The ethical issues around anabolic steroid use are more complex, especially when it comes to non-medical use. This is because steroids give users an unfair advantage, which goes against the principles of fair competition. Doctors prescribe TRT to people who have been diagnosed with low testosterone levels, a condition known as hypogonadism. Both TRT and steroids involve the use of testosterone, but the purposes, regulations, and consequences of their use vary significantly. Anabolic steroids are used in much higher doses than TRT to achieve muscle growth and performance enhancement. In this section, we will break down how TRT and steroids are delivered, their frequency, and the importance of medical supervision, especially for TRT. This could lead to continued suppression of LH and FSH levels when employed as PCT, but is assumed by AAS users to aid in recovery of testicular function. Finally, hCG directly stimulates the testes to produce testosterone by binding to the luteinizing hormone/choriogonadotropin receptor (LHCGR) which it shares with LH. HCG is able to directly stimulate the testis to produce testosterone by binding and activating the luteinizing hormone/choriogonadotropin receptor (LHCGR) which it shares with LH. SERMs are capable of negating the negative feedback imposed by estrogens and are therefore commonly used by AAS users to supposedly aid in recovery of testosterone production after an AAS cycle (‘post-cycle therapy’). If the increase indeed is causal, it remains to be determined whether this reflects a true decrease in GFR or whether AAS affect serum cystatin C concentrations by other means. (Likewise, all "androgens" are inherently anabolic.) Indeed, it is likely impossible to fully dissociate anabolic effects from androgenic effects, as both types of effects are mediated by the same signaling receptor, the AR. Norethandrolone was introduced for medical use in 1956, and was quickly followed by numerous similar steroids, for instance nandrolone phenylpropionate in 1959 and stanozolol in 1962. It was the first steroid with a marked and favorable separation of anabolic and androgenic effect to be discovered, and has accordingly been described as the "first anabolic steroid". For example, problem with function of pituitary gland or adrenal glands may lead to reduced testosterone production. As surprising as it may be, women can also be bothered by symptoms of testosterone deficiency. Some men who have a testosterone deficiency have symptoms or conditions related to their low testosterone that will improve when they take testosterone replacement. The testes produces less testosterone, there are fewer signals from the pituitary telling the testes to make testosterone. Among women, perhaps the most common cause of a high testosterone level is polycystic ovary syndrome (PCOS). Having too much naturally-occurring testosterone is not a common problem among men. Designer steroids are AAS that have not been approved and marketed for medical use but have been distributed through the black market. AAS users tend to research the drugs they are taking more than other controlled-substance users;citation needed however, the major sources consulted by steroid users include friends, non-medical handbooks, internet-based forums, blogs, and fitness magazines, which can provide questionable or inaccurate information. Another 2007 study found that 74% of non-medical AAS users had post-secondary degrees and more had completed college and fewer had failed to complete high school than is expected from the general populace.
