274 - Performance-enhancing drugs and hormones—risks, rewards, & broader implications for the public

KEYPOINTS

• 01

  Derek's own history illustrates how young men drift into steroids.

  A skinny 138-pound high-school basketball player, Derek started lifting under peer pressure, later used anabolic steroids and reached 260+ pounds. At peak he estimates a combined weekly dose of about 1,500 mg to 2 g—at 20–21, 'you just think you're invincible'.

• 02

  Supraphysiologic doses don't produce proportional results.

  Peter notes he's never prescribed more than about 150 mg/week of testosterone cypionate for TRT, so Derek's peak was 10–13 times that—but results were nowhere near 10–13x. At 500 mg+ per week, users often need aromatase inhibitors such as 1 mg anastrozole daily or every other day to control estrogen.

• 03

  Underground labs fill the gray market.

  A vial is typically 250 mg/mL (versus pharma's 200 mg/mL increments) and costs perhaps $60–70; Chinese-sourced HGH can be about $150 for 100 IU. Quality and dosing accuracy are uncertain.

• 04

  Growth hormone secretagogues differ greatly in hunger effects.

  Ipamorelin, though a ghrelin-receptor agonist, barely affects appetite, while MK-677 (ibutamoren) can drive people to eat around 2,000 extra calories a day; its half-life is roughly 24–36 hours. GHRP-6 causes acute hunger after injection. CJC-1295 with DAC has an extended half-life; most of these lack FDA approval, and some users push IGF-1 to 500+.

• 05

  Drugs dominate elite bodybuilding outcomes.

  Derek ranks drugs first, then nutrition, then training—reluctantly putting numbers like 50/40/10. Physiques changed dramatically in the late 1980s–90s; growth hormone and insulin are credited for 20–30 lb lean-mass jumps, with 300 lb competitors eating around 5,000 calories and chugging 100–200 g shakes with hydrolyzed whey before workouts to avoid insulin-induced hypoglycemia.

• 06

  The cardiovascular toll is real.

  They discuss deaths of young bodybuilders, including one in his 30s who did lots of cardio and ate clean, and Rich Piana, who died in his 40s with a heart reportedly around 660 g. Peter relates lipid harms to apoB and the limited tools of decades past.

• 07

  Testosterone declines gradually, not off a cliff.

  After about 30–35, total testosterone falls about 1% a year and free testosterone 2–3%, varying with lifestyle—so a 45-year-old shouldn't assume a 20% drop. Some very muscular men feel fine at 450 ng/dL.

• 08

  Good TRT starts low and mimics physiology.

  A reasonable starting dose is 80–120 mg/week, adjusted in fine increments like 20 mg/week. The old standard of 200 mg every two weeks produced wild peaks and troughs; daily or frequent small doses (e.g., 15 mg injected daily) or nasal Natesto avoid huge spikes to 1,500–2,000 ng/dL. Peter's clinic adjusts doses 100–120 mg/week; 'fitness-industry TRT' starts at 200 minimum.

• 09

  Estradiol shouldn't be crushed in men.

  A New England Journal study around 2013–14 with 10 groups showed estrogen matters for men's fat mass and sexual function. The old idea of pinning estradiol at 20–30 pg/mL regardless of testosterone dose is outdated. Peter's T is 300–400 ng/dL with estradiol rarely above 25; he notes a higher T would bring useful estradiol too.

• 10

  hCG preserves testicular function on TRT.

  To maintain intratesticular testosterone while suppressed on exogenous androgens, Derek cites about 375 IU every other day; a common starter dose is 625–750 IU twice weekly, rarely above 2,000 IU twice weekly. hCG's half-life is roughly 24–36 hours, and a study using 4,000 IU examined effects on FSH.

• 11

  Hair-loss drugs shift hormones.

  Finasteride and dutasteride block conversion to DHT (a 5 mg BPH dose inhibits up to ~70% systemically), raising testosterone and estradiol by about 15–22%. By the time hair loss shows in photos, 20–30%+ may already be lost. Derek doesn't recommend the topical RU58841 given alternatives with human safety data on the horizon.

• 12

  Natural testosterone release is steady; weekly 'hammers' aren't physiologic.

  Derek points out there's no situation in which healthy testes blast a man once a week with a huge dose of testosterone and its metabolites. Large, infrequent injections create spikes, then troughs with symptoms, and drive more aromatization and hematocrit rise. Smaller, more frequent dosing—or shorter-acting formulations—keeps levels closer to what the body would produce, which is why both favor it.