Anabolic

Steroids
Steroids

A guide for
users & professionals
T
his booklet is designed to provide information about the
use of anabolic steroids and some of the other drugs
that are used in conjunction with them. We have tried
to keep the booklet free from technical jargon but on occasions
it has proven necessary to include some medical, chemical or
biological terminology. I hope that this will not prevent the
information being accessible to all readers. The first section
explaining how steroids work is the most complex, but it gets
easier to understand after that (promise). The booklet is not
intended to encourage anyone to use these drugs but provides
basic information about how they work, how they are used and
the possible consequences of using them.
Anabolic
Steroids

A guide for
users & professionals
Contents
Introduction ......................................................... 7
Formation of Testosterone ...............................................................8
Method of Action ..............................................................................9
How Steroids Work (illustration).......................................................10

Section 1 How Steroids are Used ....................................... 13

What Steroid? ................................................................................ 14
How Much to Use? ......................................................................... 15
Length of Courses? ........................................................................ 15
How Often to Use Steroids? .......................................................... 16

Section 2 Side Effects ......................................................... 17

Skin ..................................................................................................18
Breasts.............................................................................................18
Heart ...............................................................................................19
Fluid Retention.................................................................................19
Side Effects of Anabolic Steroid Use (illustration) ............................20
Aggression .......................................................................................22
Liver Changes..................................................................................22
Sexual Disturbance..........................................................................23
 Bleeding ..........................................................................................24
Hair Loss ..........................................................................................24
Insomnia ..........................................................................................24
Tendon Damage ..............................................................................24
Young People...................................................................................25
Prostate Gland .................................................................................25
Infections .........................................................................................25
Women and Side Effects .................................................................26

Section 3 Other Drugs ......................................................... 27

Human Growth Hormone .................................................................28
Insulin ..............................................................................................29
Insulin Growth Factor 1....................................................................30
Clenbuterol ......................................................................................31
Creatine ...........................................................................................31
Human Chorionic Gonadotrophin (HCG) .........................................31
Tamoxifen ........................................................................................32
Diuretics ...........................................................................................32
Testosterone Precursors ..................................................................33
Legislation .......................................................................................34

Section 4 Drug Profiles ........................................................ 35

Boldenone Undecenoate .................................................................35
Nandrolone Decanoate ....................................................................36
 Methandrostenolone ........................................................................37
Oxandrolone ....................................................................................38
Oxymetholone..................................................................................38
Stanozolol .......................................................................................39
Sustanon 250...................................................................................40
Testosterone Enanthate ...................................................................40
Testosterone Cypionate ...................................................................41
Methenolone Acetate .......................................................................42
Counterfeits and Fakes....................................................................43

Section 5 Intramuscular Injections for Anabolic Steroids 45 ...........................................................................................................................................................................................

Sterile Equipment ............................................................................46

The Correct Equipment....................................................................46
Keep it Clean ...................................................................................47
Drawing up From an Ampoule or Vial ..............................................48
Where to Inject.................................................................................49
Other Sites .......................................................................................50
Pre-injection .....................................................................................51
Injection ...........................................................................................52
Post-injection ...................................................................................53
Complications of Poor Injecting Techniques ....................................54
 ANABOLIC STEROIDS 7
Introduction

Introduction

A
nabolic steroids are basically synthetic
versions of the male hormone testosterone.
They have two main effects on the human
body; an anabolic, or muscle building, effect and an
androgenic, or masculinising, effect. The realisation
that increases in weight and strength can be achieved
by their use led to a widespread use of steroids in
sport and today there is hardly a strength sport in
which anabolic steroids have not been used. Their
availability from illicit sources has made them readily
available and now they are so widespread that they
can be found in most areas where serious training is
being pursued. Nowadays the biggest group of users
are probably non-competitive users whose reason for
use is purely cosmetic.

Anabolic steroids are not the same as corticosteroids

(such as cortisone and prednisolone) which are
medically prescribed to treat asthma and skin “…the biggest group of users are probably non-competitive users whose
disorders or as anti-inflammatories. Corticosteroids reason for use is purely cosmetic…”
8 ANABOLIC STEROIDS
Introduction

have no muscle building or masculinising effects. is formed it is secreted into the blood stream where
Whenever the term steroids is used in this booklet it most of it is bound to protein and is transported in
refers to anabolic steroids. the bound state throughout the body. It is only the
free testosterone that is capable of being biologically
Formation of Testosterone active. Only 1 to 3% of the total testosterone in the
Testosterone is secreted by the testes, the adrenal blood is able to interact with receptors in the tissue
gland, the ovaries and the placenta. It is synthesised targeted for its use.
from cholesterol by a complicated series of steps There is a feed back mechanism to the pituitary,
within the steroid secreting cells. The stimulus which controls the rate of synthesis of the hormone.
to form testosterone comes initially from the This feedback mechanism is controlled by the blood
hypothalamus; an area of the brain where several level of testosterone. As testosterone levels are
hormones are developed which relate to the increased, the secretion of gnrh and as a result,
function of other glands. Luteinising Hormone, is reduced and may be totally
The hypothalamus releases Gonadotrophin Releasing inhibited. This leads to a reduction in production
Hormone (gnrh) which is delivered to the pituitary of the hormone and maintains equilibrium. When
gland by a special group of veins known as the the blood level of testosterone falls, the reverse
portal system. Once delivered there, it causes the occurs and pituitary secretion is increased to restore
pituitary gland to form Luteinising Hormone (lh) balance.
that is released into the blood stream. It is then The total daily production of testosterone in a male
transported to the testis where the Leydig cells form is about 7 mgs per day.
testosterone from the cholesterol that has been
stored there for that purpose. Once the testosterone
 ANABOLIC STEROIDS 9
Introduction

Method of Action protein. This is then released into the cytoplasm of

the cell to perform its action. The characteristics of
The free testosterone in the serum is the only active
the particular cell determine the response. Muscle
part of the hormone. This amount represents about
cells can only produce muscle protein, just as
2% of the total hormone present in the circulation
prostate cells can only make prostate protein as
and its half-life, that is, the time taken to destroy half
a result of steroid use. Differences in the various
of the substance, is 10 minutes.
drugs are due to the effect of excess material being
When testosterone is brought into the cell it is free in the blood and affecting other organs such
firstly converted to 5 alpha di-hydrotestosterone as the brain, where it may cause altered emotional
(DHT) and then the work of the cell can proceed. effects. The receptor numbers in the cell are limited
The next step is the binding of the hormone with and once saturated they cannot combine with extra
an androgen receptor (AR) in the cell to form a material, thus limiting the anabolic effect of large
complex, which can be transported into the nucleus doses or extended courses. This is referred to as
where the important reactions take place to build the refractory phase. As muscle cells hypertrophy,
muscle. There are not separate receptors for oral and the receptor numbers increase slightly but this is
injectable steroids or for different esters. The actual not enough to require large amounts or extended
protein formed depends upon the cell in which the courses for saturation.
reaction is occurring. Thus, irrespective of which
There is evidence that some steroids may bind to
anabolic steroid is used, a muscle cell can only form
more than one receptor. The most frequent one is
muscle protein.
the glucocorticoid receptor and there, the steroid
Once a complex has been formed, the resultant will replace the cortisone like substance usually
substance is then transported into the nucleus present. Corticosteroids have the effect of breaking
where it activates genes to produce the appropriate down tissue and any reduction in this activity is }
continued on page 12
10 ANABOLIC STEROIDS
How Steroids Work

How Steroids Work

The brain sends chemical signals to the testes,
THE BRAIN
instructing them to produce testosterone.
N
BRAI
E
The testes produce testosterone
THE TESTES
and release it into the blood.
TH

Once they have entered the bloodstream,

anabolic
ANABOLICsteroids
STEROIDS act in much the same way
as natural testosterone, adding to that already
produced by the testes.

