The short version
Anabolic steroids, SARMs, growth hormone, and the newer "research peptides" are sold with promises of muscle, fat loss, faster healing, and more energy. Most are either controlled substances or not approved for human use at all, many are sold with little quality control, and the risks are better documented than the benefits. This page explains what each is, what is known, and what to do if you are already using them or considering them. It is not a how-to; we do not give doses or sourcing.
- Steroids shut down your own testosterone production and can cause infertility, sometimes for months or longer after stopping.
- "Research use only" products are not for people. Contents and purity are often not what the label says.
- If your concern is low energy, low libido, or poor recovery, get tested. A prescribed, monitored treatment is a very different thing from a gray-market product.
- If you already use them, tell your doctor. You'll get better care, and the monitoring below matters.
Performance-enhancing drugs (PEDs)
| Substance | Legal status (US) | Main known risks |
|---|---|---|
| Anabolic-androgenic steroids (testosterone at high doses, nandrolone, trenbolone, oxandrolone, and others) | Schedule III controlled substances: possessing or selling them without a valid prescription is illegal | Shut down natural testosterone and sperm production, testicular shrinkage, acne, breast tissue growth, high red blood cell counts, lower HDL cholesterol, high blood pressure, heart muscle thickening, mood and aggression changes, dependence; oral types can injure the liver |
| SARMs (ostarine, ligandrol, RAD-140, and similar) | Not FDA-approved for any use; sold online as "research chemicals." FDA has issued warnings and the products are prohibited in sport | Suppress natural testosterone; cases of liver injury and cardiovascular events have been reported; product testing has found labels that don't match contents. Long-term safety is unknown |
| Human growth hormone (HGH) | Prescription only for specific conditions; distributing it for anti-aging or athletic purposes is a federal offense | Fluid retention, joint pain, carpal tunnel, insulin resistance and diabetes risk; benefit for healthy adults' muscle and performance is not established |
| hCG and clomiphene used alongside steroids | Prescription drugs | Used to blunt side effects (hCG to keep the testicles working; clomiphene to restart hormones). Have real prescribed uses, but don't make steroid use safe |
Testosterone shutdown and recovery
Taking testosterone or other anabolic steroids signals the brain to stop sending the hormones (LH and FSH) that drive the testicles. Sperm production can drop to zero. After stopping, recovery varies: many men recover over months, but some stay low for much longer, and the "crash" during that gap can bring fatigue, low mood, and low libido that drives men back to using. Anabolic steroid-induced hypogonadism is a recognized diagnosis, and it is treated differently than ordinary low testosterone. If you have used steroids and want children, see our male fertility guide and TRT and fertility page.
Prescribed TRT is a different thing
Testosterone therapy for men who have symptoms and confirmed low levels uses doses designed to bring levels into the normal range, with scheduled monitoring of hematocrit, PSA, and testosterone itself. See our TRT guide, the side effects and monitoring guide, and enclomiphene versus TRT for fertility-sparing options.
Peptides
"Peptide" just means a short chain of amino acids, and some peptide drugs are approved and well studied (insulin, and the GLP-1 drugs such as semaglutide). The products promoted to men online are usually different: unapproved compounds such as BPC-157 ("body protection compound") and TB-500 for healing, growth-hormone-releasing peptides such as CJC-1295 and ipamorelin, and tanning peptides such as melanotan.
- The evidence is thin. Most claims rest on animal studies or small, short human studies. For BPC-157, for example, there are no good human trials showing it speeds healing or is safe over time.
- They are not FDA-approved for these uses, and the rules are in flux. The FDA had listed several popular peptides, including BPC-157, among bulk substances that may pose significant safety risks for compounding, and reportedly took them off that list in April 2026. On July 23, 2026, the FDA's compounding advisory committee voted 8 to 6 to recommend that BPC-157 be added to the list of substances pharmacies may compound, over the opposition of FDA staff. That vote is advice, not a decision: as of this writing the FDA had not authorized compounding, and products sold as "research use only" remain unapproved and not for human use. We track changes in the weekly briefing.
- Quality is the larger worry. Gray-market vials have no guarantee of the ingredient, dose, sterility, or purity, and injecting an unsterile or mislabeled product carries infection and other risks.
- Growth-hormone-releasing peptides raise growth hormone and IGF-1, which raises questions about glucose control and cancer risk that have not been answered in long-term studies.
- Compounded GLP-1 and "weight-loss peptide" products are in a different category (they involve approved drugs), but compounding rules and quality vary. Read our GLP-1 overview and talk to a prescriber.
"Testosterone boosters" and prohormones
Over-the-counter "test boosters" are a separate issue: most have little evidence, and some products sold as supplements have been found to contain undeclared steroids, SARMs, or prohormones. The FDA has repeatedly warned about tainted muscle-building and sexual-enhancement supplements. See our testosterone boosters evidence check.
What men are really trying to fix
Most men who look into these products want one of four things. Each has a safer route:
| The goal | A safer starting point |
|---|---|
| More muscle or strength | Progressive strength training, enough protein and calories, and sleep (strength training guide, nutrition, recovery) |
| Energy, libido, mood | A medical check for low testosterone, sleep apnea, thyroid, anemia, depression (low T symptoms) |
| Injury healing | Physical therapy and a sports-medicine evaluation; ask a clinician about options with evidence |
| Fat loss | Diet, activity, and, if you qualify, approved obesity medicines (metabolic health) |
Also consider body image. Muscle dysmorphia, the persistent belief that you are too small despite being muscular, is more common in men who use PEDs and is treatable. See getting help.
If you already use them
This is health information, not encouragement. If you use or have used steroids, SARMs, or peptides, a candid conversation with a doctor is the safest step, and clinicians are far more interested in your health than in judging you. Monitoring generally includes:
- Blood pressure and a complete blood count (hematocrit and hemoglobin), since steroids can thicken the blood
- Cholesterol (lipids), liver and kidney tests, and blood sugar
- Hormones (testosterone, LH, FSH, estradiol) and a semen analysis if fertility matters
- Heart evaluation if you have chest pain, palpitations, or breathlessness
Do not stop prescribed medicines on your own, and do not take extra drugs from online forums to "fix" side effects. Use a registered clinic or pharmacy, never share needles, and be honest about what you take so interactions are not missed. Our provider directory lists telehealth clinics that offer monitored testosterone therapy, but a clinician will want to know your history before prescribing.
When to get care now
- !Chest pain, shortness of breath, fainting, or a racing or irregular heartbeat.
- !Yellow skin or eyes, dark urine, or severe fatigue and abdominal pain (possible liver injury).
- !Swelling, redness, fever, or pus at an injection site.
- !Severe depression or thoughts of suicide after stopping. Call or text 988.
- !Calf swelling or pain, or sudden weakness or trouble speaking (possible clot or stroke).
Sources
- National Institute on Drug Abuse. Anabolic steroids DrugFacts.
- Pope HG Jr, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341-375.
- Rahnema CD, et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101(5):1271-1279.
- Van Wagoner RM, et al. Chemical composition and labeling of substances marketed as selective androgen receptor modulators and sold via the internet. JAMA. 2017;318(20):2004-2010.
- U.S. Food and Drug Administration. Bulk drug substances used in compounding under section 503A of the FD&C Act.
- ABC News. FDA advisory committee votes to add popular peptide BPC-157 to drug compounding list (July 2026).