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Disclaimer: The following article is for educational purposes only and NOT to promote the use of illegal steroids. If you have any questions or concerns, Dr. Touliatos is currently available for consultations.

Trenbolone is one of the most coveted anabolic steroids among bodybuilders, due to its sheer power at building lean muscle mass, whilst simultaneously burning fat (without causing water retention).
Due to its versatility, it 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 rivalled by the likes of dianabol and anadrol.
However, as with any drug, if there are notable benefits, there are also equally notable drawbacks — and trenbolone isn’t the exception.
Trenbolone acetate may be the most potent steroid on the market for rapidly transforming a user’s physique, however it could be argued that it’s also 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 in esters and serum testosterone levels peaking at different speeds; the timing of side effects will occur at different stages.
For example, users will experience side effects sooner during 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).

7 Trenbolone Side Effects
Cholesterol & Blood Pressure
The most damaging side effect of trenbolone is its effects on cholesterol, causing an increase in cardiovascular strain and left ventricular hypertrophy.
Regular use of trenbolone and other anabolic steroids could ultimately result in cardiomyopathy (heart disease), particularly in users with a genetic predisposition to cardiovascular implications.
We do not advise trenbolone-use, however should any of our readers choose to go down this route, it is recommended to perform regular cardiovascular workouts, whilst supplementing with 4g/day of fish oil. This will help to decrease blood pressure and maximize blood flow to and from the heart.
Such measures will not completely reverse cardiovascular strain from trenbolone, however it may help to subdue 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. 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).
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 you cycle steroids your overall testosterone levels shoot up, but your 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, users can expect to be fully ‘shut down’ post-cycle, due to it severely effecting the HPTA axis. 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, users can experience: depression, erectile dysfunction, diminished libido, low energy levels and decreased overall wellbeing.
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. 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.
This effect can worsen if trenbolone is stacked with estrogenic steroids, such as: dianabol, testosterone or anadrol, due to an even greater dominance in female sex hormones, and further negative feedback inhibition of testosterone.
Interestingly, anti-estrogens have shown 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, being Nolvadex and Clomid, should not be taken with trenbolone, as they can increase progesterone levels — worsening tren-induced gynecomastia.
Thus, it would be appropriate to have an AI ready, incase the nipples begin to get puffy or swollen. 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).
Acne Vulgaris
Trenbolone is highly androgenic, which can cause excess sebum production, resulting in oily skin and acne vulgaris.
Some sensitive users, who naturally have high levels of sebum production, can experience severe cystic acne; which can take the appearance of golf balls under the skin.
Some bodybuilders have experienced success with products such as Accutane (Isotretinoin) for clearing up acne 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.
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 result in some thinning or recession; however this often reverses post-cycle when DHT levels regulate back to normal.
Note: if a person has strong genetics, even taking high doses of androgenic steroids (such as trenbolone) for years, may not be enough to cause excessive hair loss.
Bodybuilder 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, reducing DHT levels may also have a negative effect on muscle hypertrophy and strength gains during a cycle, with research suggesting 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).
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, progesterone can mimic certain effects of estrogen, in relation to body composition, thus tren-users are likely to experience more defined abdominals muscles — albeit at the expense of a potentially more bloated looking stomach.
Anxiety/Depression
Trenbolone’s side effects aren’t only physical but also mental, with users commonly reporting feeling increasingly: irritable, anxious, paranoid and depressed (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, triggering panic attacks or bouts of depression due to the depletion of serotonin in the brain.
It is unclear why trenbolone has a more notable stimulating effect than other anabolic steroids, however it 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 on-cycle. L-tryptophan is an amino acid that has sedative properties, helping to calm the nervous system. Not only can this subdue anxiety/depression, but it may also help bodybuilders fall asleep easier and improve their sleep quality.
Foods high in l-tryptophan are:

Whole milk
Turkey
Chicken
Eggs
Steak
Tuna

All of the above are also high quality sources of protein, that will assist with protein synthesis and muscle recovery.
Note: It is important to eat carbohydrates in the same meal as your l-tryptophan food source, 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. This 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 copious amounts of turkey and potatoes.
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.
Users can also experience chest tightness and a metallic taste in their mouth when this occurs.
Although bodybuilders may feel alarmed by this sensation, it is somewhat common and generally not dangerous. Bodybuilders have reported ‘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 its androgenic properties may be the 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 coughing can occur when injecting deca durabolin or testosterone, it is less common than on trenbolone.
Virilization in Women
Trenbolone causes virilization side effects in women, such as:

Clitoral enlargement
Jaw hypertrophy
Breast shrinkage
Deeper voice

These side effects occur due to trenbolone’s potent androgenic properties, thus it should be strictly avoided by women who value their femininity. Pro female bodybuilders however may be happy to trade this aspect of their physical appearance in order to win competitions.
However, 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, particularly in regards to cholesterol and blood pressure. For more information regarding suitable steroid options for women, read this article (which references the relevant medical research and gives dosing guidelines).
Summary
Trenbolone side effects are somewhat strange, in regards to some users experiencing virtually all of the above, whilst others can take it and experience few adverse effects.
However, in general, trenbolone’s side effects should be considered harsh, particularly in relation to the heart and its damage to the HPTA axis.
The severity of side effects will also depend on the dosage and cycle length. A typical trenbolone consists of 150-225mg/week, in a 8-10 week cycle. Thus, dosages or cycles exceeding this, present more risk.
It is also important to note that if trenbolone is stacked with other anabolic steroids, its side effects will be amplified.
Thus, it is strongly advised that users do not 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 the relevant medical research concerning this compound showing it is not to be underestimated.