Dave is an ordinary office worker in the north of England. He is about average height for a British man – 5ft 10in – and to catch a glimpse of him between 9am and 5pm, the only hint that his leisure time is spent shattering the natural limits of human growth might be his slightly ill-fitting XXL shirt, or the fact that he sometimes wears women’s trousers, to better accommodate the steep slope between his trim waist and bulging thighs.
But in the videos and photos Dave posts online, to approving comments from other weightlifters (“huge progress 💪💪💪 ”), he is a total beast. His chest looks herculean, and the skin on his legs is pulled so tight that it has ceased to conceal the striated landscape of muscles underneath. Looking at him brings to mind the peeled-back diagrams of an undergraduate anatomy textbook. You can imagine attentive medical students poring over him, admiring the clarity – there the brachioradialis, there the palmaris longus. He looks impossibly strong, and he is. His record deadlift is 250kg, about the weight of three average men.
To get this body, Dave needed two things. First, the discipline to eat well, sleep well and work out intensely four to six times a week. And second, to take steroids. Like most users, he does so in cycles – periods of 8-20 weeks, up to two or three times a year. During his last cycle, in January of this year, he was taking 600mg of testosterone enanthate a week, injected – or pinned, in weightlifting jargon – into his buttock or thigh with a needle, and 40mg of oxandrolone a day, as an oral tablet. He is so far thrilled with the results, and not shy about discussing it. “I wouldn’t say it’s a taboo subject,” he told me. Someone at work recently asked him how he got so big and strong. “I replied simply: ‘steroids’,” he said.
At the end of his cycle, Dave gets blood tests from a private medical lab. These will show his testosterone levels crashing down, and ideally his alanine transaminase, an enzyme that serves as a proxy for liver health, remaining average – indicating that, to the best of his knowledge, his body tolerated the regime well. It is also likely, though harder to measure, that the walls of his heart are thickening, increasing his risk of heart attack. His testicles, freed from their job of producing testosterone by the influx of pharmaceutical chemicals, have partially atrophied, and, at the moment, Dave is injecting small amounts of testosterone every week, to keep his levels in the normal range for a man in his early-30s – a practice that he may have to continue for the rest of his life. He isn’t planning another cycle of steroids anytime soon. But “the temptation is always there”, he told me.
A decade or two ago, it would have been unlikely a white-collar office worker like Dave would have been so seriously into weightlifting, let alone steroids. But over roughly that period, steroid use has become perhaps more widespread than ever before. One early warning, according to Jim McVeigh, a Manchester Metropolitan University addiction researcher, was that workers at needle exchanges were seeing more and more steroid users show up at their services. And the trend appears to be accelerating. In a recent paper, McVeigh and his colleagues estimated that there are about 500,000 men in the UK between the ages of 15-64 who have used steroids in the past year. Joseph Kean, a drug and alcohol services expert who currently works commissioning public health services for Bradford council, believes the number might be double that. “We might have something like 70,000 steroid users coming into needle exchanges alone,” he told me. If the lower estimate is right, there are about as many steroid users as cocaine users among men in that age group. If the higher number is right, steroids are the second-most used illegal drug in the country, after cannabis.
In the UK, steroid possession is not criminalised – although they are illegal to sell – so it may have higher rates of use and disclosure than in other western countries. But it is clear that the steroids boom is not only a UK phenomenon. A study in the US using data going back to the 1980s suggests that up to 4% of men use steroids at some point in their lives. A recent smaller scale study published in 2022 found the rate of steroid use in adolescent boys in Minnesota was almost 7%. An analysis of 187 studies around the world found that in countries where data existed, 6.4% of men and 1.6% of women had used steroids at some point.
Over the past six months, I have spoken with more than 30 steroid users from different walks of life, as well as gym owners, former pro bodybuilders and powerlifters, fitness influencers and people familiar with the dealers who sell these drugs or cook them up in underground labs. What became clear through these conversations was that the values of previously marginal subcultures long associated with steroid use – such as bodybuilding or powerlifting – have increasingly entered the mainstream. They have flourished on social media, at the same time that larger cultural taboos around drugs and medical interventions have faded. The result is that more young men now feel drawn, or pushed, to transcend their natural limits in a way that would have seemed frightening or pathological to previous generations. As one 20-year-old in the West Country taking his first course of steroids told me, he was initially “terrified about the idea of sticking a needle with mostly unknown contents in”. Now, though, it’s as easy “as waking up and making a brew in the morning”.
