If you’ve recently browsed fitness content on platforms like Instagram, Facebook, or TikTok, you might have encountered influencers who have used steroids. A recent global meta-analysis suggests that steroid usage among gym-goers varies from 6% to a shocking 29% across different countries.

This statistic might come as a shock. According to Timothy Piatkovski from Griffith University, the landscape of steroid use has evolved over the last decade. Many fitness influencers now present themselves as knowledgeable figures, openly discussing their drug use and advising followers on steroid usage.

“Regrettably, the level of medical knowledge and judgment varies significantly among these influencers,” states Piatkowski.

Influencers’ perceptions of health risks differ greatly, he observes. While some acknowledge the dangers of steroid use, asserting that risks can be managed sensibly, others are more reckless, promoting drugs like trenbolone, which is typically used to prevent muscle wastage in livestock, branding themselves as “Trenfluencers.”

Millions may question whether these substances are actually safe, or if influencers are leading them into perilous situations. What is the truth regarding the dangers associated with steroids? Is there a safer way to use them?

Piatkowski notes that research on the long-term health consequences of steroids is sparse. This is largely due to the mismatch between doses and usage patterns studied by researchers and those employed by actual users. He and his colleagues seek to bridge this gap by collaborating closely with steroid users to create more relevant and realistic studies.

However, this mismatch has already led to some influencers losing faith in mainstream scientific and medical perspectives, prompting users to seek advice from fitness and bodybuilding forums instead. These social media channels have become a major contributor to both the support network and the marketplace in the surge of steroid usage.

Users now have quick access to a range of substances that can be obtained illicitly. This includes oral anabolic steroids known as SARMs (selective androgen receptor modulators) and synthetic human growth hormone, naturally produced by the pituitary gland during adolescence. Collectively, they improve physique and performance, but their mechanisms can vary significantly.

One of the most prevalent substances is anabolic steroids, potent synthetic derivatives of testosterone. A 2022 study estimated that around half a million men and boys in the UK used them for non-medical purposes in the previous year.

Understanding Steroids

To determine whether steroids are safe, one must first grasp their effects on the body. Anabolic androgen steroids work by interacting with hormonal receptors that promote male sexual traits, particularly in muscle and bone tissues. “They aid in muscle growth and are vital for bone development; they guide boys through puberty and literally transform them into men,” explains Channa Jayasena from Imperial College London.

The desired result is evident: a bigger, stronger physique in a shorter timeframe. Medically, some of these substances are prescribed to treat conditions like muscle wasting associated with HIV. At lower doses, investigations suggest that steroids can be well tolerated. However, this is not a strategy commonly employed outside clinical settings.

Non-medical steroid use rarely mimics regulated clinical trials. Many users resort to “stacking” various drugs and alternate between cycles to allow bodily recovery, adopting practices like the “blast and cruise” regimen. Although these methods lack comprehensive scientific scrutiny, influencers often tout them as ways to minimize health risks or achieve effective muscle growth. This could explain why many users turn to influencers and online forums instead of healthcare professionals for advice.

The Risks of Unregulated Use

The temptation to test various drug combinations or follow cycling protocols stems from the belief that such strategies mitigate the adverse effects of anabolic steroids. The best-documented side effect is cardiovascular complications. Anabolic steroids are known to lower levels of high-density lipoproteins, or “good” cholesterol, while raising blood pressure and increasing low-density lipoproteins, known as “bad” cholesterol. This can thicken the heart muscle, potentially leading to cardiomyopathy—severe heart dysfunction and a lethal condition, as noted by Jayasena.

A Danish population study revealed that anabolic steroid users were three times more likely to die than other males during the study’s duration. “It’s akin to cocaine,” asserts Jayasena. Cardiovascular disease and cancer emerged as the most prevalent natural causes of death among these individuals.

Beyond cardiovascular matters, Jayasena highlights that the psychosocial implications of steroid use are significant and well-documented. The term “Roid Rage” encompasses various mental issues including aggression, mania, and mental illness—particularly among individuals consuming high doses. “When observing why steroid users have fatal outcomes, one notes three primary causes: cardiomyopathy, suicide, and aggression,” he notes, suggesting a possible correlation between steroid use and heightened tendencies toward criminal behavior.

