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So bodybuilders need a lot more T than normal to get big. Also, your body adjusts its own T production (from your gonads) to try to maintain a consistent “normal” level in your blood. Therefore, the T you inject does not supplement what your body already produces. It literally replaces the T produced by your gonads, which means they will atrophy and shrink after a while. And guys also have a little bit of E in their blood too, but it’s proportional to your T. So when there is too much T in your body, there is also going to be too much E. Therefore, most guys who take large doses of steroids not only experience gonad atrophy, they also take meds which prevent the conversion into E, and if they don’t it can cause gynechomastia, which is breast tissue development in males.
When trans men or cis men with hypogonadism undergo hormone replacement therapy, they are only taking just enough T to have “normal” male levels of it in their blood. There are still risks, like high red blood cell count for example, but it’s usually manageable.
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