada?

Testosterone and other anabolic steroids are in Schedule IV of the Controlled Drugs and Substances Act. Possessing a Schedule IV substance for your own use is not an offence under that Act, but selling, giving or sharing it, possessing it to sell, and importing it without authorization are offences. In sport, anabolic steroids are prohibited at all times.