I also spoke to doctors, scientists and harm-reduction workers who are studying the long-term effects of these drugs, many of which are still poorly understood. Some predict a tsunami of health problems crashing over the current cohort of users in two or three decades, burdening health services with their weak hearts and testicles, and currently only hinted-at cognitive impairments. In 2018 a group of prominent researchers published a review calling steroids a “hidden epidemic”, and a “looming public health threat” in the US. Other experts believe the effects can be managed. But one thing everyone I spoke with agreed on was that steroid use would continue to grow. “It’s not just a certain kind of person, certain region, certain gym,” says McVeigh. “What we have learned is: wherever we look for steroid use, we find it.”
The basic appeal of steroids is easy to understand. They do exactly what they promise to: grow muscles fast. A 2018 review of studies on steroid use concluded that, on average, users ended up with 52% greater strength gains than non-doped control groups. Historically, weightlifting records take off like a shot in the 1960s, when steroids entered widespread use. “It’s not ideal to say this about a drug we’re trying to get people not to use, but steroids do really work,” Kean told me.
For the many men – and smaller number of women – fixated on becoming more muscular, the easy availability of steroids means there is always a “what if?” question in the back of their mind. The 20-year-old man who had just started his first cycle of steroids told me that he had been in the gym less than a year, but felt he wasn’t progressing fast enough, and had begun to suspect his natural testosterone levels were a little low. Another young man in his mid-20s in the home counties told me that he’d been working out for 10 years but “hopped on gear to get more strong and aesthetic than I’d ever been”. There are older men taking steroids as they feel their strength and vitality decline, and teens taking them for a little pump up before a big party holiday abroad.
The majority of what we colloquially call steroids are kinds of synthetic testosterone. Testosterone is the hormone that promotes masculinisation, or the traits we associate with maleness: a deep voice, large muscles, body hair, aggression. On a course of steroids where testosterone levels can be up to 100 times higher than normal, the body’s systems for muscle tissue production and energy generation are thrown into overdrive, allowing a person to lift more weight, recover faster and grow more muscle.
But it isn’t just muscle tissue that responds to testosterone. Overstimulated hair follicles may shut off, causing balding. Red blood cell production increases, thickening the blood and stressing the heart. And because the human body uses testosterone as raw material to make oestrogen, steroids can cause oestrogen levels to spike, leading the body to retain water and grow fatty breast tissue. “Big muscles, a big heart and big boobs,” says Wiebke Arlt, an endocrinologist at the University of Birmingham. “Maybe not the intended result.”
What makes these side-effects so complicated and unpredictable is that steroid users are taking a huge range of chemical compounds that mimic testosterone, but aren’t as well understood. One of the best-known is metandienone, or Dianabol, colloquially called Dbol, which was developed by the American physician John Ziegler in the mid-20th century to give to weightlifters, including the American Olympic squad. Because it was tested on humans and in academic laboratories, it is generally accepted that the chemical structure of Dbol is very good at activating muscle growth, and very poor at converting into compounds like oestrogen, thus reducing side-effects. Doctors and endocrinologists I spoke with broadly agreed that Dbol acted as most users assumed it did.
Another popular steroid is trenbolone, or “tren”. But we know less about what exactly tren is doing in the body, because since its invention in the 1960s it has never been officially studied for human use. It is a livestock drug, used to fatten up cattle. Much of the best available information on its effects has been compiled over the years by users. The strength coach and podcaster Scott McNally described tren to me as “a very harsh compound, once reserved for the hardest core of bodybuilders”. One older bodybuilder described it to me as like “a steroid on steroids”. It can lead to immense strength gains, but also low moods, insomnia, acne and a strange but well-documented phenomenon known as “tren cough”, a fit of coughing immediately after injection of the drug.
This corpus of knowledge was once limited to personal conversations and pamphlets passed around gyms. Today, it is available to everyone. Instagram and TikTok are awash with memes about taking tren – there are two famous influencers with more than 1 million followers named “the Tren Twins” (although they claim that they do not use tren). On YouTube and message boards there are more detailed and serious discussions about how to tweak a course of steroids for the best and safest results – generally led by people who have been taking them a long time. The tone of the advice is often supremely confident, and it is easy to start to believe that these committed amateur muscle-scientists really do have steroids figured out.