Testosterone attaches itself to MUSCL

MUSCLE cells
boosting growth.

Testosterone attaches itself to receptors in a

variety of OTHER
otherCELLS
cells causing different effects
around the body.
ES

T
The brain detects the amount of testosterone TES
in the blood through a FEEDBACK
feedback system and
regulates the amount produced.
 ANABOLIC STEROIDS 11
How Steroids Work

ABOLIC STEROID BACK TO B

AN FEED RA
IN

OTHER
CE

LL
S
SCLE
MU
12 ANABOLIC STEROIDS
Introduction

} beneficial in building up the body but, when the the external genitalia before birth. These are the
steroid course is finished, the reverse action occurs androgenic effects of testosterone. At puberty it
and there is an increase in catabolism as a result of leads to the growth of masculine characteristics such
the corticosteroids being taken up by the receptors as increased muscularity, deepening of the voice,
again. This may be one reason for the weight loss that development of the beard and secondary sexual
occurs in some users at the end of the course. features. With the increase in testosterone secretion
at puberty, there is a growth spurt with lengthening
Once the steroid has been metabolised in the
of the long bones and eventually closure of the
nucleus, it is taken from the cell and degraded in
end of these bones, epiphyses. It also increases the
the liver. From here it is excreted in the bile or the
secretion of the sebaceous glands. The other major
urine. The actual excretion products vary from one
effect of testosterone is anabolic and the increased
androgen to another and it is these products that are
muscle growth that this produces. This is the greatest
detected in sports drug testing. Testosterone is rapidly
attraction for athletes.
destroyed by the liver, making the substance useless
as an oral anabolic agent unless it is bound with some To try and develop an ideal anabolic agent without
other radical. For oral use of testosterone, a chemical androgenic effects many changes have been made to
group is added to the molecule to allow absorption the structure of the molecule. This search has gone
from the stomach, enabling the testosterone to on for many years without the desired result. To date,
bypass the liver. This increases the duration of the all steroids have anabolic and androgenic actions.
action of testosterone by allowing more of the active A review of the chemical structure of the common
substance to reach the muscle cells. anabolic steroids shows how similar they all are.

Testosterone is important in the development of

the sexual differentiation and the development of
 ANABOLIC STEROIDS 13
How Steroids Are Used

Section 1: How Steroids are Used

I
f anyone is considering using steroids it is essential to
have an understanding of the potential benefits and
side effects of using them.

It is important that the user should not be unrealistic in

expectations and realise that large and permanent gains
cannot be made in one course. Every athlete is different,
in his or her genetic make-up. Training, diet regulation,
illness and stress determine the response to steroids.

Steroids are generally used in cycles and are often taken

in stacks. Stacking refers to the practice of taking several
drugs simultaneously. This is common among anabolic
steroid users and can also involve the use of drugs other
than steroids. Cycling refers to the pattern of steroid use
where drugs are taken in cycles of a period of weeks
followed by a drug free period.

A major factor is the number and distribution of

androgen receptors in the muscle. There is no universal
pattern of distribution of the receptors but the greater
“Training, diet regulation, illness and stress determine the response
concentration is generally in the upper body, leading to to steroids.”
14 ANABOLIC STEROIDS
How Steroids Are Used

a greater response in the arms than the legs in most, the protein characteristic of the cell. In the case
but not all individuals. The number increases slightly, of muscle cells, that will be muscle protein. This is
as the muscle grows and this may be a reason for the desired result of using the steroid. There is no
some athletes having larger gains with their later doubt that there are differences in the effects of the
course. different steroids when taken in a single dose and
monitored over some weeks. With the testosterone
A weight-training programme will lead to increased
preparations, there are differences in the rate at
strength and an increase in muscle mass. Steroid
which they are taken up from the injection site.
use should not be considered until the athlete has
These differences refer to one dose but steroids
plateaued, that is, there is no more increase in
are not used as a single dose but rather as a series
weight and strength in spite of continued heavy
of doses over a period of time and this invalidates
training before using steroids.
many of the conclusions based on duration of effect
The importance of diet cannot be overemphasised when those assumptions are based on a single dose
and must contain sufficient carbohydrate food to format.
support a training programme. The muscle needs
There is a question of whether to use oral or
protein to grow but it cannot work efficiently
injectable drugs. There is no difference in the overall
without the fuel and this is best provided by
effects if the athlete trains correctly, the route of
carbohydrate foods. Carbohydrate also attracts
administration is not the most important factor.
water into the muscle cell and this results in an
increase in the bulk of the muscle. There are variations in the rate of uptake of different
steroids by the steroid receptors. Once again, this is
What steroid? not an important factor in choosing a steroid as they
All steroids produce the same result at the end of a are used over a period and any gain that one may
course. They stimulate the cell nucleus to produce have on the first dose is insignificant when a course
 ANABOLIC STEROIDS 15
How Steroids Are Used

lasting several weeks is considered. It is the final result the amount that the androgen receptors and the cell
that is important. nuclei can take up and once they are full, they cannot
handle any more steroids at that time.
For a second or later course of a drug, there is no
reason why the same anabolic steroid cannot be To double the effect in animals takes about 10 times
used. The body does not develop tolerance and the original dose but in humans this would produce
results can be achieved with the same steroid, excessive side effects. There must be a dose at which
providing that the training programme and diet no significant benefit accrues but by continually
are adequate. increasing the dose and the variety of steroids used,
one cannot constantly improve the results obtained.
How much to use? The most important factor in gaining weight is the
There has been no scientific research performed to combination of correct diet and an adequate training
find out the effect of a specific amount of steroid on a programme.
weight training programme. The information available Increasing a dose may not increase the muscle
is related to steroid use in medicine, and there, the building effect but it will increase the chances of,
expectations are different from those seen in training extent of and types of side effects experienced.
for weight gain.

It is important to recognize that if a gain is made Length of courses?

with a large dose of steroids, it is not necessarily true Long continued courses of anabolic steroid do not
that the dose was the right one. Many of the large lead to continuing weight and strength gain. There is
doses produce the same result as smaller doses with in some athletes, an immediate response to anabolic
the excess steroid being spread around the body to steroids and others take up to 3 weeks to show any
other areas where side effects are produced before development. There is a continuing growth pattern
the material is destroyed in the liver. There is a limit to generally lasting for some 6 to 8 weeks. They plateau
16 ANABOLIC STEROIDS
How Steroids Are Used

at this level and further steroid use produces little or possible to continue the same rate of gain with
no benefit. subsequent courses.

