Up to 1 million people in the UK are taking anabolic steroids and other image- and performance-enhancing drugs (IPEDs) to change the way they look, public health experts and doctors have said.
This ranges from teenagers seeking the perfect physique to elderly men hoping to hang on to youthful looks.
Research suggests that appearance rather than sporting performance is the reason for a majority of those now using anabolic steroids and other IPEDs.
Q&AAre anabolic steroids illegal?
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Anabolic steroids are class C substances under the Misuse of Drugs Act 1971. There is no possession offence but it is illegal to manufacture, supply or possess/import/export steroids with the intent to supply, without a licence to do so. The maximum penalty is 14 years in prison and/or a heavy fine.
What are the most common IPEDs?
Methandrostenolone (Dianabol or D-Bol) is taken orally.
Testosterone enanthate (Test E) is injected.
Human growth hormones are commonly taken.
Who are the users?
The most common age to begin is between 20 and 24, but users range from 13 to mid-70s. The vast majority are male and in work or fulltime studies.
Why do people take IPEDs?
More than half say they want to change their body shape for image or cosmetic reasons. Some take them to increase chances in bodybuilding competitions, as hormone replacement therapy, to retain youthfulness or increase confidence.
What the possible complications?
Testicular atrophy, change in sex drive, sleep difficulties, aggression, mood swings, acne, injection site pain, depression, hair loss.
Long-term effects may include disease and dysfunction of the liver and both acute and chronic cardiovascular pathologies.
Users are not believed to become physically dependent, but may become hooked on the way the drugs make them look and feel.
75% wait for side effects to go away on their own. 15% of users say they have shared vials, which increases the chances of passing around blood-borne viruses.
Do users take other drugs and drink alcohol?
75% say they consume alcohol and almost half recreational drugs including cannabis, cocaine and ecstasy.
There is growing concern that the desire to conform to a “ripped” male image beloved of people featured in lifestyle magazines and reality television shows is causing tens of thousands of young men to put their long-term health at risk by taking ever more complex cocktails of IPEDs. Many also face complications by mixing steroids with alcohol and drugs such as cocaine.
Police forces and border officials are seeing an increase in the number of underground laboratories “cooking” steroids in the UK and consignments of drugs being imported to the UK from countries where IPEDs can be bought over the counter. The rise of social media has made it easier to swap both information and products.
Josie Smith, the head of the substance misuse programme at Public Health Wales, said there had been extraordinary changes in both the profile of people using IPEDs and the availability of the substances.
In Wales, which has long been seen as a hotspot for steroid use, boys as young as 13 were known to be using IPEDs. “It has become normal and acceptable,” she said. “From a public health perspective there are genuine and very real concerns.”
Just over half of people who use Welsh needle exchanges – where safe drugs equipment is handed out – are steroid users and in some of the southern valleys the proportion is 75%.
Frank Atherton, the chief medical officer for Wales, said steroid use was a significant issue. “It’s something we’re monitoring carefully. It’s a cultural thing. Among some young men there’s a desire to be perceived as bulky and muscly. It’s the message we see from GQ and other magazines.”
Police forces are promising to clamp down on dealers. Commander Simon Bray, the National Police Chiefs’ Council lead for drugs, said: “While the possession of anabolic steroids is not a criminal offence, the sale or distribution of them is and there are significant risks to the health of young people who misuse steroids for non-medical reasons.
“There is also a growing problem of counterfeit and illicit steroids which poses further health risks as they are often produced in environments unfit for the preparation of goods destined for human consumption and without the same safety testing.”
Public Health Wales estimates there are about 350,000 male users aged 16-64 who visit needle exchanges across England, Wales and Scotland. But it points out there are many more who do not use exchanges as well as those who take steroids orally. It also adds that the figure excludes women as well as very young and older IPED users.
The national IPED info report is considered the most in-depth study of usage. Joe Kean, who is the lead recruiter of steroid users for the report, said he was confident there were about 900,000 users in the UK. Kean, who is based in Yorkshire, said users he had worked with included an imam and that members of the emergency services and military were a subgroup that more research needed to be done on.
“None of them see themselves as drug users,” Kean said. “The first thing they say when they arrive at a needle exchange is: ‘I’m not a smackhead.’ If you start mentioning bloodborne viruses and HIV rates they look at you as though you’re an alien that has just landed.
“The evidence is emerging that steroid use will cost the NHS millions. Lads are taking steroids, drinking and taking a bit of coke and they go out feeling hard and manly. Steroids, alcohol and cocaine are the holy trinity for heart issues.”
The Guardian has spoken to several doctors who work closely with users and said they believed there were a million users in the UK.
Dr Aneil Malhotra, a cardiology doctor based at St George’s, University of London and a spokesman for the British Cardiovascular Society, said young people who used steroids could suffer conditions in later life such as high blood pressure, cardiovascular disease and strokes.
He said: “We may well see teenagers and twentysomethings who have repeatedly used steroids presenting with problems in their late 30s, 40s and 50s.
“We need to make people aware of the dangers of steroids. If we don’t it is going to cause extra pressure on the NHS. We need to get out the information so people can make an informed choice.”
Some claim the risks are exaggerated. Tom Maw, a steroid user and trainer who advises on the use of IPEDs, said he believed the media sensationalised their impact and called for more information to be published about how to use them safely.
