Steroid use is more widespread than most people believe—and it's increasingly dangerous
Young men increasingly feel the pressure to look jacked and they're going to extreme measures to achieve the aesthetic.
As a kid, Daniel Coffeen wasn’t very athletic.
By his own description, he was a tweener in the 2000s, stuck between two extremes: too small to push opponents around but too slow to utilize his slim frame. After he finished high school in New Mexico, Coffeen went to college where he enrolled in the ROTC program. After graduation, he joined the Army and later completed Ranger School, a rigorous voluntary training course intended to prepare soldiers for missions under tremendous stress. As he trained with specialized units, Coffeen observed performance-enhancing drug (PED) use for the first time. He says he saw soldiers using PEDs—from over-the-counter pills that contained anabolic steroids to anabolic steroids themselves. But he wasn’t ready to take the plunge himself.
PED use wasn’t encouraged in the Army, Coffeen says. “But they weren’t gonna be upset if you were bigger, faster, and stronger, to fight the enemy.” (The United States Army randomly tests for illicit drugs including marijuana, cocaine, and MDMA, but only tests for steroids under suspicion. Steroid use can result in disciplinary action.)
By the time Coffeen left the Army, he’d become an exercise fanatic—he’d gotten into CrossFit and powerlifting, and eventually, bodybuilding. He knew PEDs were part of the sport, and he decided to try them. He eventually found a supplier overseas, sent a money order, and received vials of steroids in the mail. The vials didn’t come with syringes or needles—what PEDs users call pins—so Coffeen found himself in what he describes as a “veterinarian store,” telling them he wanted needles to administer a rabies shot to his dog.
To figure out how much he should use and how to cycle—the practice of using steroids for a set period before starting up again—Coffeen visited forums where bodybuilders shared anecdotes, documenting their dosages, lifting patterns, and side effects. He started with weekly doses of testosterone and oxandrolone. Oxandrolone was originally used to medically treat the effects of osteoporosis and various forms of illness- and surgically- induced weight loss but is no longer approved for use in the U.S. for reasons of both safety and efficacy, according to the FDA. Using oxandrolone combined with testosterone was supposed to help him achieve the muscular lean aesthetic typical of bodybuilders, but Coffeen still didn’t see the results he wanted.
He was so unhappy with the way he looked that he was willing to take extreme measures. “I got stronger, I got bigger, but it was not what I was looking for,” he says.
Today, walking on a treadmill, Coffeen, 35, cuts an impressive build, with gray-flecked hair and a thick mustache. On social media, he talks about his past and present PED use with candid self-awareness. In his videos, he often speaks to the camera with a syringe tucked behind his ear, a nod to his current steroid use. He still takes steroids and believes that using these drugs is a personal choice: “I was very confident in my job in the Army, very confident [in] my skills when I was in graduate school, but I didn't like the way that I looked,” he says.
Coffeen’s story used to be unusual—steroids and other PEDs were only something competitive bodybuilders whispered about in gyms, part of a niche culture of pros and elite athletes. But using gear (slang for steroids) has become increasingly common among young men who are recreational weight lifters not looking to compete. Fueled by a social media landscape where enhanced physiques are the norm and information on these drug compounds is accessible, more men are driven to seek results that are nearly impossible to obtain naturally. They turn to a range of substances, mixing legal and illegal drugs and using them in ways that are increasingly risky with little thought about the long-term repercussions. (Anabolic steroids, for example, are Schedule III drugs in the U.S. and illegal to possess without a valid prescription or to sell.)
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Based on research he co-authored, Harvard Medical School professor and McLean Hospital physician Harrison Pope notes that the majority of users today are recreational weight lifters. Pope is among the most published researchers investigating anabolic-androgenic steroid (AAS) use, which includes testosterone and many of its synthetically derived relatives, compounds that have muscle-building (anabolic) effects. The impact from using multiple PEDs over many years is not yet fully understood and likely won’t be for decades, but known side-effects include increased risk of heart attack, loss of fertility, and decreased sex drive.
The problem with PEDs use today is much more widespread and closer to home than many people believe, Pope warns.
How getting jacked went mainstream
Both mass media and social media have played a role in normalizing steroid use.