Once the steroid receptors are full and probably Most people lose weight after a course of anabolic
fatigued, no further gain is to be expected. It is steroids has finished. Many users find it difficult
advisable to restrict courses to no more than 6 to 8 to maintain the high level of effort required for
weeks. If muscle gains are not apparent in that time, maintenance and as a result, lose weight. There is,
the cause is generally not insufficient steroids, but a in some athletes, a retention of water during the
problem with the training regime or the diet. course and when the steroids are stopped, this water
is lost and the scales demonstrate a weight loss over
How often to use steroids? a few weeks.
This is a difficult question to answer. It is important The decision to use another course should be carefully
to have goals when using steroids as this will make assessed and a new goal set. The quicker a new
it possible to evaluate progress. If progress is not course is started, the less the gain to be expected, as
being made then it may be that the goals may be the benefits of the previous course are still evident
unrealistic. A strength gain of around 5% over 6 to and receptor recovery has not occurred. It is wise,
8 weeks is good in an early course, although it is in a person who has maintained a heavy training
often difficult to estimate strength gains with any programme, that the interval between courses be
degree of accuracy. In future courses it is more at least as long as the duration of the course just
difficult to attain these types of gains as people completed. This allows a reasonable time for the
approach the maximum for their body as it is not body to recover from the effects of the prior course.
possible to continuously increase strength. A slightly
lower gain exists with muscle mass where 3% might
be considered a good result. Once again it is not
 ANABOLIC STEROIDS 17
Side Effects

Section 2: Side Effects

A
ll drugs have the potential to cause side
effects and anabolic steroids are no
exception to this. The cause of the side
effects may be due to an individual having an unusual
reaction to the drug or it may be related to using too
much. It must be remembered that what one person
can use safely, may be dangerous to another. As a
rule of thumb the more steroids used the greater the
risk of side effects and the more serious they are likely
to be. However, there are also instances of people
reacting adversely to low doses of steroids. There may
also be evidence of taking other drugs, which can
exaggerate the steroid effects.

Potential effects can be reduced or avoided by being

aware of the problems. Many but not all of the side
effects are of a temporary nature and will resolve
within some weeks of ceasing the drugs. Knowledge
of the side effects will allow you to recognise early “…the more steroids used the greater the risk of side effects and the
more serious they are likely to be…”
signs and thus reduce the overall risks.
18 ANABOLIC STEROIDS
Side Effects

Skin tender to touch. It is due to the chemical change

in testosterone brought about by a process called
Acne is a common side effect of steroid use and is
aromatisation, when the male hormone is converted
commonly seen on the back. The larger the amount
to a form of oestrogen, the female sex hormone.
of steroid used, the greater the likelihood that
There is initially a sore feeling in the breast. A skin
acne will develop. To help to minimize the risk, it
ridge appears on the outer side of the areola
is helpful to ensure that the skin is kept clean and
together with a halo appearance around the area
oily substances avoided. The acne develops slowly
but no swelling. As the course continues, a swelling
and should be watched for by those who believe
develops and it becomes tender. F atty tissue
that they may be susceptible to the problem. Once
builds up around the area and the breast becomes
it shows signs of developing, all steroids should be
prominent. At times there may be a secretion of
discontinued. The acne should abate over a period
fluid from the nipple when it is squeezed. Steroids
of 3 to 4 weeks. If this does not occur, medical
should be stopped. If recovery does not occur by
advice should be sought, being sure to tell your
the end of 2 months, surgery should be considered.
physician that you have used steroids.
Other causes of gynaecomastia that may need to
Some users develop a fine follicular rash over the be considered are the use of medications such as
trunk after some 3 or 4 weeks use of the drug. This Tagamet, a treatment for gastric problems, HCG and
is not acne but a follicular dermatitis, which should spironolactone. Some body builders use this latter
disappear when steroids are stopped. drug to reduce body fluid. Occasionally boys in the
post-pubertal phase develop breast enlargement due
Breasts to endocrine imbalance totally unrelated to steroids.
Gynaecomastia is a condition in which the mammary
glands, or breasts, enlarge and become sore and
 ANABOLIC STEROIDS 19
Side Effects

Heart Hypertension, or high blood pressure, has been

reported with steroids but there is little evidence to
There have been cases of people who have used
support a cause and effect mechanism. Any high
anabolic steroids suffering from a heart attack and
blood pressure might not be caused as a direct result
dying. This group has shown evidence of coronary
of steroid use but may be associated with other side
artery blockage that was responsible for their deaths.
effects such as heart liver or kidney problems.
It is therefore important for anyone considering the
use of anabolic steroids to have a medical check up If there are any symptoms that suggest heart disease,
before starting to use steroids. a medical opinion should be sought immediately.
The principal complaints might be shortness of breath
Raised total cholesterol and low levels of High
with or without effort, chest discomfort and feelings
Density Lipoprotein Cholesterol (hdl) are known to
of faintness.
predispose to heart disease and should be measured
before starting steroid use. Total Cholesterol is little
affected by steroids but the drug sometimes lowers Fluid Retention
hdl (good cholesterol) and increases Low Density There are some people who retain excess fluid
Lipoproteins ldl (bad cholesterol). The lowering of when on a course of steroids and feel bloated. This
hdl levels is due to the effect of the steroid on the is most easily seen in the face and around the neck
liver and this applies to injectable as well as oral drugs. region. It generally disappears within a few days of
stopping the drug. Should this not happen, medical
Cardiomyopathy, a disease of heart muscle, has been
advice should be sought, as there are other causes of
recorded in anabolic steroid users. It presents usually
water retention. As a consequence of the water loss,
as a form of weakness and breathlessness and needs
there will be a loss of weight in that period, but this
medical advice for its evaluation.
does not indicate a loss of muscle mass as this }
continued on page 22
20 ANABOLIC STEROIDS
Side Effects

Side Effects of Anabolic AGGRESSION

LIBIDO CHANGES
Steroid Use INSOMNIA

HAIR LOSS TENDON DAMAGE

GYNAECOMASTIA
(Breast development or enlargement)

LIVER DAMAGE

SHRINKING TESTICLES
PROSTATE ENLARGEMENT
 ANABOLIC STEROIDS 21
Side Effects

FACIAL HAIR
ACNE

DEEPENING OF THE VOICE

ROUGHENING OF THE SKIN

CLITORAL ENLARGEMENT
22 ANABOLIC STEROIDS
Side Effects

} fluid is in the space between muscle fibres and not It is important that all anabolic steroid users study
inside the fibres. This is not an indication to increase their own reactions to the drugs. When it becomes
the amount of steroid used in the next course, as apparent that any of the above states is becoming
a lack of steroid is not the cause of the condition. evident, then the user should stop. The user should
More steroid will accumulate more fluid and lead take time to assess his position. Not all drugs cause
to a greater loss of weight and size at the end of the the same feelings, as there are minor chemical
course. It does not occur in every user to a degree differences between the drugs that affect their
where it is obvious, but many athletes report a metabolism in the emotional centres of the brain.
sudden loss of weight after the first few weeks of Large doses are not only wasteful but also lead to
finishing a course and this is almost certainly due to more problems with the emotional symptoms.
water loss and not loss of muscle mass.
Liver Changes
Aggression Many steroids cause changes in liver function as
Aggression can take many forms: shown by alterations in the liver function tests. This is
most frequently seen with the oral preparations that
• Physical assault
are alkylated at the C-17 position. There have been
• Indirect hostility
cases of jaundice reported when steroids have been
• Irritability
used but these have often been in patients who used
• Negativism
unusually large doses or who were suffering from
• Resentment
medical diseases. Peliosis hepatica, a condition in
• Suspicion
which there are blood filled sacs in the liver has been
• Verbal hostility
found in people using steroids. Liver tumours have
 ANABOLIC STEROIDS 23
Side Effects

