November 2018

Risky ‘roids: a glimpse inside the world of steroid use

A common misconception about people who use steroids is that they all want to have enormous muscles.

“It’s not always about being huge,” says social researcher Dr Mair Underwood from the University of Queensland. “Most men who use steroids aren’t looking for a body that is beyond what is achievable naturally, they just want to get there faster and some don’t want to devote their entire life to building muscle.

“Steroids can allow you a little more leniency – you don’t have to be as strict with your diet and training. They allow you to have a more social life, rather than a life of no drinking, no junk food and never skipping gym; a life that’s a little more sociable. However, there are also many who combine steroids with a very strict diet and training to maximise their gains so be careful not to paint all steroid users as people who are looking for an easy journey”.

Mair has been researching men who use steroids for a number of years. She explains that the academic literature places community members into four distinct groups:

  1. Expert users: “These guys are very knowledgeable about the risks and effectiveness of their use.”
  2. Athlete users
  3. Wellbeing users: “These are guys who are using in order to have their testosterone at an optimum level for their own wellbeing.”
  4. YOLO (You Only Live Once) users: “These guys are more likely to combine steroid use with alcohol and other drug use.”

Mair says there’s also a fifth group: men who use steroids to counteract the physical effects of their other drug use. “They might be on ice or heroin and they use steroids so they don’t look like they are on ice or heroin,” Mair says.

Most men who use steroids aren’t looking for a body that is beyond what is achievable naturally, they just want to get there faster and some don’t want to devote their entire life to building muscle.

Dr Mair Underwood

But what exactly are steroids?

Steroids – in this case short for anabolic androgenic steroids (or AAS) – are synthetic variations of the male sex hormone testosterone. The term “anabolic” refers to muscle building and “androgenic” refers to increased male sex characteristics. Generally the goal of taking steroids is to increase muscle mass, but they can also be used for wellbeing reasons and are used by trans men to transition.

When people use steroids they are introducing synthetic testosterone to their body. This results in the body thinking that there is enough testosterone present and stopping natural production of testosterone. People who use steroids will call this “being shut down”, and describe changes in mood, libido and sexual function whilst they are shut down.

People who use steroids usually inject the steroids, but general practitioner Dr Beng Eu from Prahran Market Clinic has recently seen patients who are taking pill steroids.

“In the last six months I’ve started having people coming in using oral steroids again. I haven’t heard of that for 15 years because of the side effects on the liver. We don’t use them medically anymore,” says Beng.

Beng helps patients to monitor the side effects of their steroid use (he doesn’t condone steroid use nor can he prescribe steroids). The potential side effects are many and varied.

“Steroid use increases cholesterol and therefore increases the risk of heart disease in some people, including heart attacks,” Beng says.

“Steroid use can raise blood pressure, it can affect moods and that ranges from some people with some aggression while they are on the steroids to increased anxiety when they are off the steroids.

“There have been reported cases of depression when people come off the steroids, in the ‘off’ cycle. So there are significant mental health issues at the different phases of steroid use.

“There can also be liver issues in particular because of some people using oral steroids – that can affect the liver significantly.”

Side effects can also include kidney disease, severe acne, oily skin and hair, and hair loss. There are also the risks of injecting-related injury and disease.

“Due to the potential side effects of these substances, it is important that people who use performance and image enhancing drugs get medical advice to discuss, monitor and manage appropriately any side effects they may have,” Beng says.

The men Mair interviews for her research are usually expert users and do not see themselves as at risk of blood-borne viruses.

“I have never spoken to a steroid user who has shared a needle or even a vial of steroids. Their use is much more solitary. They are not getting together to get high. They are not using in a social way. There’s no desperation factor,” Mair says.

If the worker mentions blood-borne viruses they may become turned off from engaging with that health service again because they feel that the worker does not understand the nature of their practice.

Dr Mair Underwood

“So they find the [NSP] emphasis on blood-borne viruses stigmatising, they find it degrading. If the worker mentions blood-borne viruses they may become turned off from engaging with that health service again because they feel that the worker does not understand the nature of their practice.”

