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What are the side effects to Tren?

May 8, 2023

1. Cholesterol & Blood Pressure

The most damaging side effect of Trenbolone we see is alterations in cholesterol, causing an increase in cardiovascular strain and left ventricular hypertrophy.

We have seen regular use of Trenbolone, and other anabolic steroids, result in cardiomyopathy (heart disease). Thus, users with a genetic predisposition to cardiovascular implications should avoid Trenbolone.

We do not recommend Trenbolone use. However, should any of our readers choose to go down this route, we have found that regular cardiovascular workouts and 4g/day of fish oil decreases blood pressure and improves blood flow to and from the heart.

Such measures will not completely reverse cardiovascular strain from Trenbolone; however, we find they notably reduce the risk of atherosclerosis (hardening of the arteries).

Trenbolone should not be stacked with any oral steroids, such as Dianabol, Anadrol or Winstrol, due to their devastating effects on cholesterol levels. In our experience, orals are particularly damaging to the heart, as they stimulate hepatic lipase in the liver; an enzyme responsible for decreasing HDL cholesterol (the healthy cholesterol that reduces plaque build-up).

2. Testosterone Suppression

All anabolic steroids will suppress natural testosterone production, as the administration of exogenous testosterone causes the body to cease endogenous production.

Thus, when a person cycles steroids, we see their overall testosterone levels shoot up, but their natural testosterone levels plummet, as the body detects excessive hormone levels.

This causes a transient effect that ultimately leads to a crash post-cycle when Trenbolone injections cease.

Due to the potent nature of Trenbolone, we often see users fully ‘shut down’ post-cycle, due to Tren severely affecting the HPTA. Thus, natural testosterone levels can take several weeks or months to recover back to standard levels, with the duration depending on the dosage taken, length of the cycle and PCT protocol (which can accelerate this recovery period).

During this transition period, where testosterone levels are shut down, our patients have experienced depression, erectile dysfunction, diminished libido, low energy levels and decreased overall well-being.


3. Possible Gynecomastia

Aromatization, or the stimulation of estrogen receptors, will not occur on Trenbolone. Thus, some assume that Trenbolone cannot cause gynecomastia — which is not accurate.

Estrogen is just one female sex hormone that, if high enough, can cause the expansion of female breast tissue in males. We have found Trenbolone significantly raises progesterone, which too is a female hormone responsible for regulating menstrual cycles in women. When raised to excess levels in men, lactation can occur, resulting in puffy nipples and potentially gynecomastia.

Progesterone essentially mimics the effects of high estrogen levels, with progestins having a stimulatory effect on tissue in the mammary glands.

We see this effect worsen if Trenbolone is stacked with estrogenic steroids, such as Dianabol, Testosterone or Anadrol, due to an even greater dominance of female sex hormones and further negative feedback inhibition of testosterone.

Interestingly, we have found anti-estrogens to be effective at preventing the onset of progesterone-induced gynecomastia.

In terms of anti-estrogen options, bodybuilders can opt for AIs (aromatase inhibitors) or SERMs (selective estrogen receptor modulators).

AI’s block the conversion of testosterone into estrogen, which can worsen cholesterol levels. However, SERMs work by directly inhibiting estrogen’s effects in the mammary glands, without affecting aromatization.

The downside to AI’s is that they can worsen blood pressure, as adequate levels of estrogen are needed for healthy cholesterol ratios. Thus, in general, SERMs are a more optimal choice to prevent gynecomastia, as they do not negatively affect blood lips.

However, the two most popular SERMs, Nolvadex and Clomid, should not be taken with Trenbolone, as they can increase progesterone levels — worsening tren-induced gynecomastia in our experience.

Thus, it would be appropriate to have an AI ready, in case the nipples begin to get puffy or swollen. We find taking an AI before this point is often unnecessary and will only exacerbate the already serious cardiovascular strain that Trenbolone poses.