been noted in people who used anabolic steroids. higher the dose, the more likely it is that the testes
It is difficult to prove cause and effect, but in some will decrease in size to a notable degree. Following
people the tumours have decreased in size after the cessation of the drug, the testes usually return
withdrawal of the steroid, suggesting that the drug to their normal size, but in those who have used
may stimulate tumour growth rather than cause it. long or high dose courses it is not uncommon for
the changes to persist for many months even up to
Sexual Disturbance a year or two. If the reduction of the testes persists,
Anabolic steroids may cause a disturbance in sexual medical advice is needed to restore the bulk of the
function. The use of anabolic steroids depresses the testes and even then, the recovery may be prolonged.
formation of the pituitary hormones that affect the The reduction in Follicule Stimulating Hormone
function of the testis. Follicle Stimulating Hormone decreases the amount of sperm and decreases the
(fsh) is responsible for the formation of sperm and likelihood of pregnancy but this is not a guarantee
Luteinising Hormone (lh) stimulates the formation of of contraception. Extended courses may lead to a
testosterone. Both of these functions are suppressed, temporary sterility lasting several years possibly even
at least in part, by anabolic steroids and it is inevitable permanently.
that the size of the testis will be effected to some Steroids have an effect on libido. This varies widely
degree with their use. This decrease may not be from over stimulation to a total loss of libido. When
noticed by the individual but is present nevertheless. the latter occurs, the athlete should cease the course
The degree of decrease in size of the testes varies and wait for the expected return of the sex drive.
among users and at times can be quite obvious. This does not always happen as the sexual act is
The prolonged use of anabolic steroids will cause a very complex act and there are many causes of
a greater loss of size than a short course and the impotence. The cause of the loss of libido is not a
lack of testosterone. It is due in most cases to outside
24 ANABOLIC STEROIDS
Side Effects

influences and a few shots of steroids will not fix it the different results of steroids on the clotting
but make it worse. mechanisms. Similar events have been described in
women using the contraceptive pill.
In women there is sometimes an increase in libido
when using the drug but this will return to normal on
Hair Loss
cessation.
Balding is part of the genetic make up of many
Bleeding males. In any male who has a predisposition to it the
use of steroids may speed up the process. It should
Anabolic steroids cause a lengthening of the
be noted that a hair loss might occur in men who
bleeding time and this can lead to bleeding from the
have never used a steroid.
nose, mouth or other orifice. If this occurs and does
not settle quickly, or is recurrent, a doctor should be
Insomnia
consulted to ensure that there is no serious clotting
deficiency that could put a user in a precarious If it is difficult to sleep when using steroids the best
position as a result of a sudden bleed after little approach is to cease the drug. Using sleeping tablets
trauma such as forcibly blowing one’s nose. It goes will not cure the problem and may have a hangover
without saying that the doctor should be told of the like effect.
history of steroid use. There is evidence of some
athletes suffering a stroke when using steroids due to Tendon Damage
clot formation, the opposite of bleeding. The clotting Anabolic steroids strengthen muscle and not tendon
mechanisms are very complex and these events and there is an increased likelihood of tendon
are usually associated with large doses. To date rupture in the users. The event is sudden and
the research into this area has not fully explained demands immediate attention. The most common
 ANABOLIC STEROIDS 25
Side Effects

tendon affected is the biceps tendon and the tear interest to the older male who uses these substances
may be partial or complete. It is important that there as this age group in particular is susceptible to urinary
be no further use of the arm until the problem has blockage due to swelling of the gland. If there is a
been fully evaluated by a doctor. The other frequent difficulty in passing urine in the form of trouble in
site for muscle rupture is in the quadriceps group. starting the flow, anabolic steroids should be ceased
and medical attention is needed. It is important to
Young People establish the correct diagnosis early to enable simple
Anabolic steroids have been reported to be curative measures to be undertaken. Even the young
associated with stunting of growth in adolescents. person needs to consider this side effect when faced
The steroids may lead to premature closure of by urinary problems.
the epiphyses of the bone. This is the growing
part of the bone and once union at that site has Infections
occurred, no further increase in height is possible. The commonest infection during the course of steroid
This will decrease the future benefits of steroids for use is the one due to lack of sterility in the technique.
those interested in appearance or body building It can be avoided by using a new syringe and needle
competitions. Once this has happened there is no for each injection and making sure that the hands are
method by which it can be reversed. washed before any preparation is done. The infection
will show up as an abscess at the site of injection.
Prostate Gland This may be superficial or deep – the latter may take
Studies have shown that the prostate gland increases several days to develop. Once there is a suspicion
in size during a course of anabolic steroids and it of an abscess formation medical help is needed
will decrease after the course. This is of particular immediately.
26 ANABOLIC STEROIDS
Side Effects

Anabolic steroids have also been known to have an Skin changes are obvious in many women. Change
effect on the immune system and some users have in texture of the skin is the first abnormality seen.
been known to complain of having more colds when The development of facial hair is of two types,
using steroids. namely, a fine downy hair over the face that will
disappear on stopping the drug, and a darker hair in
The other source of infection comes from sharing
the beard area. This latter hair is likely to remain.
injecting equipment. This is one way HIV and
Hepatitis are spread. Irregularity of periods or, at times, a total cessation
of them, may be due to steroids. As courses should
Women and Side Effects only be of 6 weeks duration at the most, it is often
Anabolic steroids can produce unwelcome side hard to be sure that the absence of a period is due
effects in a female user and it is very important to steroid use. Courses of longer duration are more
that the initial signs be recognized early. The likely to cause longer periods without a menstrual
development of deepening of the voice is a sign of periods and so require a longer spell of steriod
virilisation. Once this has been detected, the drug abstinence. It is important that if another course
must be stopped to allow some degree of recovery. is contemplated, a resumption of periods must be
The recovery may not be complete in all cases. awaited before starting the next course. Pregnancy
Any hoarseness that remains after 3 months is likely is the commonest reason for missed periods and
to be permanent. needs to be eliminated before any other treatment is
considered. Once this has been done, any glandular
Clitoral enlargement is not an obvious disability in abnormality should be investigated.
the early stages and is often ignored for that reason.
 ANABOLIC STEROIDS 27
Other Drugs

Section 3: Other Drugs

T
here are a large number of drugs such
as growth hormone and diuretics used in
association with anabolic steroids for
many reasons including water loss, strength gain
and increased muscle mass. However, the most
consistent characteristic of these drugs is the absence
of scientific data to support their use. Research has
not been conducted on their effects during exercise
and there may be unexpected adverse results with
their use.

