Trenbolone Side Effects: Dangerous or Exaggerated?

Dr George TouliatosDisclaimer: The following article is for educational purposes only and does not promote the use of illegal steroids. If you have any questions or concerns, Dr. Touliatos is currently available for consultation.

Trenbolone is one of the most coveted anabolic steroids among bodybuilders due to its sheer power at building lean muscle mass while simultaneously burning fat (without causing water retention).

Due to its versatility, Trenbolone can be successfully utilized during cutting or bulking cycles, making it one of the most aesthetically pleasing AAS on the market.

Although it may not cause excessive increases in overall weight gain, its ability to add lean muscle tissue is only rivaled by the likes of Dianabol and Anadrol in our experience.

However, as with any drug, if there are notable benefits, there are also equally notable drawbacks, and Trenbolone isn’t an exception.

Trenbolone Acetate may be the most potent steroid on the market for rapidly transforming a user’s physique; however, we have found it to also be among the most harmful (both physiologically and psychologically).

Note: Different esters of Trenbolone (such as acetate and enanthate) will produce the same side effects, as they are essentially the same compound. However, due to the varying length of esters and serum testosterone levels peaking at different speeds, the timing of side effects will occur at different stages.

For example, some of our patients experience side effects very early into a cycle of Trenbolone Acetate, whereas it may take 1-2 weeks later to notice the same level of effects on Enanthate (due to it being a longer ester).

9 Trenbolone Side Effects

1. Cholesterol and Blood Pressure

The most damaging side effects of Trenbolone we see are 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 decrease blood pressure and improve 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 buildup).

Disclosure: We do not accept any form of advertising on Inside Bodybuilding. We monetize our practice via doctor consultations and carefully chosen supplement recommendations, which have given our patients excellent results.

Legal Trenbolone Alternative

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Trenorol is our #1 rated legal Trenbolone product. It replicates the muscle-building and fat-burning effects of Trenbolone, but without any unwanted side effects.

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Trenorol is best suited for weightlifters wanting to add lean muscle mass, whilst simultaneously reducing their body fat percentage.

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 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 that Trenbolone significantly raises progesterone, which is also 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).

AIs 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 lipids.

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 that taking an AI before this point is often unnecessary and will only exacerbate the already serious cardiovascular strain that Trenbolone poses.

Two popular AIs 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 20 mg/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, at 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. Anxiety/Depression

Trenbolone’s side effects aren’t only physical but also mental, with our patients commonly reporting feeling irritable, anxious, paranoid, and depressed (more so than on other steroids).

Such side effects can be linked to Trenbolone having a stimulating effect on the central nervous system, causing an increase in adrenaline output and thus shifting Tren-users into a state of fight or flight mode.

Such a chemical alteration can result in individuals perceiving normal, everyday situations as threats. This has triggered panic attacks and bouts of depression in our patients due to the depletion of serotonin in the brain.

It is unclear why Trenbolone has a more notable stimulating effect than other anabolic steroids. This is one of the reasons why some bodybuilders avoid this steroid for optimal mental well-being.

Trenbolone users may benefit from eating a diet rich in l-tryptophan to help counteract high adrenaline levels. L-tryptophan is an amino acid that has sedative properties (3), helping to calm the nervous system. Not only have we seen this subdue anxiety and depression, but it also helps bodybuilders fall asleep easier and improves their sleep quality on Tren.

Foods high in l-tryptophan are:

  • Whole milk
  • Turkey
  • Chicken
  • Eggs
  • Steak
  • Tuna

All of the above are also high-quality protein sources that will assist with protein synthesis and muscle recovery.

Note: We have found that eating copious amounts of carbohydrates in the same meal as your l-tryptophan food source is important, as carbohydrates deplete all amino acid content in the bloodstream, excluding l-tryptophan. This significantly improves the absorption of l-tryptophan, as there is no longer any competition, thus improving its biological value and sedative effects.

The combination of l-tryptophan and carbohydrates is the reason why so many people take a (seemingly involuntary) nap shortly after annual Thanksgiving meals, being the result of vast amounts of turkey and potatoes.

8. Tren Cough

Trenbolone is notorious for causing respiratory distress, known as ‘Tren cough‘, upon administration. This is essentially 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 Trenbolone.

9. Virilization in Women

We have found Trenbolone to be high-risk for causing virilization side effects in women. These include:

  • Clitoral enlargement
  • Jaw hypertrophy
  • Breast shrinkage
  • Deeper voice

These side effects occur due to Trenbolone’s potent androgenic properties; thus, Tren should be strictly avoided by women who value their femininity. However, we have treated professional female bodybuilders who have been happy to trade this aspect of their physical appearance in order to win competitions.

Yet, there are more suitable steroid options for women wanting to build muscle and burn fat without compromising their sexual characteristics, such as:

These anabolic steroids also produce milder side effects in comparison to Trenbolone, in our experience. Particularly regarding cholesterol and blood pressure levels (4). For more information on suitable steroid options for women, read this article, which references relevant medical research and gives dosing guidelines.


Trenbolone side effects are sometimes inconsistent, with some users experiencing virtually all of the above, while others only experience mild adverse effects.

However, overall, we have found Trenbolone’s side effects to be harsh (5), particularly in relation to the heart and damage to the HPTA.

The severity of side effects will also depend on the dosage and cycle length. A typical Trenbolone cycle consists of dosages ranging from 150–225 mg/week in an 8–10-week cycle. Thus, dosages or cycles exceeding this present additional risk.

It is also important to note that if Trenbolone is stacked with other anabolic steroids, its side effects will be amplified.

tren test mix

Thus, we strongly advise readers not to stack Trenbolone with any compounds that have deleterious effects on cholesterol levels and the heart. These include (but are not limited to): Anadrol, Dianabol, Superdrol, and Winstrol.

Trenbolone is generally only taken by advanced bodybuilders who have built up a tolerance to various anabolic steroids before administering it. This type of ‘caution’ by the bodybuilding community is wise, with our lab results and relevant medical research concerning this compound showing it to be highly toxic.

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