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

Known as “The Professor,” Nasser El Sonbaty, began bodybuilding in 1983. His professional debut as a competitive bodybuilder was in 1990. He competed against the greatest “mass monsters” of all time from Dorian Yates in the 90s to the rise of Ronnie Coleman in the 2000s.

Sonbaty weighed between 300 to 315 pounds during the off season and weighed between 265 to 290 pounds during competitions. His best placing was second next to Dorian Yates at the Mr. Olympia contest in 1997, the year that Yates retired when he was 35-years-old. Sonbaty’s last Mr. Olympia contest was in 2002 and placed 15th. Sonbaty retired from competition in 2005.

In 2013, Sonbaty needed a heart transplant, but he did not qualify for it because his heart was too weak. He died from kidney failure and heart complications at the age of 47. Abusing steroids increases the size of the heart, which causes weakened contraction and relaxation and damages the heart.

Rich Piana

Rich “Whatever It Takes” Piana was known for his ginormous size and openness about steroid use. In compiled YouTube videos he says, “I’ve been taking steroids for 25 years. I started when I was 18.” Piana started taking steroids for competitive bodybuilding. However, he informs us, “It’s not a good idea to take steroids... If you can stay natural for as long as you can, that’s the way to go.” He further says, “The most important thing is your mind, your mentality.”

Piana acknowledged that it takes longer and is harder to reach your goals without the aid of steroids. Thus, it is easier to reach your goals with steroids. If a person wants to remain in the game and equal the playing field, it is inevitable that taking steroids is the route, despite it being a form of cheating, unnatural, and inauthentic. Rich Piana died at the age of 46 in 2017 of cardiac arrest.

Bostin Loyd

Known as “Get Big or Die Trying,” was born into a family of competitive bodybuilders. Drawn to the discipline of the sport, he also embraced its darker side—starting steroids at just 17.

Loyd was openly honest about his use, often sharing steroid protocols and injection videos online. He argued that elite-level physiques aren’t built with just protein powder and creatine—steroids, he claimed, were essential.

Unlike most users who might take 25cc of PEDs per week, Loyd pushed extremes—taking that amount daily. His weekly steroid habit exceeded $1,000, and he referred to himself as a drug addict, though he never encouraged others to follow his path.

Loyd competed in amateur shows in Southern California but said he had no interest in going pro due to the lack of rewards. His last competition was in 2016.

Diagnosed with stage 5 kidney failure in 2020, he continued to share his health journey publicly. On February 22, 2022—just three days before his death—he posted a message of gratitude and hope, saying he was ready for whatever life had in store.

Loyd died February 25, 2022, at the age of 29 due to aortic dissection causing internal bleeding and death.

Dr. Mike Israetel

Israetel is a 41-year-old competitive bodybuilder with a PhD in Sport Physiology. He’s also a popular author and YouTuber with over 2 million subscribers and more than 500 million views.

Despite his academic background, Israetel openly admits he’s willing to sacrifice his health—and even his life—to earn a bodybuilding pro card. In a video compilation by Greg Doucette, he says:

If I die before my due time from the cardiovascular shit… it’s been real, and this is what I wanted. Do not ever feel the need to be sympathetic of me.

Israetel is open about his steroid use and addiction. He acknowledges that abusing PEDs brings intense mental side effects, including overwhelming anxiety. He says, “When I wake up every morning, I feel afraid of the rest of the day,” and throughout daily life, he experiences “rage, frustration, and anger.”

He explains that stacking steroids like Deca, Tren, and Halo can push testosterone levels to 15,000–25,000 ng/dl—up to 25 times the normal range of 300–1,000 ng/dl—and that this makes him “think about violence all the time.”

While Israetel believes that reaching elite status in the bodybuilding world is worth these risks, it raises an important question: Is it truly worth changing your nature—and dying—for a title? For some, like Israetel, the answer is yes. But choosing not to care about your life is far from natural. Self-preservation is.