Most of the known information on the use of these

substances in exercise is anecdotal and based on
a single case. Their use is generally based on some
action known to occur in a biochemical pathway
in the ill person and it is assumed the same effect
will occur in the well person. It is important that the
action of a drug is understood before it is used as this “…the most consistent characteristic of these (other) drugs is the
will help to prevent unnecessary adverse side effects. absence of scientific data to support their use…”
28 ANABOLIC STEROIDS
Other Drugs

Human Growth Hormone Illness, psychological stresses and exercise can also
affect gh formation.
Human Growth Hormone (gh) is formed in the
pituitary gland as a result of the stimulus of a A major action of gh is on glucose metabolism and
hormone released from the hypothalamus, Growth sodium balance. Gh causes hyperinsulinaemia, a
Hormone Releasing Hormone. This is transported to high insulin level, and impairs the ability of insulin
the pituitary gland which then releases gh into the to suppress the formation of glucose in the liver.
circulation. There is another hormone, Somatostatin, This increases the likelihood of developing diabetes.
released by the hypothalamus, which reduces the Another action of gh is to increase nitrogen
amount of gh formed and these two hormones retention in the body and build up the protein in
control the level of gh in the circulation. The tissues. To do this, it is essential to consume an
hormone is produced on an intermittent basis and adequate calorie supply. This action affects many
its levels in the circulation fluctuate during the day. tissues. Prior to closure of the epiphysis, or growing
As it is not bound to protein, once formed, the cells part of the bone, gh stimulates the lengthening
must use it. process, but after closure, it causes the bone to
broaden and thicken up. Gh leads to enlargement
Gh is now made commercially and produced
of the skeletal muscle mass, the attached tendons,
by genetic engineering and has specific medical
the liver, lymph glands and the thymus gland. It
uses. Previously it had been extracted from human
diminishes the level of adipose (fat) tissue and has
cadavers but this has a risk of causing Crakob-
been used in clinics over the world to reduce body
Jeutzfeld Disease, a disease of the central nervous
fat in the older population.
system. The production of gh leads to the release
of Somatomedin, principally Insulin Like Growth The attraction of gh to athletes is that it causes
Factor-1 (igf-1) from the liver and other tissues. increased muscle and tendon strength, making
 ANABOLIC STEROIDS 29
Other Drugs

rupture less likely. The major side effect of gh is the consciousness and the individual collapses. Using this
overgrowth of the bone. This is most apparent in the substance is particularly dangerous for a person who
forehead region when overhanging brows are seen. may drive a car, work near machinery or at heights.
There is also the tendency to develop diabetes when
Hypoglycaemia is recognised by a feeling of faintness,
using gh and it is wise to test the urine regularly. As a
sweating and a shaky sensation. At times there is an
result of the widespread effects of gh, there may be
onset of nervousness for no apparent reason. There
the development of cardiomegaly, an increase in the
is a sensation of confusion and uncertainty. At this
size of the heart. In this instance having a bigger heart
time, some food should be taken to prevent further
is not an advantage to the user and is likely to lead to
symptoms. If the diagnosis is wrong, no harm is
heart failure.
done, but if a warning is ignored, the consequence
may be disastrous for the loss of consciousness
Insulin
could be abrupt and this is too late for treatment.
Insulin causes changes in the metabolism of Attacks may differ from time to time and should
carbohydrate and fats in particular. Insulin is important never be taken lightly. Insulin is injected under the
in the human body as it regulates the level of blood skin (subcutaneously) – not into the muscle. It is
sugar, which fluctuates with food intake. It also important that someone near you knows that you
promotes the uptake of amino acids by the cell and have used insulin and is aware of the effects and
increases protein synthesis. It is impossible to dissociate treatment of hypoglycaemia. These attacks may come
these actions and while there may be some gain in on suddenly and without much warning. This is the
muscle, there will also be an increase in fat levels. reason why there is a need for someone close to you
There are risks in the use of insulin. The most likely to know about the use of insulin and the treatment of
problem is hypoglycaemia, a lowering of the blood its side effects.
sugar to a level where there may be an abrupt loss of
30 ANABOLIC STEROIDS
Other Drugs

Not all insulin works at the same rate. Some insulin the manufacturing process, it is combined with
works very quickly while others take longer before an animal protein. When injected into humans,
they have an effect. Not understanding how quickly this preparation may set up an antigen antibody
each type of insulin works can be very dangerous. reaction and this can lead to allergic reactions. The
most important of these is anaphylactic shock a
Insulin Growth Factor 1 life threatening condition which should be treated
Insulin Growth Factor 1 (igf-1) is important for as a medical emergency. There is also a long term
metabolism as it is the factor that mediates the possibility of the body developing an antibody to
metabolic effects of Human Growth Hormone in the its own insulin leading to diabetes, which would
body. The main source of igf-1 is the liver but it is be very difficult to treat as the allergy may also
also produced in the kidney, muscle, pituitary gland extend to the insulin ordered for management of the
and the gastro-intestinal tract. The function of igf-1 diabetes.
in the muscle is to increase protein synthesis and Igf-1 is bound to protein in the plasma and this
decrease protein breakdown. It will also decrease in enables its action to continue for hours, unlike hgh,
the fat levels of the body. which is short acting. Igf-1 causes a lowering in the
Igf-1 is manufactured by genetic engineering blood sugar levels and it is important that insulin
techniques. There is very little indication for its use is not used at the same time as this increases the
in the medical field and for that reason there is no risks involved. Also, it is important that there is an
readily available medicinal product. This leads to adequate intake of food nutrients to benefit from the
the dissemination of counterfeit materials, which use of igf-1. The diet must be high in carbohydrate
masquerade as igf-1 and flood the market with and contain sufficient protein for cellular
fakes at a high cost to the buyer. As a result of reproduction. A regular intake of a wide variety of
foods is the best approach.
 ANABOLIC STEROIDS 31
Other Drugs

There is a degree of interaction between hgh, insulin Creatine

and igf-1 and, when using any of these substances
Creatine is an essential step in the delivery of energy
one must always take care that someone else is aware
for muscle contraction. It is a major factor in the
of it and knows the treatment for hypoglycaemia.
conversion of adp (adenosine tri-phosphate) into
atp (adenosine di-phosphate), which is the source of
Clenbuterol energy for contraction of the muscle cell. Creatine
Clenbuterol is a direct-acting sympathomimetic agent has been isolated and is available as a supplement
and is used as a bronchodilator in the management for training. It does not reduce the need to train at
of asthma and obstructive lung disease. It has an a high intensity, but makes the contraction slightly
advantage over salbutamol in that its action is faster and enables recovery to ensue more rapidly, as
longer lasting. It has also been used to increase the there is more creatine to allow the conversion of adp
development of muscle in cattle. In humans it is to atp. It is this reaction which makes creatine useful
effective in reducing body fat, thus its attraction to in training.
the body building community. The adverse effects
are those of stimulation of the sympathetic nervous Human Chorionic Gonadotrophin
system. These are a feeling of nervousness, tremor (HCG)
of the hands, palpitations, headache, insomnia and
Human Chorionic Gonadotrophin (hCG) is secreted
a rapid pulse rate. In extreme cases there have been
by the pituitary gland and stimulates the formation of
cases of acute poisoning with this drug. If any of
Luteinising Hormone (lh). Lh stimulates the Leydig
these symptoms develop, the drug should be stopped
cells to form testosterone. It is this action that is of
immediately and medical advice sought.
interest to anabolic steroid users.
32 ANABOLIC STEROIDS
Other Drugs

HCG is used by male athletes for its ability to Tamoxifen

increase endogenous testosterone production,
Tamoxifen (Nolvadex) is an anti-oestrogenic
generally during, or at the conclusion of, a steroid
agent commonly prescribed for the treatment of
cycle, when natural hormone production has been
oestrogen dependent breast tumours. Tamoxifen
interrupted. At the end of a steroid course, the
achieves this effect by binding to the target receptor
pituitary gland slowly resumes normal function
sites. Tamoxifen is used by anabolic steroid users
in most cases and restores the correct balance of
to prevent or reduce gynaecomastia, caused by
hormones. If hCG is used, it takes over the duty
aromatisation or when endogenous testosterone
of the pituitary gland in starting the recovery of
levels are suppressed.
the normal balance. Once hCG is ceased, the
testes return to their reduced size and the pituitary
Diuretics
resumes its recovery.
Diuretics are used by athletes to lose weight and,
Bodybuilders and athletes use hCG either on cycle, at times, the bloated look of water retention due to
in an effort to maintain testicular integrity during anabolic steroid use. They all have the same basic
steroid administration, or after a cycle, to help result, in that they cause the body to lose water.
restore hormonal homeostasis more quickly. Both However the individual drugs do this by different
types of use are deemed effective when properly mechanisms. Some diuretics lead to the excretion
applied. of larger amounts of electrolytes than others. It
has been known for individuals to take potassium
supplements to try and replace this electrolyte.
Potassium supplementation is potentially dangerous
and has been associated with cardiac arrest.
 ANABOLIC STEROIDS 33
Other Drugs