This relationship remains contentious, as it’s challenging to differentiate the effects of steroid use from other contributing factors like recreational drug usage or pre-existing mental health issues. Nonetheless, it indicates that discontinuing steroid use may precipitate depression and suicidal thoughts. “The mind becomes lethargic,” explains Jayasena. “The recovery period can extend over months, sometimes even years.”

Research led by Jayasena revealed that nearly 30% of men who ceased steroid use experienced suicidal thoughts and major depression, possibly due to lingering steroid residues in brain areas responsible for emotional regulation. Additional studies indicate that steroids can impair kidney function and elevate cancer risks, although the data is less conclusive and heavily reliant on isolated medical case reports.

Several investigations have demonstrated that some of these health concerns might be reversible. For instance, the liver appears adept at self-repair and can manage lower clinical doses of certain steroids. Conversely, effects like high cholesterol and hypertension can be reversible post-steroid cessation; in contrast, others may require long-term or costly interventions to address, such as mood disorders and infertility.

The most severe repercussions of steroid use tend to be the hardest to treat. Structural alterations in the heart, along with research indicating lasting blood flow impairments to vital organs, is a concern that may linger long after users cease taking steroids.

Seeking “Safer” Steroids

Given the extensive and complex list of potential harms, many users experiment with steroid protocols aimed at risk reduction. This includes altering doses, timing, or combining them with other substances. However, there is a dearth of research examining the safety of these “protocols,” asserts Piatkowski.

One of Jayasena’s studies indicated that post-cycle therapy, where users take medications to restore natural testosterone production following steroid cycles, significantly lowered the risk of suicidal thoughts. Piatkowski’s research compares high-dose cycles and gradual tapering, identifying that those following a Blast Cruise approach reported fewer adverse health effects once they stopped using.

High-quality, controlled studies evaluating the effects of recreational steroid use are sparse, often characterized by small sample sizes or case reports that complicate the establishment of causal relationships. The evidence supporting specific protocols is also thin, particularly as patterns of steroid use evolve more rapidly than researchers can track.

“Further longitudinal and cohort studies are essential,” Piatkowski asserts. Such studies track individuals’ health and wellbeing over time, ultimately clarifying real risks and potentially providing strategies for risk mitigation. Nevertheless, in the absence of robust evidence, healthcare providers often struggle to offer guidance to steroid users.

Greg James, a clinician at Kratos Medical in Cardiff, UK, mentions that he provides private health and blood testing services. Some patients even inquire about combining steroids with GLP-1 drugs that suppress appetite, as well as other peptides that regulate hunger. “They ask me if these peptides are safe,” James notes. “And I respond that I cannot confirm their safety due to the lack of long-term data.”

Researchers like Piatkowski are beginning to directly engage with users in realistic settings, navigating the challenges posed by inadequate clinical data and rapidly changing user behaviors. Rather than viewing users as patients or outliers, this method considers them as valuable sources of real-life experience, contributing to the development of more relevant and realistic research.

A recent study conducted by Piatkowski and collaborators examined steroid samples from users, revealing that over 20% were contaminated with toxic substances such as lead, arsenic, and mercury. More than half were incorrectly administered, meaning users may have been taking far more potent agents intended for livestock use.

Another study involving interviews with diverse steroid users identified trenbolone as having the most negative consequences, particularly for psychological and social health. This suggests that focusing on trenbolone as a distinct harmful substance, along with targeted screening and intervention strategies, could be more effective for harm reduction compared to broad-ranging methods.

This open and collaborative methodology in drug research mirrors approaches seen in other recreational drug strategies, like psychedelic research. By engaging with real users, insight can be gained not only into harm reduction techniques but also previously unrecognized medicinal applications.

They may also collaborate with influencers and users to promote safer behaviors, rather than outright condemning drug usage, Piatkowski emphasizes. “Enhancing knowledge within these communities and legalizing information is crucial. It’s an ongoing experimental endeavor. The more we stimulate this discussion, the more we can advance the field.”