Disclaimer: This Article is for Educational Purposes ONLY
Testosterone is both a hormone and an anabolic steroid. Testosterone is a hormone naturally produced by the body—primarily in the testes for men, and in smaller amounts by the ovaries in women and the adrenal glands in both sexes.
As a steroid, testosterone can be used as a performance-enhancing drug (PED), promoting muscle growth beyond natural levels and enabling physical performance that exceeds typical human limits.
In the context of testosterone replacement therapy (TRT), however, testosterone is administered to restore hormone levels to a normal, healthy range—not to enhance performance. While testosterone is chemically classified as an anabolic steroid, it’s the purpose and dosage that differentiate legitimate TRT from steroid abuse.
Rich Piana was a modern Nietzschean figure of experimentation and a Socratic seeker of knowledge and self-mastery. He would repeatedly say:
“Use your brain! Don’t follow everyone else!”
Widely recognized for his raw honesty about steroid use, Piana became a cult figure in the bodybuilding world—not just for his physique, but for his willingness to break taboos and speak openly about performance enhancing drugs (PEDs). His YouTube channel became a platform where he shared not only training advice, but hard-earned wisdom about life, self-discipline, and the cost of chasing size.
In an April 2014 video, Piana recounted starting anabolic steroids at age 18. Within just eight weeks, he gained more than 15 pounds—going from 185 to over 200—and experienced dramatic strength increases, including a bench press from 315 to 405 pounds. He framed the experience not as a shortcut, but as part of a deliberate and extreme pursuit of growth.
However, Piana never glamorized steroid use. In an April 2016 video, he offered a stark warning to viewers:
“If you have the choice to stay natural or do steroids, stay natural. There’s no reason to do steroids—you’re only hurting your body, you’re hurting yourself.”
While he never denied the results and easier muscle gains associated with steroid use, he emphasized the risks and long-term consequences, especially for non-professionals.
For a deeper understanding of Rich Piana’s perspective on muscle, mindset, and the reality of human enhancement, his full catalog remains available on YouTube—part cautionary tale, part personal testimony.
The Four most commonly googled Steroids
The four most commonly Googled steroids—excluding testosterone (Test)—are:
Nandrolone (Deca), in use since the 1960s
Trenbolone (Tren), popularized in the 1980s
Oxandrolone (Anavar), also dating back to the 1960s
Fluoxymesterone (Halotestin or Halo), introduced in the 1950s
Deca is three times more potent than Test. Tren, the current favorite, is five times stronger than Test. Anavar often used by female athletes, bikini competitors, and bodybuilders, is six times stronger than Test. Halo, the most powerful of the group, is nineteen times stronger than Test.
In competitive sports, when everyone’s looking for an edge, steroid use becomes a way to “level the playing field.” Over time, this mindset turns enhancement into expectation—fueling misuse, abuse, and ultimately, denial.
Steroid Abuse Is Claiming More Lives Than Ever
Steroid abuse and misuse are major contributors to heart and cardiovascular disease. When used in excessive amounts, too frequently, or for prolonged periods, steroids can lead to early heart attacks and premature death. In the 2020s, more male and female competitive athletes are losing their lives to steroid-related complications than ever before. An increasing number of competitors and social media influencers in their 30s and 40s have died as a result of extreme physical conditioning—pursuing a lean, muscular, and vascular physique—combined with steroid abuse and severe dehydration.
Jo Linder
German bodybuilder Jo “alien gains” Linder, aka “Joesthetics,” was a social media fitness influencer with over 9 million Instagram followers. He died at his home of an aneurysm on June 30, 2023, at the age of 30.
Antonio Souza
Brazilian bodybuilder Antonio Souza complained of a “strong pain feeling in his chest” before competing. He died just hours after winning a trophy from a heart attack on August 3, 2024, at the age of 26.
Nasser El Sonbaty
Nasser El Sonbaty, known as “The Professor,” began bodybuilding in 1983 and turned professional in 1990, competing against legends like Dorian Yates and Ronnie Coleman. He weighed 300–315 pounds off-season and 265–290 pounds during competitions, with his best Mr. Olympia finish being second in 1997, just behind Yates. Sonbaty’s last Olympia appearance was in 2002, and he retired in 2005. In 2013, he was denied a heart transplant due to severe heart damage and died at 47 from kidney failure and heart complications, both linked to long-term steroid abuse, which enlarges and weakens the heart over time.