Testosterone Precursors be converted to testosterone. For those who use

these substances it can be expected that they will
There are a number of products in this category
act like anabolic steroids and produce similar results.
that are very similar in their actions. They are
It is essential that these drugs produce testosterone
all part of the metabolic chain leading to the
and its life in the serum is very short and any effects
development of testosterone. The first of these is
are likely to be minimal. Research suggests that the
dehydroepiandrosterone (dhea), closely followed
results obtained with these substances are no better
by Androstenedione and Androstenediol. The first
than hard training and adequate diet.
two of these are also made by the adrenal gland in
its normal function they contribute less than 5% of
the total daily production of testosterone. When
present, dhea and Androstenedione are converted
to testosterone or oestrone. Androstenediol can only
34 ANABOLIC STEROIDS
Legislation

Legislation

O
n 1 September 1996 anabolic steroids and a What does all this mean to the man in the street? It is now
number of related substances became subject an offence to supply any of the above mentioned anabolic
to the controls of the Misuse of Drugs Act. substances without a Home Office licence (‘supply’ is not
The controls are not as strict as for drugs such as heroin restricted to selling these drugs, but includes giving to,
and are aimed more at the dealer than the user. Prior to the lending to and sharing them with other people). You can no
change in legislation, steroids came under the jurisdiction longer buy these drugs legally on the internet, however you
of the Medicines Control Agency, an arm of the Department can go to another country and buy them and bring them
of Health. back for your own use.

Anabolic steroids, Growth Hormone (HGH), Clenbuterol and However, simple possession of an anabolic substance,
Human Chorionic Gonadotrophin (HCG) all became Class when in the form of a medicinal product, is not an offence,
C drugs under the Misuse of Drugs Act 1971. The maximum although possession with intent to supply is an offence.
penalties available for possession offences involving Class This is a grey area and there are no hard and fast
C drugs are currently 5 years imprisonment or an unlimited guidelines as to what sort of amount the police would
fine, or both. consider a ‘dealer quantity’. Even a few ampoules might
be, if, for example, you had been supplying them earlier.
 ANABOLIC STEROIDS 35
Drug Profiles

Section 4: Drug Profiles

T
he following section contains details of
some of the most commonly used anabolic
steroids and associated performance
enhancing drugs. The ‘Street Info’ is a summary of
some of the commonly held beliefs and views of
steroid users regarding these drugs.

Boldenone Undecenoate
Administration The Lowdown
Injectable Boldenone undecenoate is an oil based anabolic steroid used
in veterinary practice. Drive contains Boldenone undecenoate in
Alternative Names addition to Methandriol Dipropionate.
Boldenone Undecylenate
Street Info
Veterinary Products Equipoise is commonly thought to be effective in producing rapid
Boldebal-H (50mg/ml), Equipoise (25, 50mg/ml), Ganabol (25, increases in strength and muscle mass and has also been used for
50mg/ml), Pace (50mg/ml), Sybolin (25mg/ml), Vebonol (25mg/ml). ‘cutting’ prior to competition.
36 ANABOLIC STEROIDS
Drug Profiles

Nandrolone Decanoate
Administration  Street Info
Injectable Nandrolone Decanoate (Deca) is widely considered to be the most
commonly used injectable anabolic steroid used for performance
Alternative Names enhancement. It also has the reputation for being one of the
Nortestosterone Decanoate, Nortestosterone Decylate most frequently detected banned substances (metabolites can
be detected for periods in excess of one year). Because of its
Proprietary Names
popularity Deca has been widely counterfeited. Due to its relatively
Anaboline (50mg/ml), Anabolin LA-100Deca-Durabol (25, 50,
low androgenic properties it is also commonly thought to aromatise
100mg/ml), Deca-Durabolin (25, 50, 100, 200mg/ml), Dece-
only at high doses. Deca is commonly used for ‘bulking-up’ and has
ject (25, 50mg/ml), Elpihormo (50mg/ml), Extraboline (50mg/
a reputation for promoting size and strength.
ml), Hybolin Decanoate (50, 100mg/ml), Jebolan (50mg/ml),
Nandrolone Decanoate (50,100, 200mg/ml), Nurezan (50mg/ml), Reports of side effects include hypertension, acne, sexual and
Retabolil (25, 50mg/ml), Retabolin (50mg/ml), Turinabol Depot reproductive problems. The occurrence of side effects appear to
(50mg/ml), Ziremilon (50mg/ml). be more common in females and are influenced strongly by the
dosage used.
Vetinary Products
Anabolicum, Norandren.

Nandrolone Decanoate in the form of the Organon product, Deca-

Durabolin has been around for over thirty years.

As Nandrolone is not C17 alpha-alkylated it does not have as

strong an association with the occurrence of liver dysfunction and
cholestasis. However, it may cause fluid retention and oedema due
to sodium retention by the kidney.
 ANABOLIC STEROIDS 37
Drug Profiles

Methandrostenolone
Administration  structure. They are C-17 alpha-alkylated compounds and therefore
Oral exert a significant strain on the liver, with even relatively low
dosages causing temporary abnormalities in liver function tests.
Alternative Names 
Methandienon Street Info
Many users of this steroid have reported dramatic gains in both
Proprietary Names  strength and size. However, it aromatises even at low dosages,
Anabol (5mg), Andoredan (5mg), Bionabol (2, 5mg), with the development of gynaecomastia a common problem.
Encephan (5mg), Metabol (5mg), Metaboline (5mg) also Another common complaint is the problem of water retention,
contains multivitamins and nutrients, Metanabol (1, 5mg), resulting in hypertension.
Methandrostenolonum (5mg), Naposim (5mg), Nerobol (5mg),
Pronabol (5mg), Stenolon(1, 5mg),Trinergic (5mg capsules). Female use of Methandrostenolone/Methandienone can result
in virilisation due to its androgenic properties. Masculinising
Vetinary/Injectable 25mg/ml. effects can occur even at low dosages in some women who are
Anabolikum, Metandiabol. particularly sensitive to androgens.

The Low Down

Methandrostenolone usually referred to as Dianabol was first
produced and marketted by Ciba-Geigy in 1960. It was promoted
as being highly anabolic. Dianabol was also reported to enhance
feelings of well being.

Methandrostenolone and Methandienone are almost identical, the

only difference being in the spatial configuration of their chemical
38 ANABOLIC STEROIDS
Drug Profiles

Oxandrolone
Administration  Street Info
Oral Oxandrolone has relatively low androgenic properties, with little
aromatisation in males. It has a reputation for increasing strength
Proprietary Names but not size. It is popular with women because of its low incidence
Anavar (2.5mg), Lipidex (2.5mg), Lonavar (2mg), Oxandrin of side effects due to virilisation, however some cases of facial hair
(2.5mg), Vasorome (2.5mg). growth and deepening of the voice have been reported following
prolonged dosages. Gastrointestinal irritation, including pain and
The Lowdown
diarrhoea are commonly reported side effects in both male and
Oxandrolone is C-17 alpha-alkylated so there is the potential for
female users.
liver damage.

