An increasing number of men – and boys – are using anabolic steroids to change their physique. But how can you spot the signs and help users kick the habit?

More men are becoming dissatisfied with their appearance thanks, in part, to shifting cultural norms and expectations about what is considered to be ‘the body beautiful’. 

Worryingly, as men hit the gym in the hope of transforming their bodies, some are turning to anabolic steroids to achieve the muscle mass and physique they desire. While some believe that taking anabolic steroids will help them become fit and healthy, this isn’t true: taking anabolic steroids is a dangerous drug habit.

Anabolic steroids are manufactured drugs that mimic the effects of the male hormone testosterone. They are usually injected into muscle, but some are available in tablet form, or as creams or gels that are applied to the skin. They have limited medical uses and are not to be confused with corticosteroids, a different type of steroid drug that’s commonly prescribed for a variety of conditions. 

Scale of use

The vast majority of anabolic steroid users inject the drugs, with many doing so at gyms. The Crime Survey for England and Wales estimates that 60,000 people are using steroids to gain muscle, become leaner and fitter or to get stronger, but experts believe the figure to be much higher than this. 

“It is a big underestimate,” says Professor Julien Baker, an expert in steroid use from the University of the West of Scotland. “There are needle exchanges in Cardiff and Glasgow which say they’ve seen a 600 per cent increase for steroid users over 10 years. The real figure is definitely in the hundreds of thousands.”

Public Health England (PHE) says local monitoring shows that steroid users are widespread in some areas – for instance, recent figures from the north of England showed that in 12 out of 14 areas, the use of image and performance enhancing drugs (IPEDs) such as anabolic steroids was reported by more than half of people using needle and syringe programmes (NSPs).

In four of those areas, over 70 per cent of people accessing NSPs were using IPEDs, and in Essex, drugs charity Open Road says that 25 per cent of all first time users are teenagers, with boys as young as 14 taking steroids.

Sarah Wright, chief executive of Open Road, says 47 per cent of those accessing the charity’s needle exchange services are injecting performance enhancing drugs. “We have been seeing an overall increase in year-on-year visits by these service users, with roughly 32 per cent being new to either the service and/or use of steroids,” she says. “However, the total number of people using these drugs will be significantly higher, due to the fact that we as an organisation do not have the data for people only using pharmacies and/or sourcing all their equipment online.”

What the charity has seen, following analysis of a small steroid treatment pilot service within its needle and syringe programme, is a significant increase in steroid users accessing its needle exchange services, equating to one new user each day over the last year.

Accessing steroids

Anabolic steroids are prescription-only, class C drugs that can only be dispensed by pharmacists. It’s not illegal to possess, import or export anabolic steroids for personal use, as long as they’re not posted or delivered by courier or freight service. However, it’s illegal to possess, import or export anabolic steroids if it’s believed people are supplying or selling them. The penalty is an unlimited fine, or even a prison sentence.

Users often obtain their drugs from illicit and poorly-controlled sources and evidence from PHE shows widespread adulteration of anabolic steroids, with many products containing substances and dose strengths different to what is specified on the label, as well as potential bacterial and fungal contamination. 

Sarah says the vast majority of clients accessing Open Road’s needle exchange services disclose sourcing their performance enhancing drugs online and/or through social networks, with users being “rarely concerned” about the origin or quality of the product being purchased.

Health consequences

As prescription-only medicines, if taken without medical advice to increase muscle mass and improve athletic performance, anabolic steroids can cause addiction, as well as serious side effects and potentially dangerous medical conditions, such as high blood pressure or heart attacks.

The physical effects of anabolic steroids in men can include:

• Reduced sperm count
• Infertility
• Shrunken testicles
• Erectile dysfunction
• Baldness
• Breast development
• Increased risk of developing prostate cancer
• Severe acne
• Stomach pain.

In addition, users can develop:

• Heart attack or stroke
• Liver or kidney tumours
• High blood pressure
• Blood clots 
• Fluid retention
• High cholesterol. 

The use of anabolic steroids also has implications for people with diabetes, according to Dan Howarth, head of care at Diabetes UK. “Anabolic steroids cause hunger and can raise metabolism,” he says, “all of which will impact on diabetes management. In addition, they are usually used alongside testosterone, which will increase the risk of sexual dysfunction in people with diabetes.”

There are also psychological effects, such as aggressive or manic behaviour, mood swings, hallucinations and delusions, and if they’re misused by adolescents who haven’t yet had the growth spurt associated with puberty, steroids can cause premature ageing of the bones and restricted growth.

Sarah also points out the psychosocial implications for those using performance enhancing drugs, which have an impact on the users and their families. “Quickly escalating use and potential relationship difficulties as a consequence of mood swings and/or ‘roid rage’ (e.g. domestic violence) serve as reminders of the ripple effect which can be experienced when somebody decides they want to begin using performance enhancing drugs,” she says. “And there is also the financial cost of participating in successive courses – anywhere up to £400 per month. This can impact on a family unit significantly.”

Because anabolic steroids are addictive, users can crave them, require more to get the same effect, and have withdrawal symptoms if they suddenly stop taking them.

As with many medications, the best way to come off anabolic steroids is by gradually reducing the dose. Stopping them suddenly can result in withdrawal symptoms such as depression and apathy, anxiety, lack of concentration, insomnia, anorexia, decreased sex drive, fatigue, headaches, and muscle and joint pain.

Engaging with users

The National Institute for Health and Care Excellence (NICE) has highlighted the importance of engaging with and providing appropriate services for people abusing IPEDs such as anabolic steroids.

Needle and syringe programmes (NSPs) are available, but in its 2015 report Providing effective services for people who use image and performance enhancing drugs, PHE highlighted substantial variability in NSP provision across different areas and services. It found that some IPED users do not engage with local services because of the potential stigma of being seen as a drug injector. Others do not want to mix with people who inject opiates or stimulants. They may also find it difficult to access services because of their own working hours. 

PHE suggests that providing specialist IPED clinics, especially out of hours, may lead to better engagement. Other services integrated or aligned with NSPs could also support improved health outcomes for IPED users. PHE says that offering a range of services and interventions beyond basic needle and syringe provision, such as health checks and dietary advice, may also increase uptake. 

Pharmacy’s role

With the right knowledge, there is support and advice that community pharmacy teams can provide to customers who are using or trying to come off anabolic steroids. This will mainly centre on advising customers to talk to a GP if they think they are addicted to these drugs, and treatment could include referral to a drugs counsellor. 

As many IPED users are known to access the drugs in their local gyms, pharmacy teams could encourage staff at these facilities to be on the lookout for people who need support, or simply encourage staff to place posters or information leaflets in changing rooms to signpost people to local drug treatment and other services. 

PHE says it is also important that pharmacy teams are suitably trained to feel confident engaging with IPED users and to help the users feel confident in receiving their support. For example, if you provide a needle and syringe programme, have you had training on IPED use? 

As essential members of your community’s wider healthcare team, knowing as much as you can about these issues, and being able to address them with IPED users, will enable you to gain their confidence more effectively. This way, you will be better equipped to provide them with vital advice on the significant harm they could be doing to their health with these drugs.

25 per cent of all first time users are teenagers, with boys as young as 14 taking steroids