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STEROIDS

Steroids

Steroids are man-made versions of the hormones produced by your body. Most hormones are produced by the adrenal glands, two small glands found above the kidneys. Corticosteroids are anti-inflammatory medicines commonly prescribed by a doctor to treat various conditions. Anabolic steroids are prescription-only medicines that are sometimes taken without medical advice to increase muscle mass and improve athletic performance. Anabolic steroids are manufactured drugs that copy the effects of the primary male sex hormone, testosterone.

Testosterone plays a key role in developing male traits and muscle growth. Anabolic steroids amplify these effects, leading to faster muscle gains and increased physical performance. Doctors sometimes prescribe anabolic steroids for specific medical conditions, such as delayed puberty or muscle loss due to disease. However, most non-medical uses are for physique and performance enhancement. If used in this way, they can cause serious side effects and addiction.

Anabolic steroids have become embedded in parts of gym and bodybuilding culture. While many people work out naturally, those aiming for dramatic physique changes use steroids to gain muscle quickly, increase strength and recover faster. Steroids are often used by those pursuing an idealised or exaggerated body aesthetic commonly promoted on social media and within the fitness community. “Cycling” (taking steroids for a period then stopping) and “stacking” (combining different types of steroids) are common strategies among users, though these practices do not eliminate health risks.

Body image issues and steroid use in gay men | Happy Health Homo | 28 Mar 2023 | 5m 44s
What happens when you take steroids? | AsapSCIENCE | 19 Apr 2018 | 4m 14s
Beefcake: gay men and the body beautiful | UCL | 6 Feb 2012 | 1h 33m

Writing this
In researching this article, it feels like the steroid train departed the station long ago. But increasingly, there are open and honest conversations about their use, why gay men use them and the risks they present. It's interesting to note that in 2004, an NHS Trust in London produced 'In Gear: Steroids'. While it was a pioneering document in gay health education, its sympathetic framing of steroid use (accompanied by 18 photos of semi-clad men) could be interpreted by some as an indirect promotion of steroid use, particularly where body image pressures were (and are) already intense. However, health promotion like this often navigates the fine line between educating while implicitly validating the very behaviour it seeks to make safer. That includes this website!

The accelerator analogy
Steroids are like slamming your car’s accelerator to the floor; they make you go faster, helping you rapidly build muscle and strength. But like speeding increases your chances of crashing, using steroids ramps up the risk of serious health problems. The engine (your body) is pushed beyond safe limits, and while the short-term gains feel thrilling, long-term damages such as heart issues, hormonal imbalances, and other conditions become more likely. The faster you go, the less control you have, and the harder it is to stop safely. Steroids may get you there quicker, but the crash can be devastating. Too much?

Reasons why (gay) men use steroids
While steroid use exists across many demographics, studies show it's disproportionately higher among gay men, particularly in cities and urban areas. Some of these reasons are:

A desire to achieve a lean, muscular physique, often idealised in media and apps
In some gay social scenes, muscularity is linked to attractiveness, desirability, and capital when cruising
Steroids may be used to feel more confident, especially in environments where appearance is highly valued
Some use steroids to feel more sexually appealing or dominant in dating or sex
Body transformation can be a way to regain control or combat internalised homophobia
Steroid use is part of broader drug use patterns tied to sex and partying

Steroids can have powerful effects on the body and tempt those seeking fast physical results. However, their non-medical use, especially on the gay scene, shaped by body ideals and social pressures, comes with health, emotional, and social risks. Several factors contribute to this:

Body image pressures: Media and apps often promote hyper-muscular ideals for gay men, reinforcing a narrow standard of attractiveness.
Community norms: In some LGBT+ spaces—especially nightlife or circuit party culture—muscularity is associated with desirability and status, which can encourage steroid use.
Mental health concerns: Gay men are statistically more likely to face anxiety, depression, and body dysmorphia—issues that can be exacerbated by or lead to steroid use.

A brief history of steroid use in London
Medical, cultural, and societal issues have shaped steroid use among gay men in London:

1980s: During the 1980s, amidst the AIDS epidemic, anabolic steroids were prescribed to HIV+ men to counteract muscle wasting caused by the disease as well as to improve mood and libido. This medical application introduced many gay men to steroids, laying the groundwork for their broader use within the community.
1990s–2000s: In the late 1990s and early 2000s, London's gay scene saw a surge in gym culture, emphasising muscular physiques as a standard of attractiveness. A 2000 survey of 772 gay men attending central London gyms revealed that approximately 15% had used anabolic steroids in the previous year. Notably, HIV+ men were more likely to use steroids, sometimes for therapeutic reasons. However, users reported adverse effects, including testicular atrophy, increased instances of depression, and suicidal thoughts.
2010s–2020s: Steroid use among gay men is ongoing into the 2010s and 2020s, often driven by body image concerns and societal pressures. Despite the associated health risks, many users continue due to the perceived benefits in appearance and social acceptance.