Arnold Schwarzenegger—multiple-time Mr. Olympia and Mr. Universe turned action movie star turned California governor—has been frank about how steroids helped him develop his physique, as he told Barbara Walters in 1974 and Men’s Health in 2023. Steroid use was largely legal when he was competing. (Schwarzenegger won his last bodybuilding title in 1980, while the law that made his gear illegal would be passed a decade later in the Anabolic Steroids Control Act of 1990.) He ushered in the era of jacked action heroes that included Sylvester Stallone, star of the Rambo and Rocky franchises. Stallone credited human growth hormone (HGH) and prescription testosterone for developing his ripped 209-pound physique as a 61-year-old, when he starred in the fourth Rambo film. Testosterone is so beneficial to aging men, he told Time in 2008, it would be sold over the counter in a decade.
The steroid-enhanced build became a regular part of entertainment, before many viewers understood the role that steroids played. The physique continued to be celebrated in pop culture, as the late wrestler Hulk Hogan—who admitted to using steroids in court in 1994—became a mainstay on America’s television screens. One of Stallone’s on-screen foils, Dolph Lundgren, admitted to using steroids in the 1980s and 1990s and wondered if this use led to his first cancer diagnosis. It's almost comically easy to identify a patient as a heavy anabolic steroid user, Pope says, given the degree of muscularity and disproportionate upper-body muscle definition that the compounds produce.
But if film and television fostered this physique, positing it as both desirable and obtainable, then social media has turbocharged that message. Vigorous Steve, a 42-year-old preternaturally jacked fitness influencer and PEDs educator who is open about his past and current steroid use, points to the power of peer pressure. He notes there are many influencers on social media who he believes are using steroids, “even if they’re lying about it.” Steve adds that it can lead impressionable young men to make permanently life-altering decisions during an interest in lifting and muscle gains that they may grow out of and come to regret.
What used to be mentioned in hushed tones, in brokered locker-room meetings, is now openly touted on social media, complete with graphics, guides, and recommended doses recommended down to the milligram.
Online fitness influencers openly assess if a guy is natty (natural), not natty (on steroids), or fake natty (pretending to be natural while using steroids). One prominent fitness influencer who goes by the mononym Derek on the YouTube channel More Plates More Dates—which has over two million subscribers—has grown his steroid discussions into something of an empire. While some social accounts address steroids seriously and soberly, others lean into the absurdity. One such account belongs to two jacked brothers who post content as The Tren Twins to their nearly two million subscribers on YouTube; their name references trenbolone, an anabolic steroid popular with bodybuilders. On their website, the duo leans into the joke, selling merchandise that says, “I love tren.”
For young men eager for gains, finding a range of PEDs and learning how to use them for maximum effect is as easy as scrolling their favorite app. Videos that serve as gleeful informercials for anabolics (“I love steroids, I’ll probably be on them forever”) can be found right next to videos that sound more like a personal injury lawyer’s ad (“Is Tren making you a paranoid psychopath?”) with the viewer left to make sense of the contradiction.
It's not just steroids, it’s the polypharmacy
There are several licit and illicit substances on the market, spanning from prescription testosterone to illegal anabolic steroids and legal drugs used off-label that are designated to treat animals. As a result, young men looking to get muscular often find themselves in a polypharmacy, taking multiple compounds to mitigate side effects while maximizing results. Experts are concerned that this heightened use of steroids, in addition to other compounds, could lead to longer-term side effects.
Testosterone and other traditional anabolics, like nandrolone and stanozolol, are still the most popular substances for users, says Katinka van de Ven, a principal consultant at 360Edge, an Australia-based alcohol and drug consultancy, and a visiting fellow at the University of New South Wales. She co-authored research on anabolic steroids, including studies around steroid use disorders in male weight lifters and the media’s stigmatization of steroids and steroid users.
Using multiple steroids, or steroids stacked with additional compounds, is now commonplace, van de Ven says. Common additions for performance include: HGH, which encourages muscle growth and fat loss (HGH is legal by prescription in the U.S.); tamoxifen and anastrozole, drugs prescribed to treat women’s breast cancer that are used to counter the estrogen-boosting effects of testosterone, such as gynecomastia; and clenbuterol, often referred to as clen, which is deployed as a fat burner, though its only approved clinical use in the U.S. is to treat asthma in horses.
