It's not all gym junkies and 'roid rage'—people use steroids for a variety of reasons
After critically assessing the research in this field, we found people use steroids for a variety of reasons. And while steroid use does carry risks, not all users will develop personal problems or cause harm to others.
Steroid use in Australia
Anabolic-androgenic steroids are synthetic variations of the male sex hormone testosterone. "Anabolic" refers to the drug's capacity to increase protein synthesis, which results in increased muscle tissue. "Androgenic" refers to its properties in promoting the development of male sex characteristics (for example, deep voice and body hair).
So we don't know exactly how many people use steroids in Australia and whether this number is increasing.
Many different types of users
The caricature of non-medical steroid users as narcissistic "gym bros" suffering from body image issues provides a simplistic account of user motivations. It ignores the spectrum of people who use steroids.
Certainly many people use steroids for body image/cosmetic purposes, and to develop athletic performance—bodybuilding can encompass both.
But people also take steroids to support occupational performance. For example, police officers, security personnel and prison guards have been reported to use steroids to improve physical performance on the job.
Steroids and health harms: what do we know?
But several serious health harms have been linked with steroid use, too.
Most knowledge about the harmful effects of steroids is at this stage based on low level evidence, such as expert opinion, case reports or small observational studies, so we still need stronger evidence. Prospective clinical trials which examine the efficacy and long-term effects of recreational steroid use are absent, but there are some important studies underway.
In a number of studies comparing harms from a variety of drugs, relative to other drugs steroids consistently appear low on the list for general health harm as well as for physical, psychological and social harm to both users and society.
We must also appreciate the circumstances in which people use steroids can contribute to their risk of harm. For example, a person could be taking multiple substances simultaneously, or they might be using unverified products sourced illegally.
The type of steroids used, the dosage and the length of time someone has been using steroids are all relevant factors. So depending on their patterns of use, some people who use steroids will run greater health risks than others.
Another frequently cited side effect of non-medical steroid use is aggression and violence. In the mid-1980s, the notion steroid use leads to aggressive or violent behaviour became widespread, giving rise to the term "roid rage".
Studies on animals have found a direct link between testosterone and increased aggressive behaviour. We need further research to see whether or not this phenomenon translates to humans.
There are likely to be many factors influencing the relationship between drugs (including steroids) and aggressive behaviour. This includes personality traits, neuropsychological risks, environmental influences, socioeconomic status, and/or the use of multiple substances at once.
While some people who use steroids report increased irritation, the complexity of the relationship between hormones and behaviour suggests violent outbursts can't simply be accorded to using steroids.
A narrative centred on public health harms, the potential for violent behaviour and psychological disturbance naturally prioritises repressive means to combat the issue (for example, the criminalisation of drug users).
This tends to exclude evidence-based approaches based in public health and harm reduction such as the provision of tailored safe injection advice, drug testing services, and medical monitoring for people who use steroids for non-medical reasons.
Research in the field of alcohol and psychoactive drugs has highlighted the importance of acknowledging the benefits and pleasurable effects of drug use by healthy individuals.
For example, studies exploring motivation for party drug use show fun and pleasure are central for users. Participants in these studies report using drugs gives them energy and confidence, reduces inhibitions, enhances feelings of connection to others, and intensifies sexual experience.
Similarly, bodybuilders derive aesthetic pleasure from their body modification practices. Steroid users have also reported positive and pleasurable feelings such as increased libido, greater confidence and increased well-being and strength.
While the effects of steroid use differ from the "highs" of traditional drugs, they are nonetheless seen as pleasure-inducing and form part of the appeal of taking drugs in this context.
Progressing drug policy
Like all drugs, steroid use has the potential to cause harm. If you're someone who uses steroids, it's safest to do so under the advice and guidance of a medical professional.
At the same time, we need to acknowledge the role of pleasure and other benefits in the use of steroids. Failing to do so may hinder our ability to address the phenomenon and explore alternative regulatory models.
Rational and critical debates on this topic are particularly important in a world that appears increasingly eager to explore the opportunities for human enhancement.