But that isn’t really the case. These community-compiled resources are often “very impressive”, says Channa Jayasena, an endocrinologist at Imperial College London, but the bottom line is that “most of these compounds were never approved for people, so scientifically we are very in the dark”. Steroids themselves are complex enough, but many people also source black-market versions of prescription oestrogen blockers to reduce side-effects, as well as gonad-stimulating drugs like human chorionic gonadotrophin in an effort to restart testicles and improve fertility.
This, says Jayasena, is perfectly logical – using one drug’s intended effect to block another – but it’s not actually very scientific. There are no studies about these methods, no knowledge of the strange and unexpected ways multiple drugs might interact in the body, and no doctor would recommend the approach. There are too many unknowns. No doctor or scientist I spoke with wanted to hazard a serious guess about what caused “tren cough”, either.
There was a time when sourcing trenbolone, or the horse steroid boldenone, or any number of performance-enhancing drugs, required initiation into the inner sanctum of bodybuilding culture. “Even a decade or so ago, you really had to know a guy, in a gym, and you had to be trusted,” says Tim Piatkowski, a drug researcher at Griffith University in Australia. Nick Gibbs, a Northumbria University criminologist who has written a book about the evolution of steroid markets, noted that this put a hard limit on who could get steroids. “I wouldn’t be able to approach those kind of networks. I’m too small, I don’t look the part,” he said.
That’s all changed now that steroid sales have moved online. It took no more than 20 minutes of research to find Instagram, TikTok and Telegram accounts that offered to send me an eight-week cycle of testosterone, tren, and the syringes I’d need to administer them, all for a bank transfer of about £150. It was even easier to find a website that offered a full pharmacopoeia of steroids and related compounds, to ship to my home in the UK (or US, when I asked their extremely helpful WhatsApp customer service line).
The consensus on bodybuilding forums, and among most of the steroid users I spoke to, was that aside from the odd scammer, these dealers are generally trustworthy. Popular suppliers have been active for years and have thousands of satisfied customers. Most of what we know about the actual scale and authenticity of illegal steroids comes from border police. A 2017 analysis of 1,200 different steroids and related chemicals seized at the Swiss border found that “less than 20% of the products contained the claimed substance in the respective amount”. But research by Gibbs, the criminologist, suggests that in the UK the majority of steroids – one of his sources put the number at 80-90% – are manufactured domestically in underground laboratories, using legal chemical precursors, often imported from China or India. This is a vast network supplying hundreds of thousands of users, almost completely invisible to the law.
As steroids have become more widely available, the kind of person who takes them has changed. Jon Findlay, national harm reduction lead for the drug treatment charity Humankind, told me that he and his colleagues had found that “the average steroid user is now younger – in their 20s or even teens – and more naive. Not a bodybuilder who is monitoring his bloodwork and taking care, but a kid who might barely even work out.” I heard the same from several outreach workers. (As far as I could tell, this shift mostly involved men – with women who use steroids generally still being committed strength athletes.)
Most of the older steroid users I spoke with noted this shift, too, and disapproved of it. Steve Gardener, a 59-year-old former grip-strength champion based in Wales, who has used steroids, and hosts an advice podcast, told me that he would “never tell a kid to take steroids. Even up to 25 is too early. You need physical maturity, and emotional maturity.” Most people, he said, simply weren’t dedicated enough to make the risk of steroids worth it. “I see it all the time, the majority of people come to the gym and stick with it for two, three years, max. Then they’re gone, on to a job or marriage or whatever else in life, and they never come back,” he said. “So you risk fucking up your health for nothing. What’s the point?”
But norms like this can’t be enforced once steroids are no longer confined to a subculture of strength-sport enthusiasts. And this leap into the mainstream is visible everywhere. Earlier this year, at the Arnold Sports festival UK – a bodybuilding and strength sports convention – I spoke to a group of young men in their early 20s from Belfast. One was a powerlifter who attended competitions. He was noticeably stacked, and in the valley between his pectoral and deltoid muscles were puckered red stretch marks, from growing so fast. He told me that he was on synthetic testosterone and Dbol. His friend was just a regular gym goer who didn’t compete in anything. But he, too, was on a high dose of synthetic testosterone, looking to give his body “a kick into gear”.