Oxymetholone
Administration  jaundice common even at therapeutic doses. There have also been
Oral links between Oxymetholone treatment and the development of
leukaemia.
Proprietary Names
Adroyd (50mg), Anadrol 50 (50mg), Anapolon (5mg), Anapalon 50 Street Info
(50mg) Hemogenin (50mg), Oxitosona (50mg), Plenastril (50mg), Oxymetholone, a derivative of dihydrotestosterone (DHT) and
Roborol (50mg), Synasteron (50mg). is commonly recognised as the strongest oral anabolic steroid
available. It is both highly anabolic and androgenic and being
The Lowdown C-17 alpha-alkylated, very toxic to the liver. There have been many
Oxymetholone is C-17 alpha-alkylated, with liver disturbances and reports of acne and hair loss (due to high levels of DHT) in addition
 ANABOLIC STEROIDS 39
Drug Profiles

to its strong association with liver damage and gynaecomastia.

There have also been reports of headaches and stomach pains.
There is substantial evidence of loss of size and weight, which
has been attributed to the drug being too hard on the body. Very
few women are able to tolerate oxymetholone due to its virilising
effects.

Stanozolol
Administration Street Info
Oral Stanozolol tablets have a reputation for causing gastrointestinal
discomfort after prolonged use. Both the tablets and injection form
Alternative Names are not considered to aromatise. Tablets are often taken in divided
Androstanazole, Methylstanazole doses to reduce the gastric irritation. This practice is popular
with female users, as it reduces the risks of virilisation which is
Proprietary Names
associated with large amounts of androgens in the female system.
Stromba (5mg), Winstrol (2mg).

The Lowdown
Stanozolol, when given for prolonged periods, has been associated
with elevated liver function results due to the fact that it is a C-17
alpha-alkylated compound.
40 ANABOLIC STEROIDS
Drug Profiles

Sustanon 250
Administration The Lowdown
Injectable Sustanon 250 has considerable anabolic and androgenic
properties. It was designed to maximise the synergistic effect of
Proprietary Names using four testosterones. The variation in half-life times of the
Sostenon 250, Sustenon 250. testosterones means that the product is fast acting and then
remains effective for several weeks.
Vetinary Products
Deposterone Street Info
Sustanon 250 has a reputation for being very effective at
Make Up
increasing both size and strength. The adverse effects of water
Sustanon contains four different testosterones:
retention and aromatisation leading to gynaecomastia are
Testosterone Propionate 30MG considered to be less pronounced than in long-acting testosterone
Testosterone Phenylpriopionate 60MG injections.
Testosterone Isocaproate 60MG
Testosterone Decanoate 100MG

Testosterone Enanthate
Administration Proprietary Names
Injectable Androtardyl (250mg/ml), Delatestryl (200mg/ml), Durathate
(200mg/ml),Malogen (100, 200mg/ml), Primoteston Depot (100,
Alternative Names 180mg/ml), Testo-Enant (100, 250mg/ml), Testosteron Depot (50,
Testosterone Enantate, Testosterone Heptanoate 100, 250mg/ml), Testoviron Depot (100, 250mg/ml).
 ANABOLIC STEROIDS 41
Drug Profiles

Veterinary Street Info

Testosterona 200 (200mg/ml.10ml vial) Testosterone Enanthate is considered to be very similar to
Testosterone Cypionate but less likely to cause water retention.

Testosterone Cypionate
Administration Street Info
Injectable Testosterone Cypionate is considered to aromatise easily leading
to problems such as gynaecomastia. Large dosages have been
Alternative Names associated with causing psychological effects including aggression.
Testosterone Cipionate, Testosterone Cyclopentylpropionate Hypertension, acne and premature balding are also commonly
reported problems.
Proprietary Names
Andro-Cyp (100, 200mg/ml), Depo-Testosterone (50, 100, 200mg/
ml), Depotest (100, 200mg/ml), Duratest (100, 200mg/ml), Testa-C
(200mg/ml), Testex Leo (100, 250mg/2ml)

The Lowdown
Testosterone Cypionate is an ester of testosterone with high
anabolic and androgenic properties. It is oil based and therefore
long acting.
42 ANABOLIC STEROIDS
Drug Profiles

Methenolone Acetate
Administration Street Info
Oral Primobolan has a reputation for having low androgenic properties
causing little aromatisation, water retention or liver damage. It is
Alternative Names generally considered to be one of the safest anabolic steroids.
Metenolone Acetate Muscle gains are reported to be slow to develop but of good
quality.
Proprietary Names
Primobolan (5mg), Primobolan S (25mg)

The Lowdown
Primobolan tablets are not C-17 alpha-alkylated and do not have
the liver toxicity associated with many of the other oral anabolic
steroids.
 ANABOLIC STEROIDS 43
Counterfeits and Fakes

Counterfeits and Fakes

T
he existence of counterfeit anabolic steroids is to have been drawn with a felt tip pen were and still are
by no means a new phenomenon. Due to the the most obvious indications of fake products. Other
limited availability of genuine pharmaceutical pointers include visible contamination of ampoules,
products and the laws of supply and demand, many variability in appearance and content of ampoules and
anabolic steroid users have grown to accept the fact that vials, and incorrect tablet consistency. There are, however,
the majority of products available to them will be either fake exceptions to these guidelines as is evident in the poor
or counterfeit. However it is important to note that although quality packaging of genuine pharmaceutical products
the terms fake and counterfeit may imply inferior quality, manufactured in developing countries. While it is still
there is evidence to suggest that many of these products possible to find these rather amateurish fakes being sold
do in fact contain anabolic steroids (although not always to the unwary, a more sophisticated type of product has
of the dosage or type specified). In some instances these appeared on the market which is much more difficult to
products have acquired such a positive reputation that they identify.
have become sought after in their own right, even to the
One of the most disturbing aspects of fake and counterfeit
extent of being counterfeited themselves.
anabolic steroids is the variations in content of these
Traditionally, fake anabolic steroids were relatively easy products. This is especially significant when one considers
to identify. Poor packaging, badly printed or photocopied that some anabolic steroids which have been tested were
information inserts and bar codes that often appeared found to contain nearly twice the strength of the stated
44 ANABOLIC STEROIDS
Counterfeits and Fakes

content. These results clearly demonstrate the problems steroids are used. The risk to female anabolic steroid users
facing anabolic steroid users who purchase products on is particularly worrying as the virilising effect of androgens
the illicit market. Many users will be aware of the probability in women can result in irreversible side effects.
of a product being fake or counterfeit. There is often the
Over the last few years there has been a big expansion in
presumption that the fake steroid will be weaker than the
the ‘designer steroid market. These are usually steroids
stated content. The user will often compensate for this by
that have been chemically modified to make them legal,
increasing the amount taken. As illustrated above this could
sometimes the modification makes them more toxic to the
be a very dangerous practice.
liver (orals), sometimes people just take them more than
In addition to the strength variations of illicitly produced they should because they think legal means safe. Do your
anabolic steroids, there are many examples of the stated research and find out what is actually in the drug and what
anabolic steroid being substituted with a different active modifications have been made before ever using.
ingredient. There have been cases of high androgenic
anabolic steroids being packaged as steroids with much
lower androgenic properties. Many of the side effects
associated with anabolic steroids are a direct result of
their androgenic properties. The potential for harm can be
greatly increased if large doses of high androgenic anabolic
 ANABOLIC STEROIDS 45
Intramuscular Injections

Section 5: Intramuscular Injections

for Anabolic Steroids

I
njecting drugs can be a hazardous procedure with
serious risk of injury and disease. Anabolic steroid
injectors need to follow some basic rules and
procedures to minimise the potential harm. Thankfully,
most risks are easily avoided by following a few basic
rules and procedures.

