Anabolic steroids: why do people use them, and what is the science?

Like chiselling ancient Greek statues, some men are trying to sculpt the perfect body using steroids. This dream for some has created a struggle with dependence and may have warped the way the rest of us see the natural male physique.

Anabolic steroids are synthetic hormones which work on the same receptors as the male sex hormone testosterone. They are derived from cholesterol and help with nitrogen retention and production of protein.

They are normally used to increase muscle mass, but they also get rid of fat, have anti-aging properties and cause a quicker recovery from injury.  They also can be addictive and are associated with a range of serious medical conditions.

Despite their use being highlighted by doping scandals in sport and huge body builders like Schwarzenegger, steroids are used mostly as a cosmetic enhancement – allowing men to build more muscle. This is why they are known as a ‘performance and image enhancing drug’ or PIEDs.

“You cannot out compete, out diet, out train someone who is using, and once people start taking steroids and feel that power, it’s very hard to return to what is a regular pace,” said Dr Scott Griffiths – the Co-director, Physical Appearance Research Team at the University of Melbourne.

Although we don’t have any concrete numbers on the number of people in Australia using illegal steroids, we know that the numbers are increasing.

“The 2019 National Drug Strategy Household Survey, for example, showed that lifetime use went from 0.3% in 2001 to 0.8% in 2019,” Dr Katinka van de Ven, Senior Lecturer in Criminology at the University of New England told Cosmos.

“There are other indications within Australia that steroid use is more prevalent than we probably think.”

For example, she tells me, the Australian Needle Syringe Program Survey has showed a significant rise in PIEDs as a proportion of those who inject drugs – from 1% to 1995 to 6% and 2021.

---

Read more: New test for performance-enhancing drug cheats

---

But steroids, like many illegal drugs can have some serious down sides. In the long term, it’s associated with infertility, high blood pressure, artery damage, heart attacks and strokes.

Plus, because of the way steroids work, about a third of users become dependent, or unable to stop. 

With steroids giving people a high influx of artificial testosterone, natural testosterone production is turned off – which is why testicles shrink.

“Basically, your balls go on a holiday,” said van de Ven.

“When men stop using, it can take a while for that natural production to kickstart again – it can take several months in some cases. And in some cases, it even never returns.”

So, when men start coming off anabolic steroids, physical changes from an abundance of testosterone to none will occur. But there’s also the mental and hormonal effects that come from that.

Griffiths work looks at body image, muscle dysmorphia and steroid use in men. He notes that for people with muscle dysmorphia, steroids give them a ‘sense of control’, in a similar way that controlling eating does with anorexia.

Reading interview transcripts, Griffiths would see things like “If I have this on lock, my training, my dieting, etc, then I’d feel like things aren’t spinning out of control. My life is progressing forward, and I’m self-actualizing. And steroids are a necessary part of that,” he told Cosmos.

“Because in part, we lionize people who have bodies that are like that. We think, ‘Oh, that person is in control of themselves, they’ve got their shit together’. We put them on a pedestal. It’s no wonder that people use that as an arbiter of whether or not their life is going well.”

It’s important to note a couple of things here. Firstly, not all anabolic steroid users have muscle dysmorphia and not all users are breaking the law.

Men with low testosterone can be prescribed anabolic steroids by their doctor, while trans men are given anabolic steroids to mimic the natural testosterone that occurs in cis men. Other types of steroids are also used for a range of medical purposes – from asthma to arthritis.

One of the other issues, according to Griffiths is that we’ve become desensitised to what someone on steroids looks like.

Bodies that use steroids are not just huge muscle-bound men. Lean, ‘naturally’ muscled looks can also be achieved using steroids, meaning that many of us are biased to what a natural male body can actually look like.

With so many images – either with steroids or photoshop – of six packs and toned men, our understanding of how quickly people can build up this muscle is also flawed.

“You see this with actors who play Hollywood superheroes as well. There’s a lot of speculation about steroids, and a lot of those transformations simply wouldn’t be possible if steroids weren’t in the picture.”

There’s a number of types of anabolic steroids. Some like dianabol – in bodybuilding circles once called the ‘breakfast of champions’ – are taken orally, while others are injected. Some people will only use one type, while others will use both to try and counteract some of the side effects.

Anabolic steroids that are not prescribed by a doctor are illegal, and in some states are classed as ‘schedule one drugs’ – on the same level as heroin, cocaine, and ice.

For those in gym and fitness settings, van de Ven explains that it’s relatively easy for someone who wanted anabolic steroids without a prescription to access it. Although some steroids are injected through needles, many of the problems that injecting drug users face are different to the ones that steroid users face. For example, there is very little sharing of needles and therefore HIV spread is less of an issue.

Unfortunately, because of these differences, for those that do need help with steroid use, there aren’t a lot of support systems to turn to.

Harm minimisation strategies reduce the potential damage caused from risky activity like drug taking. Harm minimisation does not condone drug use but suggests some strategies can limit the worst outcomes of drug use, like injury or death.

“A lot of people get information from online sources and friends … Although in some instances reliable information is provided, we do see that often the positive sides are being emphasised and potentially some of the adverse effects are ignored or minimised,” says van de Ven.

“A lot of steroid consumers have also experienced stigma and discrimination. When they seek help, basically GPs say, ‘just stop using’ and then send them off.”

van de Ven was one of the researchers involved in creating a GP guide for people who use anabolic steroids for non-medical reasons.

She suggests that including questions about steroid use as part of regular assessment – similar to drugs and alcohol – would avoid missing people who could be taking steroids who aren’t stereotypical users.