Many of the young men I spoke to felt surrounded by signals that a muscular body was what they needed. They had noticed that celebrities, from movie stars to the sexed-up randos on reality shows such as Love Island, had got more muscular, though no one I talked to wanted to emulate a movie star exactly, let alone go on reality TV. The idea that “muscles get you girls” came up often, although most men I spoke to acknowledged that only a small subset of women prefer a mammothly muscular body. Many mentioned social media, where they saw constant images of successful muscular men – friends they knew and influencers they didn’t – which had, in some small way, made them feel bad about themselves. Many had got into weightlifting or fitness in order to feel better, and yet they often felt as if they were falling behind, or not achieving the milestones – “gains” in muscle or strength – that they should. Steroids, they hoped, would help.
The desire for this kind of body is relatively recent. In her 1999 book, The Male Body, the feminist social critic Susan Bordo noted that in the preceding decade, advertising and mass culture had become fixated on a kind of male body – muscular, athletic, often nearly nude – that hadn’t been considered ideal or attainable for much of the modern era. The erosion of mid-20th-century social hierarchies had weakened the traditional connection between body type and social position: the plump office manager versus the muscled factory worker, for example. Free of such associations, people were beginning to see their bodies as a representation of their identity or self. In this new reality, Bordo realised that the inescapable gaze of mass consumer culture would soon have the same shame-making effect on men as it did on women. “I never dreamed that equality would move in the direction of men worrying more about their looks rather than women worrying less,” she lamented.
Almost everyone I spoke to mentioned influencers. Strength training is huge on social media, and plenty of influencers have no truck with steroids. Some of today’s muscle-bound internet stars are what you might expect: brash, alpha types here to shout you into shape. But there are influencers for every audience. “If you want someone to drone on about studies and citations, you got it,” says Mike “Dr Mike” Israetel, a sports scientist and bodybuilder whose YouTube channel has 1.8 million subscribers. “You want someone to be super relatable and cool and not make you think too hard, you got it, too.” There are strength influencers for Asian moms, and ones for craft-beer nerds. Among the most popular at the moment are the Joe-Rogan adjacent, self-optimisation-obsessed More Plates More Dates channel, with 2 million YouTube subscribers, and Joey Swoll, a relentlessly positive himbo sort whose main non-lifting shtick is calling out instances of cyberbullying for his 4.4 million Instagram followers.
But the current king – and the person most mentioned by young men I spoke with – is Sam Sulek, a 22-year-old Ohian with 5.7 million Instagram followers. Sulek is a slab of pure lean meat with an 80s-rocker shag of black hair, and an affable style: plainspoken, no histrionics, lots of warm eye contact. When I asked people what they liked about Sulek they cited his humility and the way he seemed like an ordinary person. He shoots his videos in what appears to be a suburban family fitness centre. Indeed, Sulek is perhaps the perfect example of an influencer: in every way normal and relatable – someone like you, or someone you know – except for one almost unbelievably extreme quality, in this case being perhaps the most muscular person I’ve ever seen. (I stood near Sulek in a washroom at Arnold UK, and the width of his shoulders and back made taking a position at the urinal next to him essentially impossible.)
Sulek has stated that he does not use steroids, but his most famous predecessor, Arnold Schwarzenegger, has admitted to doing so in the past. In a 2017 paper on the history of gym culture, the sociologists Jesper Andreasson and Thomas Johansson note that Schwarzenegger didn’t just introduce bodybuilding to mainstream culture, he also pioneered a punishing, steroidal, aesthetically extreme version of it, and made the mainstream culture more aesthetically extreme as a result. (Last year, Schwarzenegger gave an interview to Men’s Health warning of the dangers of steroids.)
There isn’t a single influencer with the thousand-watt charisma of a young Schwarzenegger – an actual movie star – but there are hundreds who are just as large and steroidal, and en masse, once your algorithm has realised you want to see big guys, you are going to see a lot of big guys. The result is a now-familiar online dynamic, where what was once extreme comes to seem normal, and what is genuinely normal can come to feel inadequate.
