Body of evidence?

The Crime Survey for England and Wales estimates that about 60,000 people are using steroids to gain muscle, to become leaner and fitter, or to get stronger. But academics and experts who work with steroid users believe the real figure is much higher – probably in the hundreds of thousands.

Needle-exchange clinics across the UK report that steroids users are a growing group and, in some cases, even exceed other illegal drug-using groups. Recently, Merchants Quay Ireland, the largest needle-exchange clinic in Ireland, reported that during the past two years 50 per cent more people have come to the service for needles and other equipment to inject steroids.

What is even more alarming is that a significant number of young men are consuming a range of performance and image enhancing drugs, including steroids and human growth hormone. While the use of steroids has traditionally been limited to professional athletes, bodybuilders, soldiers and police, it is increasingly becoming a mainstream choice for young men looking to bulk up or lose weight.

A rising number of young people are unhappy with the way they look. Although social pressure to conform to idealised beauty standards is nothing new, the growth of social media sites such as Instagram, Snapchat and Facebook has exacerbated this focus on appearance. Young people spend several hours a day using social media, interacting with and comparing themselves with their peers, often in the pursuit of the perfect profile picture or to increase their number of followers and 'likes'.

While it is widely known that a distorted body image affects many females, there is growing evidence that males are under similar pressure – not to be thin but to be muscular. Television programmes such as Obsessed with my Body and Dying for a Six Pack illustrate that there is a huge growth in male teenage vanity, from boys seeking to “get ripped” in the gym to men having invasive plastic surgery. For instance, the number of men opting for cosmetic surgery has almost doubled in the past decade in the UK, from 2,440 treatments in 2005 to 4,614 in 2015.

There is mounting concern in the UK among healthcare professionals that males suffer from poor body image and its subsequent detrimental effects on health, well-being and confidence. For example, an all-party Parliamentary group on body image reported that there are high levels of body image dissatisfaction among adults and young people in the UK. It is estimated that roughly two-thirds of adults suffer from negative body image and that 34 per cent of adolescent boys have been on a diet to change their body shape or to lose weight.

In the UK and in other countries there is an alarming rise in obsessive weight training, with young men spending large amounts of money on supplements, exhibiting abnormal eating patterns and, for some, even the use of steroids and other image enhancing drugs such as clenbuterol (to lose weight) and melanotan II (tanning agent).

Steroid use can cause major health problems including liver malfunction, heart problems and skin infections. It can cause psychological disturbances too, such as dependence, depression and body-image disorders. Also, in the UK there is evidence of HIV among steroid users, with an HIV prevalence of 1.5% in men who inject steroids, which is comparable to that in those who inject heroin, amphetamine and other street drugs.

Several studies show that steroid users often use other enhancement drugs, such as human growth hormone and weight-loss drugs, and recreational or psychoactive substances, such as cocaine and ecstasy. Mixing drugs can be harmful. For example, taking oral steroids and alcohol can cause liver damage. And, so-called 'roid rage' can be exacerbated by mixing steroids and psychoactive substances, such as cocaine and amphetamine (speed).

Health workers and academics in the UK are urging organisations and politicians to increase help for steroid users. Public Health England has also advised local councils and healthcare professionals to engage more effectively with young men using these substances. But it is difficult to reach this group as they often don’t see themselves as drug users. As such, users, especially younger ones, tend not to use local services because of the stigma of being seen as a drug injector.

To make matters worse, GPs often lack the specialist knowledge to meet the needs of people who use steroids. This forms a significant barrier for users to get the help they need. Instead, they tend to turn to the internet or their friends in the gym for advice.

What is needed are specialist steroid clinics run by local councils. As well as providing needles and syringes, such clinics should also provide education and health checks for steroid users.

There are some prevention and harm-reduction initiatives in the UK, such as the Steroid Educational Toolkit, the SMART method, the Human Enhancement Drug website, Nine Zero Five and several needle exchange clinics that provide such services.

Still, prevention and harm reduction measures lag far behind those for alcohol and other street drugs, not just in the UK but in most countries. The Government needs to address the needs of this rapidly growing drug-using population and include steroid users in health interventions.

First published on The Conversation (theconversation.com). Katinka van de Ven is a lecturer in criminology at Birmingham City University. Kyle J.D. Mulrooney is a PhD Fellow holding a doctorate in cultural and global criminology, at the University of Kent