It is Tuesday evening and four men sit on sofas in a large open room overlooking the frenetic streets of Soho in Central London. One, in his forties, wears a pinstriped suit over a paunch, two are in jeans. A younger man in chinos and a tight sweater leaves no doubt about the bulk of his shoulders and the tautness of his six-pack. This is a needle exchange and these men are drug users.

“What the heck,” says Craig, the hunk who is 24 and works in IT. “I don’t do any other drugs, I drink very seldom. Let’s say anabolic steroids are my sin.”

A few of the men who visit the charity Turning Point’s Smart Muscle sessions are so bulked up that they walk in sideways, says Roy Jones, who runs the advice facility and needle exchange. Most look ordinary, as though you could meet them anywhere. Anabolic steroids have been used since the 1950s, but where once they were the preserve of bodybuilders and then gay clubbers and certain athletes, now increasing numbers of men — from lawyers to students, teachers to prison officers — are using them to bulk up their bodies. They are not competitive sportsmen, some want the bulk for occupational reasons, but most just want the kind of beautifully toned body they see in pants ads and cartoon superheros, and they’ve discovered that anabolic steroids provide a short-cut.

What some of them ignore is that anabolic steroids can have unpleasant side-effects and that because supplying them is illegal, the consumer can never be sure what he is buying. Fifty-four anabolic steroids are already controlled substances, legal to possess for personal use, illegal to supply, and the Home Office, concerned that they are being abused by increasing numbers of young men, is consulting on adding another 24 to the controlled list.

The exact number of anabolic steroid users is impossible to measure. In 1993 a report for the Department of Health estimated that 5 per cent of people entering gyms were users; in 2006 a study in South Wales claimed that users accounted for 70 per cent of those who attended hardcore body-building gyms. The British Crime Survey (BCS) estimates that 200,000 people have used anabolic steroids, but professionals in the field believe this is an underestimate. At the Liverpool John Moores University the head of substance use, Jim McVeigh, whose study of anabolic steroids was published in March, puts usage at three times the BCS estimate. “Our best indication comes from syringe exchange schemes. We know that more people are engaging with them and that the profile is changing to people who are not competitive sportsmen. They’re doing it because of peer pressure, the media, and for some there’s an economic drive. If you’ve got little educational or occupational aspirations, if you’re big enough and strong enough you can do security work in the grey economy.”

Oral anabolic steroids are available, but most users inject as the oral versions are more harmful to the liver. As those who work at needle exchanges are aware, many of these men — and the Advisory Council on the Misuse of Drugs has reported that boys as young as 12 are among them — do not consider themselves drug users.

“It’s vanity and self-esteem,” says Jones, a former psychiatric nurse who has worked with drug users for more than a decade. “They feel under pressure to look a certain way, if they don’t they struggle, and because they’re attempting to improve themselves, they don’t see it as abuse. That’s why it’s best to have a separate service because they won’t turn up if they’re going to be alongside heroin users. We want to tell people about potential side-effects, to allow them to make informed decisions. We work with heroin users in the same way but steroid users are not committing crimes to buy their drugs. They’re not unemployed, a lot of them are in responsible positions and that makes them a difficult group to engage with.”

Over 18 months the Smart Muscle sessions have attracted 270 men, half of whom had not previously used anabolic steroids. Jones estimates that over the past ten years the average age of users has dropped from late thirties to 23 or 24. Most of them hear about Smart Muscle from friends or at the gym and would otherwise rely on their supplier for information; they buy their phials from friends, their gym or online. Jones offers advice on nutrition and how best to exercise. That persuades some that they don’t need any chemical help. But if a client wants to go ahead after learning about potential side-effects — which include acne, the development of breast tissue and testicular atrophy — and the risks of buying counterfeit substances, Jones, never judgmental, advises on dosage and explains how to inject into the muscle as safely as possible. “Will I feel pain?” asks a motorcycle courier. “Normally the day after there’s some stiffness in the muscle,” Jones says. “If there’s any redness, go to your doctor.” Smart Muscle also offers liver-function tests and sexual health screening.

Craig went to Smart Muscle on the advice of his gym manager before he took anabolic steroids. He has now done a six-week course, backed up by intensive training at the gym — the drugs don’t add bulk in the right places unless you train and eat plenty of protein — and his weight has gone from 75kg to 87kg (11st 7lb to 13st 9lb). The drugs cost £130. “I was big at school because I played lots of rugby, but I lost it from not eating well at university and I missed having that physique,” he says. “My best friends are good-looking and muscular and I was always the skinny one who was left out. Everyone would pull and I wouldn’t.

“In six weeks, I’ve gained more than I would in a year of working out. My tennis has become more competitive and it’s certainly helped me pull. I was always the one in the shadows and it’s given me extra confidence. In the short term, I think the benefits outweigh the risks, though I’m nervous that I’m going to lose what I’ve gained.”

Jones points out that muscle gained entirely through training is more sustainable. Does this mean that using anabolic steroids can become addictive? “Not physically,” he says. “But psychologically people can get used to the feeling of being bulked up, being hard, a bit aggressive. Some people get muscle dysmorphia, even when they’re huge they don’t think their bodies are up to scratch and don’t want to show them.”

This reverse form of anorexia has been noted by Dr Rob Dawson, a GP who has led the debate on the misuse of anabolic steroids for 14 years and runs a needle exchange in Co Durham that has supported 1,000 patients. He believes that the use of anabolic steroids by elite athletes, such as Ben Johnson at the 1988 Olympics, acts as product placement and regards the issue as full of moral and ethical dilemmas, not least because the effects of the drugs on health are under-researched. “People have lost confidence in clinicians over this issue,” Dawson says. “We said that they didn’t work, then we said they work but they kill you.”

Few deaths have been linked to steroid use, although it does appear that Matthew Dear, a 17-year-old Army cadet from Southend, died in April after taking what he believed to be an anabolic steroid, a tragedy that may reflect the risk of buying a substance when you can’t check what it is. It is not known what substance Dear took; three people arrested on suspicion of supplying a controlled substance are to appear in court this month.

Dawson is anxious that government policy on anabolic steroids should not be directed by the considerations of elite sport and he is concerned by the paradox thrown up by the proposed male contraceptive, an anabolic steroid that would be given in “a dose that probably would have performance benefits”. He hopes too that the harmonisation of European legislation will not lead to the drugs’ criminalisation.

“That would drive this problem underground. The current classification is the right one because it makes a clear statement that you mustn’t give these to other people but you can seek care. We need to engage with these people, to educate them, to regain trust. When we say there are potential health problems, they need to know we are telling the truth. How can we further research sideeffects if these people can’t come forward with impunity?”

Contact Smart Muscle by e-mail at:
smart.muscle@turning-point.co.uk 020-7851 2955