Rich Piana
Rich “Whatever It Takes” Piana was known for his massive physique and outspoken honesty about steroid use, openly stating in YouTube videos, “I’ve been taking steroids for 25 years. I started when I was 18.” While he began using steroids for competitive bodybuilding, he also warned others against it, saying,
“It’s not a good idea… If you can stay natural for as long as you can, that’s the way to go,”
emphasizing that mindset is more important than drugs. Piana admitted that steroids make it easier and faster to reach goals, and that in a competitive environment, using them often feels necessary to stay on a level playing field—even if it’s unnatural and inauthentic. He died of cardiac arrest in 2017 at the age of 46.
Bostin Loyd
Bostin Loyd, known for the motto “Get Big or Die Trying,” was born into a bodybuilding family and began using steroids at 17. He was open about his drug use, sharing injection videos and claiming steroids were essential for elite physiques. Loyd took extreme doses—up to 25 mL of PEDs daily, spending over $1,000 a week—and called himself a drug addict, though he didn’t promote his choices to others. He competed in amateur shows but lost interest in going pro due to the lack of rewards, with his last competition in 2016. Diagnosed with stage 5 kidney failure in 2020, he continued sharing his health journey until his death on February 25, 2022, at age 29, from an aortic dissection.
Dr. Mike Israetel
Dr. Mike Israetel, a 41-year-old competitive bodybuilder with a PhD in Sport Physiology, is a popular author and YouTuber with over 2 million subscribers. Despite his academic background, he openly admits he's willing to risk his health—and even his life—for a bodybuilding pro card, stating,
“If I die before my due time… this is what I wanted.”
Israetel is candid about his steroid use, acknowledging intense mental side effects like anxiety, rage, and constant thoughts of violence. He explains that stacking drugs like Deca, Tren, and Halo can raise testosterone to 25 times the normal range. While he believes the risks are worth it, his mindset challenges the natural human instinct for self-preservation.
My Story From Fat to Fit, Fit to Cancer, and Life Without TRT
My first major body transformation occurred between the ages of 15 and 16. I went from a skinny 125 pounds to a solid 155 pounds in just one year. During the first eight months, I bulked up to 180 pounds, then cut down by 25 pounds over the next four months—resulting in a net gain of 30 pounds of muscle in a single year.
More than four decades later, between the ages of 56 and 57—from January 2019 to March 2020—I experienced a second major transformation. I went from a fat 200 pounds to a fit 175 pounds in just 15 months. In the first 16 weeks alone, I lost 17 pounds and ultimately shed a total of 25 pounds over the year.
Midway through this transformation, in mid-July 2019, I faced a second recurrence of testicular cancer, which resulted in the removal of my right—and only remaining—testicle. With no testicles, my body could no longer produce testosterone naturally. This marked the beginning of testosterone replacement therapy (TRT), carefully guided and monitored by my physician.
Despite my testosterone level being just 172 ng/dL—well below the clinical norm—my transformation from January 2019 to March 2020 was entirely natural: no caffeine, no supplements, no muscle enhancers. And to be absolutely clear, I’ve never used performance-enhancing drugs.
In November 2021, just a year and a half after my second transformation—and only six months after publishing The Fitness Mindset—I was hit with a third recurrence of testicular cancer. Over the next ten weeks, from November 15, 2021, to January 21, 2022, I underwent an intense chemotherapy regimen (Etoposide 204mg and Cisplatin 40.8mg), totaling 40 bags.
Despite the physical toll, I stayed committed to my fitness routine and continued exercising throughout treatment. On December 7, 2021—23 days into chemotherapy, just days after losing my hair, and right after a six-hour chemo session—I tested my strength and deadlifted 315 pounds for two sets of 10 reps.
In mid-January 2022, due to a history of elevated prostate levels and blood clots, my doctor discontinued TRT on two separate occasions—totaling 14 months without treatment. During those times, my body relied solely on estrogen—the only remaining endogenous hormone—and a minimal testosterone level of just 55 ng/dL.
There’s a widespread belief among oncologists that intramuscular testosterone can fuel prostate cancer, potentially enlarging the prostate and raising PSA levels. Although this claim has largely been debunked, it was the basis for my physician’s decision to halt treatment.