Trenbolone is perhaps the most popular steroid by name; it has long been romanticized in the bodybuilding world, Steve says. Trenbolone has zero medically approved uses for humans (both in the U.S. and elsewhere) but is regularly employed to bulk up livestock cattle and increase their feed efficiency, or the amount of food it takes for the animals to gain weight.
Somewhat paradoxically, steroid use can suppress natural testosterone production, which can lead some users to require testosterone replacement therapy (TRT) just to maintain an average testosterone level after they’ve stopped their cycles.
Human chorionic gonadotrophin (hGC) can be used to mitigate testosterone suppression and is sometimes recommended by urologists in addition to—or instead of—TRT. One surprising compound used by bodybuilders is the lifesaving medication for people with diabetes: insulin. It’s taken by bodybuilders to boost muscle growth, despite serious risks including hypoglycemia and diabetic comas, van de Ven says.
The polypharmacy of compounds that steroid users subject themselves to, matched with prolonged and frequent use, raises the risk of “cardiovascular, hormonal, and psychiatric side effects,” van de Ven says. However, few services, if any, are available to those experiencing steroid-related health issues, and many doctors lack the training to effectively communicate with this group, she adds. It leaves many steroid consumers without sound, nonjudgmental medical advice, “pushing them further into peer forums or black-market sources for guidance.”
Blasting and cruising
When Vigorous Steve started steroid cycling about 15 years ago, the motto in the bodybuilding community was “time on is time off,” he says. The regimented break from using was important because it allowed for cataloging side effects. Steve says that on early internet forums, men would share cycle reports, offering week-to-week details on the compounds they’d injected, along with their results and observations. Users would sometimes report one or two weeks of immediate muscle gains, with common side effects like breast-tissue growth, acne, and blood pressure issues presenting after the third week. “That was a good place to learn what not to do,” Steve says.
But that’s changed. As the pressure to look jacked 24/7 has intensified, many users aren’t taking those regimented breaks anymore. Bodybuilders who cycle their gear expect to have periods where they carry more body fat, followed by a period of caloric restriction meant to lean out. Many men now want to walk around looking like they’re competition ready. That’s especially true for fitness influencers who must look flawless all the time, unlike bodybuilders of the past who needed to look perfect just a few days a year.
“You need to look good, so there’s no time off,” Steve says. Because of this, many have turned to what’s popularly referred to as blasting and cruising, an approach that could be described as doing steroids on steroids. In practice, blasting and cruising means that users “blast,” or take high doses of steroids to pack on additional muscle, and then “cruise” on lower doses intended to maintain that size and prevent the negative side effects of crashed testosterone, which can happen after abruptly stopping steroid use.
Blasting, Steve explains, is unhealthy, and cruising needs to be done to restore some state of health. When blasting and cruising, which Steve considers to be an outdated technique, the user is on steroids the entire time, prolonging their exposure, increasing their risk of long-term effects, and taking no time to give their body a chance to recuperate.
Both blasting and cruising and the polypharmacy are higher profile than they’ve ever been. With the advent of underground labs—black-market facilities ranging from home brew to small factories where raw materials are turned into injection-ready compounds—buying steroids went from a shady back-alley transaction to an easy online purchase. Selling steroids became just like any other online business, with sales promotions and buy-one-get-one-free offers. Compounding pharmacies, which offer custom formulations of drugs, provide a route for gear, sometimes incidentally—professional athletes have tested positive for PEDs after unwittingly taking prescription supplements contaminated with banned substances.
Men who want doctor-prescribed testosterone can still get it, thanks to online clinics that vary in their discretion. One doctor’s research highlights how dangerous that can be. In a secret-shopper study, Florida urologist and andrologist and host of the Man Up Podcast which focuses on men’s health issues, Justin Dubin sought out TRT from direct-to-consumer companies posing as a 34-year-old man who wanted to have children in the future. His blood work showed total testosterone levels of 675—an above-average reading and far away from 300, when most clinicians will consider TRT.
Based on his blood work and plans to have children, he was “clearly not a good candidate” for TRT, he says. Even so, six of the seven companies prescribed Dubin testosterone, and only three informed him of the fertility risks. Though TRT can increase libido and can treat erectile dysfunction in men with low testosterone, it can also cause spermatogenesis (the development of sperm) in the testes to sharply diminish or completely stop, resulting in infertility.