Millions of people are now saturated in the previously niche world of “gains”, “hypertrophy” (muscle growth), nutrition, recovery and its attendant values. And while working out is generally a healthy activity, a mind-boggling amount of the online culture around it is anything but. Only a handful of strength training influencers actually admit to using steroids, the rest avowedly do not. But the reason that so many influencers need to spell out that they do not use steroids is that the wider community is obsessed with them. The question of “natty or not” – is your body natural, or not – is posed in comments, and discussed on endless podcasts, YouTube videos and internet forums.
Jesse James West, a 24-year-old American strength influencer with 4 million YouTube subscribers, told me that he receives hundreds of comments and direct messages about whether he uses steroids, and even small fluctuations in his weight are dissected on forums like Reddit’s 175,000-member “nattyorjuice” message board. West is, in fact, natty, and in several recent videos, he has highlighted what he calls the fitness industry’s “steroid epidemic”, by interviewing bodybuilders and dealers. “We can say ‘don’t blast tren!’, but it would be even better to be honest about the fact people use, and not present a false image,” he told me.
West’s online persona is more that of a class-clown than an ubermensch, but he isn’t under any illusion about the power he has. “Influencers have to realise how much influence they actually have. There are people out there who will literally do what you tell them.”
There was, in all my conversations, a resignation that steroid use was only going to grow over the coming years. If that’s right, it will make understanding the long-term consequences “incredibly urgent”, says Findlay, the harm-reduction expert. “The question for us really, in medicine, is not why people are using, but what exactly the dangers are,” says Jayasena, the Imperial College endocrinologist. “A very rigorous study in Denmark showed us that over a decade, your overall chance of death taking steroids triples versus non users. That’s about the same risk as cocaine, but less than a third of heroin use,” he told me.
The basic medical consensus is that during the period when steroids are being taken, the risks are high. A study in Australia in 2020 showed that while taking steroids affected basic heart functions, after steroid use had ceased, the heart appeared to rebound, recovering over the course of a year or more. This is less true of the testicles. While many men will regain the ability to produce their own testosterone – and make viable sperm – for some, “it simply never comes back, and we’re not sure why”, says Jayasena.
Testosterone also has a potent effect on the mind. On this, I found there was a stark split between novice steroid users and veterans. Younger, or first-time users were often thrilled with the psychological benefits: “You’re the alpha everywhere you go. Confident, dominant and at times intimidating. You feel like you command respect. It’s wild,” the young man from the home counties told me. Older users tended to lament the side-effects. “One of my coaches used to call it ‘the burden’,” said Mike Istraetel, referring to the long-term feelings of deadened emotion, anxiety and the dips in mood that accompany cycles of steroid use. Israetel has been open in his videos about his own use, and often begins those discussions with the statement: “Steroids are not fun.” Another thing he said, echoing many other older men I spoke to, was that “steroids make you stupid”, citing deficiencies in memory and reasoning that come with regular use.
Astrid Kristine Bjørnebekk, a psychiatrist at Oslo university hospital in Norway, conducted one of the first large-scale studies on the effects of steroids on the brain. Her team scanned the brains of more than 80 people who had used steroids for at least a year, and compared the scans with non-steroid users. (To ensure the control group led a similar gym-based lifestyle to the steroid users, Bjørnebekk only included men who could bench press at least 225lbs.) They found that the steroid users had on average, smaller brain volume and significant reductions in grey matter. “It is not one small region being affected,” says Bjørnebekk. “It is the whole brain.”
In the short term, how should states deal with the growing number of steroid users? Starting in the late 2000s, Denmark and Sweden, along with the Netherlands and Belgium, took a hardline approach. According to April Henning, a professor of sports science at the University of Stirling, a combination of the Olympic steroid scandals of the 1980s and 90s, and the “fear that steroid users would be a drain on the future public health system” led them to adopt harsh penalties, including jail time, for steroid use.
In Denmark and Sweden, police were given powers to raid gyms at random, and even to stop notably ripped people on the street and demand an immediate urine test. This came to be known as muscle-profiling, or muskelprofiler in Swedish. In 2010, the policy made international news when the American bodybuilder Toney Freeman was detained after an appearance at a sports shop in Sweden, taken to a police station, and reportedly forced to pee in a cup. (Freeman was released the same day and was not charged with any crime.) Alex Danielsson, the former editor of Body magazine in Sweden, told me it created a culture of fear around not just bodybuilding events, but gyms and fitness centres, and had little effect on overall steroid use. A report by a Swedish drugs charity concluded that the number of steroid users in Sweden has likely increased since the 1990s.
