Anabolic steroid misuse

Also called Image and performance enhancing drugs, Steroids, IPEDs

Widely used and rarely disclosed. The harms are real, and the person most likely to help is a needle exchange rather than a lecture.

What it is

Misuse of synthetic testosterone derivatives to increase muscle mass and improve appearance or performance.

Use in the UK is substantial and largely hidden, extending well beyond competitive sport into gyms and ordinary workplaces. Users are disproportionately young men, and they very rarely tell a clinician.

The harms are genuine and often not what users expect. Cardiovascular effects include high blood pressure, thickening of the heart muscle, adverse cholesterol changes, and premature heart attack and stroke in young men. Liver injury occurs with oral forms. Gynaecomastia develops as testosterone is converted to oestrogen. Acne, hair loss and stretch marks are common.

**Suppression of the body's own testosterone is the effect most users underestimate.** After a cycle, natural production is shut down, causing profound fatigue, low mood, loss of libido and infertility, and in some men it does not recover, requiring lifelong testosterone replacement. Infertility is a common reason men present, having assumed the effect was temporary.

Mood effects are real: irritability and aggression during use, and depression and suicidal thinking during withdrawal.

Injecting brings infection risk, including HIV and hepatitis, abscesses and nerve injury, and steroid users are now a major group using needle exchanges.

Dependence occurs, and stopping is genuinely difficult.

Signs you might notice

Rapid increase in muscle bulk.

Acne, particularly on the back and shoulders.

Male pattern hair loss.

Breast tissue development in men.

Testicular shrinkage, erectile difficulty, infertility.

Mood change: irritability, aggression, and low mood on stopping.

High blood pressure.

Jaundice, abdominal pain, or dark urine, suggesting liver injury.

In women: deepening voice, facial hair, menstrual disturbance and clitoral enlargement, several of which are irreversible.

Urgent: chest pain, breathlessness, or stroke symptoms in a young person using steroids; jaundice; severe abdominal pain; or a red, hot, painful injection site with fever.

Also: thoughts of suicide during or after withdrawal, which are a recognised risk.

How it can affect day-to-day life

Non-judgemental engagement is what works. Users who expect a lecture do not disclose, and the result is that avoidable harm is missed. Asking directly and without moralising, in the way alcohol and drug use is asked about, gets far more useful answers.

Needle and syringe programmes serve this group and provide equipment, testing and health checks without judgement; many users do not know they can use them.

Blood tests are worth offering: liver function, lipids, blood pressure, full blood count and hormone profile, plus blood-borne virus testing for injectors.

Post-cycle recovery of natural testosterone is not guaranteed, and endocrinology referral is appropriate where it does not return, rather than buying replacement online.

Fertility can recover with specialist treatment in many men, and this is a strong motivator for engagement.

Body image is frequently the driver, and body dysmorphic disorder, particularly muscle dysmorphia, is common in this group and treatable.

Products bought online are frequently counterfeit or contaminated, adding unpredictable harms.

Supporting someone well

Ask directly and without judgement. Nobody discloses to a lecture.

Use a needle and syringe programme for equipment, testing and health checks.

Get blood pressure, lipids, liver function and hormones checked, and blood-borne virus testing if injecting.

Never share needles or vials.

Understand that natural testosterone may not recover, and ask for endocrinology referral rather than self-medicating.

Ask about fertility; specialist treatment often helps.

Take mood changes seriously, particularly low mood and suicidal thinking after stopping.

Ask about muscle dysmorphia and body image; it is often the underlying driver.

Get chest pain, breathlessness or jaundice in a young user assessed urgently.

Where to get help

A GP practice for health checks and referral; endocrinology for hormone problems and fertility.

A local needle and syringe programme, which serves steroid users and is non-judgemental.

999 or A and E for chest pain, stroke symptoms or jaundice.

Talk to Frank for information, and We Are With You for local drug services.