So what should NSP workers do?

“The guys tell me that they are concerned about bacterial infections, about abscesses and about post-injection pain. They say: ‘We are concerned about preventing injection-related risk; we just don’t want it framed in terms of blood-borne viruses.’

“For the NSP worker, the best thing to do is to frame advice in terms of ‘we want to help you prevent abscess and infection’. The term ‘infection’ includes blood-borne viruses, but you don’t need to specifically mention blood-borne viruses.

“It’s the same sort of advice you would give to help someone prevent blood-borne viruses – swabbing everything, not sharing any injecting equipment, cleaning hands, not re-capping each other’s syringes – you can still give this advice, but give it in the context of bacterial infection, abscess and infection in general.”

NSP workers also need to be aware of a new trend Mair has seen in her research – the use of insulin to boost the impact of the steroids.

“I have noticed an increase in the use of insulin as a performance and image enhancing drug. The insulin is meant to make the steroids more effective,” Mair says.

But there are potentially catastrophic implications of using insulin.

“You can’t overdose on steroids but you can easily overdose on insulin,” Mair explains. “For example if you misunderstand the markings on the syringe, then you can overdose and die.”

Sophie Marcard

Mair’s top tips for NSP workers relating to clients who inject steroids:

  • Encourage clients to stock up with enough of the right kind of equipment. Most prefer a bigger gauge needle for drawing up and a smaller needle for injecting, but remember that people have individual preferences.
  • Remember that the client may also be injecting insulin so may need standard 27g fits.
  • Frame health discussions in terms of preventing injecting related injury and infections, rather than focusing on blood-borne viruses.

Mair’s research community of men who inject steroids (expert users) also have some direct advice for NSP workers:

  • “Don’t judge us.”
  • “Gain our trust before trying to influence us. This can take weeks or months.”
  • “Don’t offer advice that’s not requested. Listen. Ask questions. Learn of our experiences. Get to know us.”
  • “Have a brew, chat, sit, get to know the person, learn our drivers. Don’t focus on what we use.”
  • “Learn more about people who use steroids and steroid use.”

Terms from the world of steroid use: 

  • Cycle on and off: the more traditional way of using steroids. The person injects steroids for a period of 6-12 weeks, then tapers down and has a “break” of no steroids for a period of 6-12 weeks during which post-cycle therapies are often employed to help counter side-effects and restart natural production of testosterone. The logic behind cycling is that is minimises the harm of steroid use as it gives the body a break. Cycling is the traditional way of using steroids, and is more suited to competitive body-builders who want to be at their best for a particular competition date, or those who can handle the fluctuations in appearance and mood that come with the changes in hormone levels caused by cycling on and off.
  • Blast and cruise: a newer way of using steroids. The person first “blasts” by using steroids for 6-12 weeks then tapers down to a dose that is at about the level of testosterone the man would produce naturally. Consumers call this lower dose a “cruise”, “physiological” or “TRT” (testosterone replacement therapy) dose. They stay at this cruise level for another period of 6-12 weeks before ramping up to another “blast”.

Mair says that this type of use suits men who “want to look good all the time” and also want to avoid the negative side effects of coming completely off testosterone, which can include depression, anxiety and low sex drive. The logic behind blasting and cruising is that they minimise the harms caused by the wild fluctuations in hormones that accompany cycling, and that they are more likely to maintain the muscle between blasts (as compared to someone who cycles off completely).

“Stop telling us what size needle to use. There’s no reason to pin with 23g or 25g if we’re not using much. A 27g would be much better and less scar tissue,” – comment from one of Mair Underwood’s research participants.

However, Penington Institute’s project lead Crios O’Mahony disagrees. “A 27g isn’t long enough and you’ll end up with abscesses,” Crios says.

“Steroids need to be injected into muscle. You should never use a needle that is less than 1 inch long. If you do you may end up with an infection.”