(Is there a 'low T' crisis? What young men need to know about testosterone therapy.)
The stigma around steroids
In bodybuilding, the entire ethos is more. More muscle is put on by more training, which is fueled by more nutrition, more protein, more extreme supplementation, and branding that emphasizes radical amounts of more.
David Crosland knows this firsthand. A former bodybuilder and current steroid harm reduction educator, Crosland was 415 pounds at his peak weight. “You’re not going to feel healthier at that size,” he says, and the side effects of steroids don’t help. “There’s an element of just generally feeling toxic,” he says. “You don’t feel healthy.”
Still, steroids are hard to quit, and it’s not just that users fear losing their gains, it’s more insidious. There’s a psychological dependency associated with steroids, and some users may fear a loss of identity if they stop taking them. Now 54 years old, Crosland knows the mentality firsthand. He first tried steroids when he was 19 and spent a total of seven years cycling gear on and off over a 25-year period. He explains how that logic can keep a user addicted: “I’m Big Dave. If I’m not big, I’m not Dave. I use drugs to get big. If I don’t have drugs, I’m not big, therefore I’m not Dave.”
Mair Underwood, an anthropologist in the School of Social Science at the University of Queensland who focuses on bodies, particularly body decoration and body modification, says that we “have done a real disservice to these guys.” The stigma around steroids is somewhat unique, even as more empathetic approaches to other substance use disorders and eating disorders have gained traction.
“It is hard to have sympathy for a big guy with a lot of muscles,” she says. People sometimes struggle to recognize when a powerful-looking man is suffering from a debilitating condition, like muscle dysmorphia, because body image problems are often thought to be exclusively a women’s issue.
That stigma can prevent users from seeking out health care, as well. Pope says there are many ways that steroids can adversely affect the cardiovascular system, including but not limited to raising cholesterol levels and increasing risk of heart attack and stroke. As a physician, Pope realizes that the average 20-year-old man probably isn’t thinking about what’s going to happen to his heart when he’s 60. But it’s not just the heart—there are neuroendocrine effects as well, which affect testosterone and sperm production. Long-term users risk a diminished sex drive or infertility.
“Some people don't fully recover normal testosterone levels, even several years after their last steroid exposure,” Pope says, though the mechanism as to why is not yet fully understood. And there can be effects on the brain such as increased irritability. Steroid use has also been associated with markedly increased aggression in some users. A 2009 review found that AAS use may have extensive health impacts like cardiovascular toxicity and psychiatric effects, including mood disorders. The jury is still out on cognitive effects.
If Crosland could go back in time to tell his younger self that he’d experience renal failure and a heart problem, he says, it wouldn’t have changed his decision to use steroids. “I was going to do what I was going to do. My whole mindset was to push the boundaries, to see how far I could push things, to see where the limits were,” he says.
Considering the repercussions
On Instagram, where he has more than 300,000 followers, Coffeen often posts daily-routine videos, reporting a day in the life of a bodybuilder and posing coach for professional bodybuilders. When he first started using—what he calls a time of "inappropriate use”—he experienced an “acne explosion,” and gynecomastia, which he had treated surgically. He recently had a cyst removed from his head, he says, caused by his previous anabolics use. He estimates that he’s experienced almost every steroid side effect.
While the physiological effects of hopping off gear can be managed, many users are not willing to part with the identity they’ve cultivated. “I, as of yet, have not found a steroid user that wants to stop using steroids but can't,” Crosland says.
Despite the side effects, Coffeen says he continues to use steroids, albeit smaller amounts, with regular blood work drawn every eight to 12 weeks. Since harmful drugs like alcohol and cigarettes can be celebrated and advertised, he finds the stigma around steroids to be nonsensical. Still, Coffeen advises younger men to take a beat before picking up a syringe—he doesn’t recommend making life-changing decisions based on a weight lifting phase that might end up being a hobby. Even if it’s a long-term goal, they first need to put in the time at the gym, get strict about their nutrition and sleep, and consider the repercussions.
“The first course of action is not to start to take steroids,” he says. “The first course of action is to stabilize everything in your life before you jump off the cliff into the unknown.”