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. Initially, I bulked up to 180 pounds before cutting down by 25, resulting in a net gain of 30 pounds of muscle.

More than four decades later, between the ages of 56 and 57—from January 2019 to around March or May 2020—I experienced a second major transformation, this time going from fat to fit in just 15 to 17 months. In the first 16 weeks alone, I lost 17 pounds, eventually shedding a total of 25 pounds over the course of a year.

Midway through this transformation, in July 2019, I faced a second recurrence of testicular cancer, which resulted in the removal of my left—and only remaining—testicle. That event marked the beginning of TRT, carefully guided and monitored by my physician.

Despite my testosterone level being just 172—far below the clinical norm—my transformation was entirely natural. No caffeine, no supplements, no muscle enhancers. And just to be 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 to exercise throughout treatment. At one instance, on December 7, 2021, after 23 days of chemotherapy, a few days after losing my hair, and finishing a 6-hour chemo session, I put my strength to the test and deadlifted 315 pounds for 2 sets of 10 reps!

Chemotherapy drastically affected my body—physically, hormonally, and visually. In January 2022, due to a history of elevated prostate levels and blood clots, my doctor discontinued my TRT. There’s a widespread belief among oncologists that intramuscular testosterone can fuel prostate cancer, possibly enlarging the prostate and raising PSA levels. Although this claim has been widely debunked and shown to be false, it was the basis for my physician’s decision—made again in spring-summer 2023 after another episode of prostate enlargement.

However, 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 | Newsroom. Retrieved: https://newsroom.uw.edu/news-releases/study-testosterone-therapy-does-not-raise-prostate-cancer-risk.

During these periods without TRT, my testosterone levels dropped dramatically.

On the first occasion (winter 2022), my testosterone level was 39—without TRT. At the time, I was 60 days into post-recovery chemotherapy. That was when I hiked up a mountain in Montana.

On the second occasion (spring-summer 2023), my testosterone level was 74—again, without TRT. That was when I ran my first half-marathon in Montana.

Since I no longer have testicles, my body can’t produce testosterone on its own. And with my doctor advising against TRT, my body had to rely solely on estrogen—its only remaining endogenous hormone. As a result, I’ve experienced significant changes: hair loss, a softer midsection, smoother skin, frequent hot and cold flashes, blood clots, and a sharp drop in muscular and cardiorespiratory endurance. These effects were worsened by both the chemo and the hormone deficiency. To combat these physical changes, I modified my training approach and adjusted my variables.

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—winter 2022 and again in spring–summer 2023—I went without TRT for 10 months and still made measurable physical progress. It was far from easy, but it was real.

Low, Normal, and High Testosterone Levels

The “normal” range that most labs use to measure naturally occurring testosterone in men—produced by the testes—is typically between 200 and 600. However, some labs use different metrics, which can show a wider range, such as 280 to 1,100.

Now, imagine a man with a natural testosterone level of 500 decides to inject 0.5 cc of testosterone weekly (which adds up to 2 cc, or 2 ml, per month) to boost his physical performance. That’s considered the misuse of testosterone—it’s steroid use. Why? Because this practice artificially elevates his levels far beyond the normal range, often pushing it to 1,500–2,000 or even higher. In this case, he is no longer “natural.”

In contrast, I no longer produce testosterone naturally—my testicles are gone. My adrenal glands provide only a minimal amount, reflected in levels between 39 and 74 when I’m off TRT. Fortunately, with my prostate now stabilized, my primary care physician has allowed me to resume TRT.

Currently, I’m on a modest dosage: 0.5 cc every two weeks (or 1 cc per month). At this dose, my testosterone level holds steady around 253. 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 enhance my physique, and I take pride in that.

Building a strong, muscular body doesn’t require sky-high testosterone. What you truly need 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 best natural testosterone boosters out there.

Yes, testosterone plays a role in increasing 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!

Updated: April 24, 2025