A study by the University of Washington School of Medicine, which analyzed nearly 150,000 patient cases, found that intramuscular testosterone injections or TRT treatment does not increase the risk of prostate cancer. You can access the study here: Brain Donohue, “Study: Testosterone therapy does not raise prostate cancer risk” (June 21, 2018)—UW Medicine. Retrieved: https://newsroom.uw.edu/news-releases/study-testosterone-therapy-does-not-raise-prostate-cancer-risk.
After just three weeks without TRT, I experienced 20 to 30 hot and cold flashes every day and night. My doctor prescribed a low-dose antidepressant to help mitigate the symptoms. My sex drive disappeared. My physiological drive to train intensely dropped. Recovery became slower. I felt more pain throughout my body. My skin became soft, smooth, and slippery. And I gained fat around my midsection. To fight back against these changes, I modified my training approach, adjusted my variables, and trained as intensely as I could.
On March 11, 2022, my testosterone level measured just 39 ng/dL, derived solely from my adrenal glands. At that time, I was 60 days into post-chemotherapy recovery. Just over two weeks later, on March 27, 2022, I hiked up a mountain in Montana—without TRT.
Frustrated and angry at my doctor’s decision, I took matters into my own hands. Using the remaining testosterone from a 10 mL bottle, I resumed TRT without medical supervision in mid-May 2022, injecting 1 mL weekly for four weeks. The hot and cold flashes stopped after three weeks, and my workouts became energizing once again.
At a follow-up in mid-June, my bloodwork showed a testosterone level of 1500 ng/dL. My doctor was nearly ready to drop me as a patient. Fortunately, my prostate was still within the normal range, so he resumed TRT at a lower dose of 0.5 mL every other week. I promised to follow his guidance moving forward.
In mid-September 2022, however, my prostate values spiked again, and my doctor discontinued TRT for a third time—this time for 10 months. During that period, my testosterone level hovered around 74 ng/dL. Still, I continued to train and exercise. On June 25, 2023, I even ran my first half-marathon in Montana—again, without TRT. In mid-July 2023, my doctor resumed TRT at 0.5 mL every other week, or 1 mL monthly.
Can a man live with low testosterone? Absolutely.
Can he work out? Without a doubt.
Can he make physical improvements? Yes, he can.
Now, does any man want to live with less-than-optimal testosterone? Of course not.
But here’s the truth—I’m living proof that it’s possible. On two separate occasions—from mid-January to mid-May 2022, and again from September 2022 to July 2023—I went without TRT for a total of 14 months and still made measurable physical progress. It wasn’t easy, but it was real.
Low, Normal, and High Testosterone Levels
The “normal” range used by most labs to measure naturally occurring testosterone in men—produced by the testes—is typically between 200 and 600 ng/dL. However, some labs use broader reference ranges, such as 280 to 1,100 ng/dL, depending on their testing methodology.
Now, imagine a man with a natural testosterone level of 500 ng/dL who decides to inject 0.5 mL of testosterone weekly (totaling 2 mL per month) to boost his physical performance. This is considered a misuse of testosterone—it’s steroid use. Why? Because this practice artificially elevates his levels well beyond the normal range, often pushing them to 1,500–2,000 ng/dL or even higher. At that point, he is no longer “natural.”
In contrast, I no longer produce testosterone naturally—my testicles are gone. My adrenal glands supply only a minimal amount, reflected in testosterone levels between 39 and 74 ng/dL when I’m off TRT. Fortunately, now that my prostate is stable, my primary care physician has allowed me to resume TRT.
Currently, I’m on a modest dosage: 0.5 mL every two weeks (or 1 mL per month). At this dose, my testosterone level holds steady around 253 ng/dL. While that number is on the low end of the spectrum, it’s enough for my body to function well. I don’t need more, and I’m not chasing inflated numbers. That’s why I can confidently and honestly say: I am natural. I’ve never used steroids to artificially “enhance my physique”—and I take pride in that.
Building a strong, muscular body doesn’t require sky-high testosterone. What it truly requires is a strong mindset—a fitness mindset. If you want to naturally boost your testosterone, train hard—especially your legs. Intense exercise (not necessarily heavy lifting) is one of the most effective natural testosterone boosters.
Yes, testosterone plays a role in libido, general drive, and recovery speed. But it doesn’t directly give you the energy to work out. That energy? It comes from your mindset. Fuel your mind with purpose. Fuel it with The Fitness Mindset!
