Everywhere we turn, the male bodies we’re shown are muscular. On TV, in adverts, on social media, we’re bombarded with six-packs and ‘transformed’ bodies. At the same time, the use of anabolic steroids, which increase muscle mass and strength, is rising among young men. Prescribed to treat some illnesses, these steroids are increasingly used by those looking to boost physical performance and pursue the “perfect” body – prompting health warnings over dangerous side effects and addiction.
“We’ve got shows like Love Island and all those kind of images, which I think young men are just as vulnerable to as young women are,” says Ian Hamilton, an addiction researcher from the University of York. “And it’s not just Love Island – young men have got the same access to imagery of young, fit-looking men and the idealised body in the same way that young women do.”
He describes a “levelling up” when it comes to body image concerns among young men and women. “For young women it’s about dieting in a dangerous way and cosmetic surgery, while for young men this [steroid use] is one of the routes they take.”
There tend to be two types of steroid user, says Hamilton. Those who are rigorous (almost clinical) with their regime, supplementing it with exercise and diet; and those who don’t do much exercise or attend to their diet, who likely have some self-esteem issues. This includes adolescent boys with body dysmorphic disorder, who spend much of their time worrying about flaws in their appearance and sometimes turn to steroids to make themselves look bigger.
Anabolic steroids work by mimicking the effects of the male hormone testosterone, providing a shortcut to a muscular physique. A 2014 study estimated that 3.3% of the world’s population and 6.4% of the male population are abusing anabolic steroids. In the UK, where they are a class C drug – it is legal to carry them for personal use, but not to supply them to others unless you are a pharmacist – those aged 16-24 years old are most likely to use them.
According to the Home Office’s 2017/18 Crime Survey, there has been a rise in the use of anabolic steroids among 16 to 59 year olds over the last decade. In contrast, the use of crack cocaine, methadone and amphetamines has fallen.
“It’s a little bit different to what you see with other drugs like MDMA or cocaine,” says Hamilton. “It’s a group of people, particularly young men, who are doing it for a very clear purpose – they’re using it to bulk out body mass and get to an ideal shape very quickly.”
Anabolic steroids can be injected straight into the muscle, taken orally as tablets or rubbed onto the skin as a cream. There are more than 100 varieties of these steroids, according to the Center for Substance Abuse Treatment, but only a limited number have been approved for human or veterinary use.
Roz Gittins, director of pharmacy at Addaction, reports an increase in the number of people reaching out to the drug and alcohol charity for support with image and performance-enhancing drugs, while Dr Samar Mahmood, an NHS GP, says of the 400 patients he sees each month, there are 2-3 who admit to, or he suspects are, taking steroids. Often he can put two and two together based on their appearance and the kinds of symptoms they’re experiencing, he explains.
Dr Mahmood confirms the majority of those patients are male and under the age of 30. Many struggle with erectile dysfunction. “Young men are embarrassed to talk to their friends about it but they will come to the doctor because often the whole reason why they’re using steroids is because they want to look good and have a relationship – and when they do get to that stage they can’t get an erection,” he says. “They do tend to be quite open and speak up about erectile difficulties but socially I suspect it’s not talked about.”
The worry is that more and more men continue to abuse steroids despite actively knowing they have serious side effects. A recent study surveying 550 gym-goers in Russia found 30.4% used steroids. Of these, 70.2% said they were aware of the side effects. Presenting the findings in Lyon, at the European Society of Endocrinology’s annual meeting, the study’s authors raised concerns not only for the health of these men, but for future generations.
Dr Mahmood’s patients tend to be aware of more common issues with steroid abuse such as erectile dysfunction, reduced sperm count and infertility. (One study found men who use steroids have a 90% chance of becoming sterile). “But what people seem less aware of is the other, possibly more serious, stuff – the mental health problems, high cholesterol, risk of blood clots, heart problems and heart attacks,” he adds.
Many drugs – legal or not – come with possible side effects. But with anabolic steroids, they can be substantial. Prolonged use can have a life-limiting impact and a wide range of repercussions in men such as shrunken testicles, baldness, breast development, acne, stomach pain and increased risk of prostrate cancer. In teenagers, anabolic steroids can impact development and growth. Known psychological effects include anger and aggressive behaviour, mood swings, paranoia, manic behaviour and hallucinations or delusions.
Problems that can appear later in life as a result of steroid misuse include heart attack or stroke, liver or kidney problems, high blood pressure, blood clots, fluid retention and high cholesterol.
Hamilton says he suspects a lot of young men are focusing on the short-term rather than long-term risks of steroid use. “Young men are willing to be a bit riskier with their own health at 18 than they are at 38. I think you have a different perception of risk at that age and think that it will be other people that it happens to, not you,” he says.
The addiction expert likens it to trying to talk to an 18-year-old about pensions. “I’m sure you can reel off some of the side effects, but what that actually means to them and whether they act on it is another thing,” he says.
Experts agree that steroids are mainly being bought online or shared between gym members, which means people don’t always know exactly what they’re putting into their bodies. Gittins, from Addaction – which provides free drug testing and injecting equipment – says drugs are often mislabelled and turn out not to be what an individual is expecting. “They may also contain harmful contaminants,” she adds.
The packaging itself can also lull people into a false sense of security, as they arrive neatly boxed or bottled with tamper-proof seals. In comparison, says Hamilton, cocaine might be supplied in a bit of cling film. “Because they’re drugs that are used in medicine they may be seen as safer,” he suggests. “You could have that perception that they’re relatively safe but of course they’re using them in doses that you wouldn’t see used in a therapeutic way [ie. for rheumatoid arthritis].”
Injecting technique is one of Hamilton’s biggest concerns, more so than the side effects of using: “There are well-known problems with injecting any drug, and beyond the risk of things like sharing needles or not using clean equipment [and therefore risking infection or blood borne viruses], there’s the problem of abscesses.” The issue is that young men can’t really go to a peer and ask them how to inject, he adds, which means for a lot of young men, injecting steroids tends to be a solitary activity. And that is where mistakes can happen. “It can be quite nasty,” he continues, “particularly if you feel ashamed when you do develop an abscess and you don’t get help with it.”
Ultimately, Hamilton believes gyms could play a big part in facilitating change. “If they were to all, as an industry, agree on something [an initiative to help tackle steroid misuse] then I think that would help,” he says. Much like with the gambling and alcohol industries, there needs to be a “collective owning up” to the problem on behalf of the industry. “I think they have a central role to play in all this,” he adds.
The Hench Project is one initiative trying to pave change. Founder Aaron Carnahan travels around gyms in the Midlands and works alongside Shropshire Community Health NHS Trust offering expert advice on image and performance-enhancing drugs, including safer alternatives. He also provides free and confidential blood borne virus screening.
But Hamilton warns that what we don’t want is initiatives happening in one area and not another. He said all gyms need to unite to take action and provide signposting to support and more information about the impact of steroids – although whether that happens or not is another story.
“It won’t solve it [steroid misuse] but it will be another way of trying to address the problem,” he says. “And doing it in a supportive way rather than a punitive way, not banning people from the gym but making sure they have access to support.”