The dangerous consequences of anabolic steroids: ‘I am possibly sterile’

According to a report by the European Commission, 6% of gym-goers in EU member states take anabolic steroids, with the figure rising to 7.9% among men over 18 years of age.

Anabolic steroids are synthetic versions of testosterone. As the US government health department notes, they are officially used at a certain dosage to treat health problems such as disease-related muscle loss, but many fitness lovers, body-builders and athletes take them illegally and without medical supervision in much higher doses (10 to 100 times more concentrated than in medical doses) to build muscle and improve sports performance.

The drugs are popularly known as “cycles” because they are usually taken over a specific period of time, between 8 and 12 weeks, which is then followed by a period of rest and readjustment. Of the hundreds of variants that exist, users often combine two or more types of steroids. Some are taken orally; the most effective are injectable.

The trend is inspired by the physical idea of a very muscular and fat-free body, such as those often seen in Hollywood blockbusters, which are credited with spreading the dangerous idea that such a body can be achieved by anyone by putting in the work at the gym along with an eating plan and schedule of supplements.

Zac Efron, for example, warned the public that the physique he achieved in Baywatch (2017) was not realistic or healthy, and Mickey Rourke confessed that he had taken steroids as part of his training for The Wrestler (2008). Kumail Nanjiani gained about 12 kilos of muscle in less than a year to become a Marvel superhero in Eternals (2021), usually an impossible achievement in such a short time.

Warnings from the stars have not stopped men trying to emulate the rippled bodies they see on screen, and often in the shortest time possible. According to Aida Natalia Arranz Guerrero, a resident doctor at the Family and Community Medicine Center in Granada (Spain), the reasons for these efforts are both aesthetic and competitive.

“Anabolic steroids can lead you to achieve the same results as exercise” without having to wait, explains Arranz, adding that use often spreads through word of mouth at the gym.

“[The gym is] a very visual world in which people are constantly comparing themselves.”

One gymgoer will recommend the steroids to another, and usage will begin often “without having any idea of the effect they can have on the body.”

“You can see who’s doing it”

César, who prefers not to provide his real name to EL PAÍS, works in a gym in Madrid and admits that it is easy to guess who is using anabolic steroids.

People hide it more now, he says. “It’s a taboo subject. But you can see who’s doing it, you see the results, people talk.”

César said he used the drugs for many years because he wanted to bulk up and felt he could not achieve his goal with diet and exercise alone.

Nacho, a young man in his thirties from Madrid, says he has been taking the drugs for about five years. He explains the process of deciding to try them: “You start going out and see the physical competition that exists, so you go to the gym. But results are very slow to appear, so you get curious and look for information.”

Nacho went online to research steroids; even reading up on clinical trials and scientific publications which he was able to access through his work in the pharmaceutical industry. Once he decided to take the plunge, the substances were easy to get hold of: “Everything is on the internet. [There’s] no need to go to the dark web.”

Juan took his first cycle of anabolic steroids at the age of 48. “I wanted to be strong, but I also worked as a DJ, dancing during my sessions, and wanted to look good in front of the public,” he says.

He said he achieved “a great appearance” in three months with two cycles, remembering it as a joyful time where he felt great vitality, though he also experienced restlessness and irritability and did not sleep as well. He is pausing before considering a third cycle, as he is concerned about the impact on his health, at his age. Further, “when you finish [a cycle], the body returns to its natural state and you notice a strong mood drop,” he notes.

Nacho explains his cocktail, which he adjusts depending on the latest research and the intended effects. The basic ingredient is testosterone, he says, “then there is Boldenone, Deca, Winstrol…”. These are ‘dry steroids’, which, he says, create muscle with less fluid retention – less bulk, but longer-lasting muscle. (Liquid steroids result in the fuller, thicker type of muscle we have come to associate with the use of cycles).

César also says he used Deca and Winstrol, as well as Primobolan and Testex. He describes a process where “first you gain a lot” of muscle, “and then it dries up.”

The effects are visible for a limited time which causes many to end up doing it regularly, often to detrimental effects on their health.

Many types of anabolic steroids only exist on the black market, but some of the drugs being used by these body-builders are legal - prescribed for conditions such as anorexia, growth problems, and endometriosis.

A representative of the Spanish Agency for Medicines and Health Products (AEMPS in its Spanish acronym) told EL PAÍS that these include “other hormonal anabolic substances such as nandrolone, growth hormones such as somatropin, insulins, adrenergic agonists such as Clenbuterol and other drugs used to counteract some adverse effects: anticancer drugs, drugs for the treatment of erectile dysfunction or liver protectors.” In these cases, cycle guidelines are designed to avoid long-term effects.