Two popular AI’s that bodybuilders take are Letrozole (Femara) and Anastrozole (Arimidex).


4. Acne Vulgaris

Trenbolone is highly androgenic, which can cause excess sebum production, resulting in oily skin and acne vulgaris.

We have seen sensitive users, who naturally have high levels of sebum production, experience severe cystic acne; which can take the appearance of golf balls under the skin.

We have experienced success with products such as Accutane (Isotretinoin) for clearing up acne in patients on-cycle. Accutane is designed to shrink the sebaceous glands, reducing sebum buildup and thus preventing the pores from blocking.

Research has shown that 20mg/day of Accutane (Isotretinoin) is a highly effective and safe treatment for moderate to severe acne (1). There is also evidence that Isotretinoin possesses long-term effects, helping to prevent acne breakouts in the future.


5. Male Pattern Baldness

Trenbolone possesses one of the highest androgenic ratings of the anabolic steroid family, being: 500.

Such androgenicity is destructive to hair follicles, due to elevated levels of dihydrotestosterone (DHT), causing receding and thinning on the scalp.

DHT causes hair follicle miniaturization and scalp inflammation; however, the severity of shedding and total hair loss will be determined by a person’s genetics.

Anabolic steroids (particularly Trenbolone) will accelerate hair loss if taken frequently over a significant period of time.

AAS taken in the short-term may cause some thinning or recession; however, we find this often reverses post-cycle when DHT levels regulate back to normal.

Note: A few of our patients with strong genetics can take high doses of androgenic steroids (such as Trenbolone) for years and still not experience any notable hair loss. Thus, this side effect is largely determined by genetics.

Bodybuilders sometimes use 5-alpha-reductase inhibitor medications, such as Finasteride, in a bid to block the conversion of testosterone into DHT and thus decrease follicle damage on the scalp.

However, we have seen that reducing DHT levels can have a negative effect on muscle hypertrophy and strength gains during a cycle. Research also suggests that DHT is a superior muscle-building hormone to testosterone (2). This is due to it increasing amino acid uptake and protein synthesis in fast-contracting muscle fibers (whereas testosterone does not).

6. Visceral Fat

Many anabolic steroids burn subcutaneous fat — but increase visceral fat levels.

Subcutaneous fat is what you can see externally, whereas visceral fat surrounds the internal organs under the abdomen (and isn’t visible to the naked eye).

High visceral fat levels can cause a bloated or protruding look to the midsection, even if a person has a low level of subcutaneous body fat. The pregnant belly look that is common among IFBB pro bodybuilders is due to high visceral fat, caused by the administration of estrogenic steroids.

Estrogen causes an increase in visceral fat mass, which is why women typically store more body fat in the abdomen area than men.

Although Trenbolone does not convert to estrogen, we see progesterone mimicking certain effects of estrogen, in relation to body composition. Thus, Tren-users are likely to experience more defined abdominal muscles — albeit at the expense of a potentially more bloated-looking stomach.



7. Tren Cough

Trenbolone is notorious for causing respiratory distress, known as ‘Tren cough‘, upon administration. This essentially is a violent fit of dry coughing, typically lasting several seconds.

Bodybuilders at our clinic have also complained of chest tightness and a metallic taste in their mouths when this occurs.

Although bodybuilders may feel alarmed by this sensation, it is common and not considered dangerous. Our patients report ‘Tren cough’ occurring in approximately 20% of injections.

It is not entirely known why Trenbolone causes severe coughing (more so than other injectable steroids); however, one theory suggests androgenic properties to be the main culprit.

Trenbolone’s potent androgenic nature can cause vasoconstriction, due to the activation of inflammatory lipids, known as prostaglandins.

Vasoconstriction of the bronchus’ muscular wall (in the lungs) may trigger such coughing, immediately upon injection.

Although our patients have also reported coughing following Deca Durabolin or Testosterone injections, it is less common than on Trenbolone.