Risks and side effects
Using anabolic steroids without medical supervision can have serious and wide-ranging side effects. Physically, these may include liver damage, high blood pressure, heart disease, severe acne and other skin issues, shrunken testicles, erectile dysfunction, infertility and gynecomastia (breast development in men). Steroids can cause mood swings, aggression, irritability, anxiety, and even depression, particularly during withdrawal. As anabolic steroids are often injected, there are risks associated with sharing needles and the same risks associated with slamming. Anabolic steroids are also addictive, with long-term users requiring more to get the same effect, and experiencing withdrawal symptoms if they suddenly stop taking them. Doctors, when prescribing steroid medication, will always advise coming off the medication slowly by gradually reducing the dose. Coming off anabolic steroids suddenly can result in withdrawal symptoms that include depression and apathy, anxiety, difficulty concentrating, insomnia, anorexia, decreased sex drive, extreme tiredness (fatigue), headaches and muscle and joint pain. Crucially, because many people obtain steroids illegally or through unregulated channels, there's an additional risk of contaminated or mislabelled products.

Legal status
Anabolic steroids are Class C drugs which can only be issued by pharmacists with a prescription. Personal use is legal, and you can import or export them only if done in person, not by mail or courier. Supplying or selling them, even to friends, is illegal and can lead to an unlimited fine or up to 14 years in prison. Most professional sports organisations have banned the use of anabolic steroids and conduct regular drug testing to enforce this policy. Athletes who test positive for steroid use may face serious consequences, including suspension, disqualification, or a permanent ban from competition.

HIV treatment and steroids
HIV treatments, especially protease inhibitors (PIs) such as ritonavir and cobicistat, can interfere with the metabolism of numerous other drugs, including anabolic and corticosteroids. This is primarily due to their effect on liver enzymes. Ritonavir, in particular, is a strong inhibitor of the cytochrome P450 3A4 (CYP3A4) enzyme, which metabolises many substances in the body. As a result, taking them alongside taking any steroids can lead to increased drug levels in your body and a higher risk of side effects such as hormonal imbalances, fluid retention, liver toxicity, or immune suppression, especially with long-term use. The combination of ritonavir or cobicistat with anabolic steroids (or corticosteroids) requires careful management, including adjusting doses and monitoring any side effects. Both HIV patients and those using steroids for medical or performance-enhancing purposes should always consult their healthcare providers about potential drug interactions to avoid serious complications.

Muscle Mary
For those of you old enough, "Muscle Mary" was a slang term that referred to a very muscular gay man, often seen as gym-obsessed but also fashion-conscious, balancing hypermasculine physiques with camp or feminine energy. The term playfully combines “muscle” (physical strength) with “Mary”, a feminising nickname. It’s typically used teasingly or affectionately, though it can be a slur. Who would have thought?! While it still exists in LGBT+ slang, it should be used mindfully, as tone and context affect how it’s received.

What is it to be a gay man
Tom of Finland's art was central to the emergence of leather and fetish communities, especially in the US and Europe from the 1960s onward. His drawings remain powerful, influencing what gay men desire in other men, the leather and muscle scenes, dress and behaviour codes. The artwork has become a global symbol of sexual liberation, and events like Folsom Street Fair have often adopted his imagery and ethos. Tom of Finland helped reimagine what it meant to be a gay man and has left an indelible mark on both queer and mainstream culture.

Tom of Finland | Wikipedia
Tom of Finland | Foundation

More
Men are buying potentially risky steroid substitutes online to get the ‘ideal body’ | The Conversation | 2 Sep 2020
The gay men risking their health for the perfect body | BBC News | 29 Jan 2020
Steroid use in the gay community: The rise of performance and image-enhancing drugs | GCN | 23 Jul 2019
It’s not all gym junkies and ‘roid rage’ – people use steroids for a variety of reasons | The Conversation | 19 May 2019
Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects | GOV.UK | 14 Dec 2016
Body of deceit | BBC News | 2 Sep 2004

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