By Gemma Fraser
Head of content
“How to buy steroids online”.
A five-minute Google search scrolling past the ‘kit only’ sellers and drug information websites, and I’m sitting with 200mg of Trenbolone Enanthate in my online shopping basket.
All that separates us is £46 (plus £7.49 delivery fee) and my unwillingness to supply my personal details to create an account.
As anabolic steroids are Class C drugs, and supplying them carries a maximum sentence of up to 14 years in prison, it’s surprising how easy it is to source them, and it might explain – at least in part – why more and more young fitness enthusiasts are turning to Image and Performance Enhancing Drugs (IPEDs) as a ‘legitimate’ way of increasing muscle mass and improving their athletic performance.
The soaring popularity of weight-loss drugs like Mounjaro and Wegovy, which can result in significant muscle mass loss, is also thought to be driving a desire to bulk up.
The steroid-promoting website looks professional, claims to have more than 8,200 reviews with a respectable 4.9 star average rating, and has friendly pop-ups such as ‘someone in Huddersfield’ has just purchased Testosterone-E.
But while IPEDs are normalised in gyms up and down the country and all across social media – usually accompanied by images of young men with impossibly large biceps – the dangerous side-effects and long-term health risks are not as readily promoted.
Liver and kidney failure, blood clots, high blood pressure, infertility, heart problems, strokes and heart attacks are all associated with steroid use, not to mention the risks associated with drug injection such as damage to veins, and the transmission of blood-borne viruses including HIV.
And then there’s the psychological impact: addiction, depression, aggression, mood changes.
“I think a lot of people who use steroids in this way actually see it as part of a healthy lifestyle, a way of increasing their muscle mass and looking and feeling stronger and fitter”
“The need or tendency to keep using it even in the presence of harmful effects is really a hallmark of addiction,” says Dr Peter McCann, a consultant psychiatrist specialising in addictions.
“But it’s not seen as an addiction. It’s not categorised as that in the diagnostic criteria that we have, and there have been calls for it to be recognised.
“I think a lot of people who use steroids in this way actually see it as part of a healthy lifestyle, a way of increasing their muscle mass and looking and feeling stronger and fitter.
“There’s a culture around that. Social media is a big driver of it, influencers promoting these lifestyles. It’s seen as a lifestyle thing rather than recreational drug abuse.
“A lot of people will try it through someone they’ve spoken to at the gym. It’s also very easy to access online.
“It’s not a criminal offence to buy it or use it, whereas it is to sell it. I think that affects how people view it themselves.”
McCann says he has seen a rise in patients with IPED addictions at Castle Craig, a private residential drug and alcohol rehabilitation centre in the Scottish Borders, where he is medical director.
However, as appears to be the picture across the board, he doesn’t have figures to evidence the rise.
This is partly down to the relatively new prevalence of IPEDs, and also down to the nature of the abuse of these kinds of drugs, with users leading what look to be normal, healthy lives.
And, as McCann alludes to, many users themselves don’t acknowledge their steroid use as problematic.
“I would say it’s sometimes hard to pick up on the exact number because often they’re [combined] with other drug or alcohol addictions,” he explains.
“I often see it combined with cocaine use in particular and so sometimes it’s not actually picked up before admission and it’s something that’s picked up once we start talking to them.
“It’s actually quite rare that we would have someone come in saying ‘I need help for my steroid use’. If they see it as a problem at all, then it would very much be a secondary problem.
“Anecdotally – I don’t have numbers – but I’ve seen an increase in people reporting this as a secondary problem over the last year.”
Most of the UK’s statistics around steroid usage are based on estimates and are not recorded in the same way as other drugs.
UK Anti-Doping (UKAD) published a status report on IPEDs in 2020 highlighting experts’ estimations that the number of individuals using steroids in the UK was close to, and more likely over, one million people.
This figure has been repeated several times – including in the House of Commons – but there remains a worryingly large gap in accurate and valuable evidence showing the scale of the issue, which UKAD has described as a “public health time bomb”.
According to the organisation’s 2020 report, Public Health Wales estimated there were about 350,000 male steroid users aged 16-to-64 who visited needle exchanges across England, Scotland and Wales. But again, this data is outdated and said to be vastly underestimated.
In Scotland, a petition was lodged to Holyrood’s public petitions committee in 2023 to ‘create a national, public information programme to raise awareness of the impacts of steroids, selective androgen receptor modulators, and other performance enhancing drugs’.