Anabolic Steroids should only be injected into a muscle

and the following pages provide basic instruction
on intramuscular injection. Anyone considering
self-injection should first get advice from a health
professional. Prospective injectors should approach
their needle exchange service or a local drugs agency.

“Anabolic steroid injectors need to follow some

basic rules and procedures to minimise the
potential harm”
46 ANABOLIC STEROIDS
Intramuscular Injections

Sterile Equipment
A clean needle and syringe should be used for each injection.
By ‘clean’ we mean equipment which has just been removed
from its sealed wrapper. No injecting equipment should be shared
with anybody else under any circumstances as this can spread
blood bourne viruses (like hepatitis C and HIV). Sterile injecting
equipment and boxes for the safe disposal of contaminated sharps
can be obtained from your local syringe exchange.

The Correct Equipment

Not just any needle will do. The needle must be long enough to
reach into the muscle and of a sufficient bore to enable an oil based
solution to be injected with the minimum of tissue damage. For an
intramuscular injection to be given correctly, either a 21g x 1.5" (long
green) or a 23g x 1.25" (long blue) needle is usually required. Two
needles are needed for each injection – one to draw up with and
one to inject. A 2ml syringe should be used as this is the maximum
volume that should be injected into a muscle at any one time.
 ANABOLIC STEROIDS 47
Intramuscular Injections

Keep it Clean

a
Gather together all the sterile equipment for the injection on a
clean and clear surface. Remember, no equipment whatsoever a
should be shared.

Before proceeding, hands and the part of the body to be injected

b should be washed thoroughly with hot water and soap. By piercing
the skin with a needle the injector is opening the door for bacteria.
Keeping clean is vital to avoid infection. Using a sterile alcohol swab
will help but it is not a substitute for soap and water.

b
48 ANABOLIC STEROIDS
Intramuscular Injections

Drawing Up From An Ampoule

or Vial

a
Before drawing up a solution it should be examined for any signs
of contamination. If there are any particles visible, if the seal is
a b
broken or if the solution is discoloured, it should not be used.

Allow solutions that have been refrigerated to reach room

b temperature before injection.

When drawing up a solution into a syringe the needle may become

c blunt as it passes through the rubber seal on the top of a vial, or if
it is scraped against the inside of an ampoule. If a blunt needle is
used to inject it may damage the muscle and can cause pain. The
solution should be drawn up slowly and the used needle disposed
of into a ‘contaminated sharps’ box and replaced with a new one. c
Any air big bubbles should be expelled by holding the syringe
upwards and flicking the barrel. The plunger is then pressed until
a drop of the solution appears at the tip of the needle.
 ANABOLIC STEROIDS 49
Intramuscular Injections

Where to Inject
Anabolic steriods should never be injected into a vein.
They should only ever be injected into a muscle. The main
sites for intramuscular injections are the upper outer quadrant
of the buttock (Gluteus maximus) and the middle outer muscle
of the thigh (Vastus lateralis). Since the pathway of the sciatic
nerves is around the Gluteus maximus, it is important to inject
carefully in this area. Hitting the sciatic nerves is very painful
and can be very dangerous.

Injection sites should be rotated for successive injections to

avoid too much damage in any one place. Since steriods work
throughout the body and not locally, it is pointless to target
particular muscle groups with injections.
50 ANABOLIC STEROIDS
Intramuscular Injections

Other Sites
If it is not possible to inject into the thighs or buttocks, the deltoids
a
a are the next best site for intramuscular injection.

The smaller the muscle, the more pain and damage an injection
b will cause. Great care should be taken. Warm oil-based solutions
to body temperature, inject slowly and then gently massage the
area to help distribute the drug.

b
 ANABOLIC STEROIDS 51
Intramuscular Injections

Pre-injection
Get rid of any big air bubbles in the syringe. Flick the barrel to
a send them to the top of the syringe and then press the plunger
until a drop appears at the tip of the needle.

If you use an alcohol swab on the injection site, allow a few

a
b seconds for your skin to dry before using the needle. There is no
reason to use a swab if your skin is clean. Soap and water is a
healthier option.

b
52 ANABOLIC STEROIDS
Intramuscular Injections

The Injection
With the syringe held like a dart, the needle is pushed through
a
a the skin and into the muscle. There is no need to insert the needle
to the hilt and care should be taken to avoid hitting bone. b
Before injecting the solution it is necessary to check the needle
b is not in a blood vessel. The plunger is eased back to make sure
no blood is seen in the syringe. If blood appears, then the needle
must be removed and the injection reattempted.

To minimise damage, it is important that the solution be

c injected slowly.

c
 ANABOLIC STEROIDS 53
Intramuscular Injections

Post-injection
A small amount of bleeding at the injection site is normal. Direct a
a pressure applied with a clean tissue for a few minutes will stop
the bleeding and help prevent bruising. Other transient effects
include slight swelling, redness, burning, or itching. These should
subside shortly.

Used needles, syringes, swabs and empty ampoules should be

b placed in a ‘contaminated sharps’ container and returned to an
agency operating a syringe exchange scheme for safe disposal. c
Remember to wash your hands thoroughly.
c b
54 ANABOLIC STEROIDS
Intramuscular Injections

Complications of Poor Injecting

Techniques
Infection muscle tissue, resulting in impaired muscle
function. Any subsequent injections in the
Sharing of injecting equipment can lead to
damaged muscle will be both painful and poorly
many infections including Hepatitis B and HIV.
absorbed in the scarred tissue.
Poor hygiene or unsterile equipment can cause
inflammation or abscesses at the injection site
which may be hard to heal. Haemorrhage
Accidental puncture of a blood vessel inside the
Nerve, Tendon and Ligament muscle can cause bleeding and the formation of
Damage bruising deep inside the muscle. This may result in
stiffness and discomfort, restricting training ability
Incorrect siting of injections can cause damage to
and performance.
tendons and ligaments causing pain and impairing
training. Severe nerve damage can occur resulting
in impaired sensation or even paralysis. This may Anaphylactic shock
result in long term mobility problems. Injecting may cause an allergic reaction, which
although very rare, can be fatal. Symptoms include
Muscle Damage urinating a lot (often together with increased thirst),
breathing difficulties, low blood pressure etc. Seek
Repeated injections into the same muscle group
immediate medical help.
can cause destruction and breakdown of the
Text by Pat Lenehan and Tony Miller, updated by Gary Beany
Design and Illustration by Richard Kemplay
code A28 | version 1.2
Print date 07/2015

aims
To provide detailed information on anabolic steroid
use and substances. This booklet also includes a
step-by-step guide to intra-muscular injection,
the purpose of which is to encourage safer practise.

audience
Drug workers and anabolic steroid users, aged 18+

content
Some illustrations of drug use, no swearing

funding
Self-financed

To re-order go to exchangesupplies.org
Published by: Exchange Supplies, 1 Great Western Industrial Centre, Dorchester, Dorset DT1 1RD