Dianabol (Dbol) has a lower androgenic strength compared to testosterone, but certain side effects can still occur. The drug is an agonist of the androgen receptor (AR), the biological target of androgens like testosterone and dihydrotestosterone (DHT), and has strong anabolic effects and moderate androgenic effects. Side effects of metandienone include symptoms of masculinization like acne, increased hair growth, voice changes, and increased sexual desire, estrogenic effects like fluid retention and breast enlargement, and liver damage. Once endogenous testosterone has been restored, if a user wants to continue taking AAS, we have found hCG to be effective at maintaining fertility in doses of 500 IU every other day. This combination has proven to be successful in treating 44–100% of our male patients suffering from hypogonadism. High doses and longer cycles will cause a more severe suppressing effect. However, we find injectable Dianabol to be less common on the black market, with orals being the more standard form of administration. Some people have reported a notable reduction in liver enzymes after 8 weeks when taking 2 x 1000 mg per day. Dr. Thomas O'Connor, head of our medical team, states, "There is evidence that if you could use these (steroid alternatives), they would be much better than using anabolic steroids." Due to Turinabol being moderately anabolic and not causing water retention, it is often utilized as a cutting steroid to maximize fat burning and retain muscle tissue while in a caloric deficit. Due to Turinabol’s chemical structure, it is often referred to as baby Dianabol in bodybuilding, with it possessing less potent anabolic and androgenic effects than its father compound. This modification meant Turinabol would not replicate Dianabol’s estrogenic effects, and thus dry muscle gains could be experienced without any water retention. This adverse effect on blood lipids is typical when taking any anabolic steroid. However, users should not be complacent and use Turinabol in lengthy cycles beyond 8 weeks, as liver failure and jaundice remain possible. We find that Turinabol’s hepatotoxicity is typically less severe than other oral steroids. Also, since the early 1970s, many female athletes have started taking other virilizing steroids, such as testosterone esters and nandrolone (Deca Durabolin). We have seen Turinabol used as a bulking agent among beginners, helping them to build 15+ pounds of lean muscle; however, such gains in hypertrophy are less pronounced among experienced steroid users. Trenbolone is a powerful steroid, producing large gains in muscularity and strength. Creatine causes considerable water retention (37, 38); therefore, the combination of creatine and Dianabol will cause the body to hold even more fluid. A bodybuilder’s goal when cutting is often to achieve maximum muscle definition and a small waist; thus, Dianabol will counteract this. Furthermore, Dianabol causes significant extracellular water retention, causing bloating and a loss in muscle definition. We have seen users abstain from lifting weights and still see noticeable improvements in body composition (being sedentary) from Dianabol use. If a beginner administers Dianabol in a reasonable dose, being 10–20 mg per day (for men), they will experience notable increases in muscle size and strength. Dianabol can on top carry out a negative role in blood pressure, which can be controlled by controlling water retention in most cases. Such side effects of Dianabol use include acne, accelerated hair loss in those predisposed to male pattern baldness and body hair growth. However, AI’s will be far more effective as they will directly inhibit aromatization and reduce serum estrogen levels. Several of our patients have also developed notable strength increases from Turinabol. Dr. Thomas O’Connor suggests that Turinabol may be more powerful than Anavar but less so than Winstrol in regard to its effects on body composition. Turinabol is not suited for users wanting exceptional results in terms of mass gain, with it only possessing an anabolic rating of 54. Turinabol is not estrogenic due to the 4-chloro alteration of clostebol; thus, it does not typically cause issues in regard to gynecomastia or fluid retention. Clostebol is a weak anabolic steroid used in research and medicine for dermatological purposes (1). The half-life of Dianabol is roughly 3-6 hours; thus, using the highest value (being 6), we can calculate that all of the methandrostenolone will have left the body after 33 hours. You can work out when a drug will leave your body by 5.5 times the half-life. We start these medications as soon as Dianabol has fully left the body. At this dose, we have had women avoid virilization side effects, which are commonly experienced at doses of 10 mg or more per day. Women can experience significant muscle growth on just 2.5–5 mg of Dianabol per day. Psychological symptoms involving decreased well-being contribute to steroid addiction, with 30% of AAS users becoming dependent (20). Low testosterone levels can cause testicular atrophy due to reduced sperm production. However, we find it can take several months for a user’s testosterone levels to return to normal. Injectable Dianabol is an option for those who don’t want to experience liver issues when taking this steroid. Also, milk thistle is generally considered to be safe when taken orally (16), with only a small percentage of people experiencing any side effects. To combat hepatotoxicity, our patients regularly take liver support supplements, such as milk thistle (Silybum marianum).