Nacho says the syringes that he uses to inject the cycles range in cost between €200 ($207) and €500 ($507), with shipping costs, and the price can go up a lot.

A more elaborate program with three cycles and a staggered intake can go up to 12 or 16 weeks instead of eight, he explains, with the price rising accordingly.

“The more sophisticated the substances, the more expensive.”

Juan says that, while he balked at injecting himself, he ultimately chose this mode of entry instead of taking the drugs in tablet form.

“Pills are worse for the liver,” he said, adding that the pills approach is also high-volume: “You start with a few but end up with days in which you have to take more than 20.”

“A serious health risk”

The AEMPS says the consumption of unauthorized medicines, or those obtained through illegal channels, presents “a serious health risk” as these substances “lack quality, safety and efficacy.” The agency provides advice to legal authorities on the fight against the distribution of illegal substances, and has managed to close down some internet channels that sell them.

To be sure, the accessibility and use of these substances increased after the first years of the Covid-19 pandemic in Spain, especially among young men. According to the Spanish National Police, use has grown by 20% since March 2020. The AEMPS has also noted an uptick in the traffic of anabolic steroids across borders.

As the practice of illegal substance use remains taboo in wider society, in certain circles young men are actively advocating for it, presenting arguments such as this one, from one @socalben in 2020: “If steroids aren’t allowed in sports, makeup shouldn’t be allowed in beauty pageants,” the TikTok user said to his more than 20,000 followers.

Another user named Ben, @ben.dunn, with 500,000 followers, writes that “taking PEDs [performance-enhancing drugs] is a personal decision that has too much stigma attached to it.”

Notably, according to a recent study, 70% of people who take anabolic steroids are aware of their adverse effects.

“The most common side effects are the mildest,” says doctor Arranz. They include “acne, sexual dysfunction, breast development in men, stretch marks, and pain where the injection occurs.”

“But then there are the serious ones”, adds Arranz. These, she says, are most likely to occur when a person injects hormones or anabolics in large doses, very often and/or during long periods of time,” such as over five or six months without a break.”

As the AEMPS notes, many of these serious effects are sometimes irreversible: hepatitis, liver cancer, stroke, heart attack, thrombosis, atherosclerosis, severe acne, thyroid disorders, overdevelopment of breast tissue or erection difficulty.

“A couple of marbles”

Some of the less desirable effects of using cycles are related to behavior.

“It changes your character completely, you become aggressive,” says César. “All you can think about is training, training and training. Your sex life is reduced, everything is reduced, you put yourself into a bubble and end up bursting.”

Each substance has its own risks. For example, trenbolone, as Nacho discovered, can create heightened, irrepressible sexual desires,. The use of anabolic steroids has also been associated with psychological disorders such as depression and psychotic episodes, leading to suicide in some cases.

“It’s true,” says doctor Arranz, “that testosterone improves mood, helps against depression, muscle fatigue or lack of energy.”

“But if it is consumed for a long time or in large doses, violent, manic, narcissistic, histrionic states can also develop.” Suddenly stopping consumption can also result in depression.

One of the most common consequences is the shrinking of the testicles, because the brain, perceiving that there is an excess of testosterone in the blood, stops producing it on its own. Nacho confesses that his are “like a couple of marbles.”

To reverse this phenomenon, it is necessary after a cycle of anabolics to take substances such as human chorionic gonadotrophin, which can resume hormonal production.

That is, “if it resumes,” says Nacho. “I am possibly sterile right now, and irretrievably so.”

Last year, Youtuber Noel Deyzel, a bodybuilder with almost two million followers, posted the video ‘Why I’m honest about my steroid use,’ warning his audience that “many influencers are chasing money and profiting off of vulnerability.”

“It’s too common to see lies for sale of workout and diet plans, even supplements. And when these beginners do buy and apply this advice, most of the time it doesn’t work how they expect,” he said.

Nacho says he does suffer from a certain degree of dependence on the substances, because they produce a sense of well-being and euphoria. His technical knowledge, he says, can work as “a lie that I tell myself,” that he is in total control because he knows precisely how the drugs work. Sometimes he thinks about quitting, but he feels better and looks better when cycling, so, right now, he is “in the thick of it.”

As for César, he says that, simply, “one day I decided to quit.”

“I couldn’t sustain that level of training, and the financial cost was too high.”

He says that in retrospect his steroid use also changed his character and damaged his relationship with his partner. César says he misses the physique he achieved when taking anabolics, and has set out to achieve it through more natural means, even if it takes more time and effort.

“Looking back, I don’t recommend it to anyone. In the long run, all I did was harm my health.”