Why Is Hormone Replacement Therapy Not the Same As Steroids?

Although the testosterone prescribed during hormone replacement therapy is itself an anabolic steroid, and steroid users seek many of the same benefits as those receiving hormone replacement, there are many differences between hormone replacement and recreational use of steroids. These differences include distinctions in legality, medical diagnosis, side-effects and motivation for taking the drugs.

What Is Hormone Replacement Therapy?

• Hormone replacement therapy is a medical regimen prescribed by doctors to alleviate or reverse the effects of low testosterone in men. Testosterone is a naturally occurring steroid hormone that promotes muscle growth and bone density and produces sperm in the testes. After the age of 25, the body's natural production declines by a rate of two percent per year, and many men begin to experience decreased libido, depression, loss of muscle that coincides with fat gain, fatigue, and a lessened sense of mental health and well-being.

  After receiving a doctor's prescription, men take hormone replacement therapy to restore quality of life. The desired changes include more youthful energy and improved muscle levels, the restoration of libido, and heightened well being and sense of self.

What Are Steroids?

• Though steroids have other medical uses besides hormone replacement therapy (such as treating anemia), in popular usage, "steroids" refers to anabolic steroids, a class of drugs similar to or derived from testosterone. Those who take steroids use them for cosmetic reasons to improve appearance (to gain muscle and lose body fat) or to enhance performance in sport or bodybuilding. These types of use are recreational in nature, and the drugs must often be attained through illicit or illegal means. Using steroids during participation in sport is banned by many sport governing bodies, including the International Olympic Committee, the NCAA, and the four major professional sporting leagues.

Legality

• The testosterone used in hormone replacement therapy is itself an anabolic steroid, albeit one approved by the FDA for medical use. The FDA has not, however, approved anabolic steroids for use in sport, bodybuilding, or for cosmetic reasons, and doctors generally do not prescribe steroids for these reasons.

  Under US Federal Law, it is illegal to possess anabolic steroids without a doctor's prescription, and the Department of Justice lists them as a Schedule III drug. This classification means that any illegal possession, sale, or distribution of anabolic steroids is punishable by up to five years imprisonment (state laws vary, and punishments can exceed five years).

Diagnosis

• Hormone replacement therapy is intended to treat a natural deficiency of testosterone brought about by aging (and in some cases, injury to the pituitary, hypothalamus, or testicles). Doctors determine a deficiency by testing blood serum testosterone and luteinizing hormone (a precursor to natural testosterone production). If testosterone levels are low while luteinizing levels are normal, doctors will begin hormone replacement therapy.

  By contrast, there are no medically valid diagnostic tests used to determine anabolic steroid need for recreational purposes.

Side Effects

• Hormone replacement therapy can cause a number of side effects, some of which may overlap with the illicit use of anabolic steroids. These effects may include insomnia, acne, oily skin, male breast enlargement, depression, irritability, enlarged prostate, difficulty urinating, and changes to blood serum cholesterol.

  Anabolic steroid use can result in the same side effects and also include a number of more dangerous conditions including blood-filled cysts in the liver or spleen (can result in fatality), high blood pressure, increased risk of arterial plaque, accentuation of male characteristics (including baldness, deepened voice, and excess body and facial hair), and liver or coronary damage.

  However, because hormone replacement therapy is administered and supervised by a doctor, treatment is considered safer, especially since recreational users expose themselves to the risk of illicitly purchasing counterfeit drugs that may be of dubious quality or even harmful.