It was submitted by Cael Scott, after his friend was admitted to hospital with a ruptured aorta as a result of steroid use.
“When I spoke to him, he was horrified at the severity of the issue, and was unaware of how bad the impacts could be having seen many people at his gym, and fitness influencers online, openly use IPEDs without apparent impact,” Scott’s petition stated.
“This is not an isolated incident. Every time I attend my gym, IPEDs are easily obtained, but information about them is not. Something must change.”
The Scottish Drugs Forum supported the aims of the petition, stating: “A national campaign would raise awareness of risks and potential harms.
“This should be accompanied by the provision of adequate services to reduce harms. For example, the introduction of blood testing and other health checks, such as cardiovascular function, would go some way to identifying and responding to problems experienced by individuals at the earliest stage with evidenced-based tailored responses thereafter.”
Before her death, the then drugs minister Christina McKelvie, in response to the petition, stated: “The Scottish Government’s policy on IPEDs remains that we will continue to support Police Scotland in tackling any criminality and we will continue to support local treatment and recovery services to provide help for people who have been impacted by drugs of any kind, including IPEDs.”
The petition was closed in April this year.
“I was disappointed but it’s kind of what I expected,” Scott tells 1919. “It’s not very high up the political agenda because when you talk about drugs deaths, everyone thinks heroin because we see that.
“So, introducing policies or doing an awareness campaign about steroids, most people will think it’s a very small proportion of people who go to gym who use them, and the main problem is they have ‘roid rage’ or acne. That’s the public perception.
“But actually, if you look over the course of 10 years, it will be about the same number of deaths from steroids as there will be from heroin because there are a lot more steroid users and it’s a long-term harm.”
Again, data to back up the long-term harm is hard to come by, but experts have warned that significant health problems directly linked to prolonged steroid use will surface before long, accentuating the need to address the problem now.
“There are lots of case reports of people developing heart failure, liver problems, you see increased rates of hepatitis and fatty liver and also some neurological cognitive effects as well”
Dr Peter McCann
The UKAD’s 2020 report states: “Given that IPED use has only recently increased across society, there has been no opportunity for the results of longitudinal studies to assess any long-term health impacts.
“However, the evidence case is building. For example, in 2018, the University of Copenhagen published a survey in the Journal of Internal Medicine of more than 500 men who used steroids.
“Over the seven years of the study, mortality rates were three times higher amongst users compared to non-users.
“The survey also showed that the rate of hospital admission was 125 per cent higher amongst users.”
McCann, who has a number of residential patients at Castle Craig receiving treatment for steroid use, elaborates: “There are very significant health risks. It’s an injected drug so it has the risk of shared needles, or transmitting blood-borne viruses.
“Even if you’re using clean needles there’s still significant risks of injection sites, abscesses, infections.
“The products people are buying, they have no idea where they’ve come from. They can be impure – there was one study that showed lots of microbes, lots of bacteria essentially, in some of these products, so they’re not well made so the risk of getting infections is very real.
“Some of them can also have profound effects on cardiovascular system. There are lots of case reports of people developing heart failure, liver problems, you see increased rates of hepatitis and fatty liver and also some neurological cognitive effects as well. Quite a lot of people are reporting issues with memory, paying attention and other cognitive processes.”
The nature of taking IPEDs means it is a long-term commitment; to keep seeing results, you need to keep taking the drug
Cael Scott
The cycle – both literal and metaphorical – is vicious.
“Often, if you dug down into it, there would be signs of dysfunction and issues with moods, and I think people would be getting treatment for things like depression without anyone realising that it’s probably the steroid use that’s driving it,” McCann explains.
“But people can live very normal lives – that’s also one of the reasons it’s seen as kind of OK to do by a lot of young men.
“There are very elaborate routines around it and a kind of pseudo-science that’s very much pushed by social media and lots of people who portray themselves as experts around what combination of different steroids to use, and additional products like non-steroid weight management and muscle-promoting products and supplements, which have very little science behind them, but people will promote them as being credible.
“They really effect your hormonal system in a way that could take a long time to reverse. Usually most of the changes would be reversable, but it can take months, sometimes years.”
The UKDA has made it clear that the use of IPEDs is a “growing public health issue”, but it is one which appears to be largely going under the radar currently.
After spending vast amounts of time researching the issue during his petitions committee bid, Scott firmly believes there will soon come a day when this public health crisis finally manifests in the drug deaths data.
He warns: “This is a ticking time bomb and the ticking is getting louder and collectively we’re ignoring it. But we can’t ignore it forever.”