With its relatively permissive drugs policy, the UK offers an alternative approach. In early May, I visited one of the longest-running steroid clinics in the country, Sheffield’s Juice clinic, which runs out of an addiction support complex in a commercial building just outside the city centre. John McNeil, an outreach worker with a thatch of blond hair, faded forearm tattoos and warm, commanding manner, has been working with steroid users for nearly two decades. Over that time he has seen the same shift that other needle exchanges around the country have reported: “Then, it was 70% heroin and crack users, 30% steroids. Now, it’s flipped entirely around,” he told me.
The point of the clinic is not to confront people about abusing steroids. “They don’t see themselves as the same as other drug users, they see themselves as much healthier,” said McNeil. And, as a former IV drug user himself, he knows confrontation doesn’t work anyway. The point is to help people be safe, and then encourage them to think about what they’re doing.
On the day I visited, men were waiting outside two GP surgery rooms to get blood tests done, with the promise of a consultation to discuss the results two weeks later. Sitting in on the sessions, I met a tanned, healthy-looking man who buys synthetic testosterone on trips overseas. He was an evangelist for low doses of testosterone, but keen to keep an eye on his health after two years of use. He chatted easily as McNeil expertly slipped a needle into his forearm and drained blood out into three small tubes for testing.
Next, a compact, nervous man who used to take steroids years ago arrived. He said he was thinking about starting a testosterone replacement therapy dose again, bought from a local contact. McNeil told him he would chat about the safest way to inject when the man came back next time for his results. A little later there was a hushed conference among the staff about an active bodybuilder’s bloodwork. His liver results were worrying. It was unlikely to be just the result of steroids, and they wondered if he had been drinking heavily, too.
McNeil and the two nurses working with him did not have special expertise in steroids, but they could offer people a safe place to discuss their worries and monitor their health. Many steroid users told me they’d never talk to a doctor outside an emergency, because doctors had little specialist knowledge about steroids, and they didn’t want to get a moralising lecture and a note on their medical record. But they come to the clinic. Juice has recently had to restrict appointments to Sheffield residents. “We had people driving across the country for us,” McNeil said.
But there are only a handful of these services across the UK, and they can only keep going as long as often-ephemeral public health funding lasts. Kean, in Bradford, said that running a monthly clinic doing bloodwork and basic harm reduction might cost as little as £25,000 a year. But the dream would be something bigger, offering blood testing, psychological wellbeing services, and always accessible. “That takes time and money, though,” he noted, ruefully. Jayasena, the Imperial College endocrinologist, is hoping to create a model for NHS steroid services, but doesn’t know where the funding might come from.
People need some kind of service. When I was speaking to young men, I found them well informed, but also overconfident, in the way that young people are. They assured me that they would beat any negative health consequences, that they would only use steroids “for a little while” and quit while they were ahead. It was hard to believe them. Online, newer steroid users often seem lost: posting on forums asking for help, with little idea of safe dosing or side-effects. The quality of the responses are a matter of pure chance.
One of the last people I chatted to was a 20-year-old from the West Midlands who became depressed and quit in the middle of his second cycle of steroids. He was convinced he had thrown his whole hormone system out of whack for ever. “After I stopped pinning, my mood went down, no motivation and no morning wood, so my testosterone is pretty much messed up at this moment,” he messaged me. He felt awful. “I actually never thought about the reasons why I shouldn’t start steroids. I only looked at the good stuff. I was pretty much blinded by all the progress influencers and people online made on gear,” he said.
People online had been telling him he had been stupid and reckless, which was probably true. Still, he wasn’t dissuaded from taking steroids again. “Taking gear was enjoyable, but coming off it was the fucked-up part, if you get what I mean. I am planning on going back on gear sometime in August to hopefully try to get myself in shape and my testosterone levels back up. If there’s anything else just let me know man,” he wrote to me. He didn’t write again. I checked in a few days later, but he was off to some other corner of the internet, or attending to his real life. He seemed as if he needed a counsellor, or a doctor. I hoped he knew how to find them.
