clock menu more-arrow no yes mobile

Filed under:

The open secret to looking like a superhero

How performance-enhancing drugs helped create the new male body standard.

An illustration of men with outstretched limbs superimposed on a larger man and a Hollywood sign at his head Christina Animashaun/Vox
Alex Abad-Santos is a senior correspondent who explains what society obsesses over, from Marvel and movies to fitness and skin care. He came to Vox in 2014. Prior to that, he worked at the Atlantic.

Timothy says he had nothing to lose during the pandemic, so he took steroids. It was, of course, a little more complicated than that. Timothy — who requested to be referred to by a pseudonym so he could speak freely about his steroid use — is an actor, although not one you’d see on the cover of magazines; he’s been working for 25 years, and he was on a criminally underrated show that you’ve probably heard of.

In 2020, when much of his industry was still struggling to figure out how to return to work, he watched a documentary about steroids being trafficked into the United States. It was his tipping point. The movie made getting steroids seem really easy and their benefits really sexy, he says, even though that wasn’t the point the film — which was about their dangers — was trying to get across.

As doctors, psychologists, and researchers told Vox, Timothy’s reaction is actually not so unusual.

Even before the documentary, Timothy had been kicking the idea around in his head. As a gay man living in Los Angeles, he has been inundated with images of male physical perfection. He saw every action star and every influencer sporting the same impossibly cut look. He noticed the men he’d see at auditions, the people he followed on Instagram, and guys at the gym getting bigger and bigger. Two of his friends got ripped so fast that Timothy’s shock wasn’t about the effects of the steroids or their frank admission, but rather that they didn’t tell him they were going to do it in the first place. He wanted a heads-up. At the same time, Timothy wasn’t getting any more buff, even though he seemed to dedicate the same amount of time to lifting heavy things up and putting heavy things down.

Timothy wanted to get muscles quickly, to feel more attractive, to see his arms, his back, his chest finally show off all the work he was putting them through.

After he took a three-month cycle of steroids, his muscles swelled and he got exponentially stronger. He felt he looked better. He was having more sex. Not just more sex, but sex with guys he thought were hotter. He was booking more jobs. (Seven television jobs, he told me.) His mood changed, he said, perhaps because moods tend to get better when you’re having more sex, getting more jobs, making more money, and feeling more confident.

When I last spoke to Timothy, he had a second cycle that he hadn’t begun. He’s probably at the gym right now.

An illustration of a person standing in front of the Hollywood sign and images of muscles.

Using steroids and other performance-enhancing drugs (PEDs) to get bigger, faster, stronger isn’t, by any means, a new enterprise — especially for men in certain circles. Historically, these drugs made news when it came to Olympic and professional athletes like Lance Armstrong, Mark McGwire, and A-Rod using them to achieve peak superhuman condition. In those high-profile sports cases, the implication is that those athletes were cheating. Cheating, especially when you’re caught, is bad.

But real life isn’t the Olympics or a professional sports league. In the US, it’s not legal to use steroids and PEDs without a prescription for personal and aesthetic gains, but it also isn’t considered “cheating” per se. And these drugs work very well — they wouldn’t be banned from the Olympics if they were duds.

That’s made PEDs, to doctors’ dismay, more popular than ever.

These drugs are dangerous and their long-term effects are understudied, experts say, but with what they offer, those concerns seem to get lost in the shuffle. We’re accustomed to buying what we need to improve our appearance, performance, and job prospects, and while PEDs are nominally forbidden to the average consumer, sources say they’re surprisingly easy to obtain.

What’s more, PEDs have already suffused our culture. We see their effects on the action heroes of mainstream movies, on the fitness influencers of Instagram, maybe even on the people lifting next to us at the gym. PEDs are becoming mainstream.

That’s changed the way the larger culture, especially men, think about men’s bodies, what they look like, and what we think they’re supposed to look like. Steroids and other PEDs have skewed our sense of what’s normal and attractive. What’s desirable might not be realistic or safe, and there are already many men out there willing to risk their health to achieve it.

Harrison Pope, a psychiatry professor at Harvard Medical School who is one of the leading researchers on steroid use, said there are usually two types of drugs we’re referring to when we talk about muscle-building PEDs: anabolic steroids and human growth hormone (although there is a vast array of drugs that boost athletic performance).

Anabolic steroids can build muscle, increase strength, and reduce body fat, especially in people who are working out two or three times a day, in a relatively short time. These steroids are a synthesized version of naturally occurring testosterone; when taken in heavy doses, steroids shut down organic testosterone production in the body. These drugs were popularized by bodybuilders in the ’80s and ’90s, and gained favor with young men who wanted more muscular bodies.

Pope said these drugs are quite effective at building bigger bodies: “A man who takes anabolic steroids, even if he works out and misses half of his workouts and smokes and drinks and so on, can still surpass even the most dedicated male who does not take steroids.”

That appeal, he said, can often seem to outweigh the health risks like the increased possibility of a stroke and potential cardiovascular problems.

The use of human growth hormone (HGH) for performance enhancement is even newer than that of steroids. HGH is a protein that naturally occurs in the body, but, just like testosterone, it decreases over time. This is one reason that the older you are, the harder it is to maintain muscle. Its conventional medical use, which began in the 1950s and was synthesized and FDA-approved in 1985, was primarily for children who have been diagnosed with a growth hormone deficiency and were smaller in stature. Doctors prescribe HGH to literally help these children grow. In adults, HGH has been prescribed to people with HIV to combat the loss of body mass. There are also studies of growth hormone therapy used to help treat cystic fibrosis, inflammatory bowel disease and Crohn’s, and osteoporosis.

Doctors are still studying the full effects of HGH, but they believe its performance-enhancing properties can lead to body fat reduction and muscle building and recovery.

“It helps you regulate or decrease the fat body mass,” said Olivier Rabin, the senior executive director of science and international partnerships at the World Anti-Doping Agency (WADA). WADA is best known for monitoring drug testing in the Olympics, among other competitive sporting events. Rabin’s expertise is in pharmacology and toxicology.

Rabin said that a popular method today is to combine the two; taking HGH with a steroid regimen allows someone to take lower doses of steroids — perhaps decreasing the side effects or dependency — while enhancing their effectiveness.

What worries Pope, Rabin, and their colleagues is how effective these drugs are and how little we know about their long-term effects. What’s already clear is how influential they can be.

In Los Angeles, you don’t just stop your car on the freeway — even if a very busy, very buff, very good-looking movie star needs to inject himself with performance-enhancing drugs.

Still, Amy, who asked to be referred to by a pseudonym in order to speak candidly about what she knows about PED use in Hollywood, found herself in a car veering onto the shoulder, asking her date if it could wait. “No, no, it has to be now,” she recalls him telling her, an alarm going off on his phone. “It’s very, very serious.”

“He gets out of the car, jabs himself in the abs with a needle, gets back in, and then we go,” Amy recalled. They weren’t even late for dinner.

Amy, who has been working as an actress and in entertainment for 20 years, explains that she is good at being discreet and protecting her friends. She doesn’t get starstruck. She doesn’t want anyone to get in trouble. But at the same time, she says, she’s witnessed so many people she cares about put their bodies through hell — endless workouts, diets calculated to the last fraction of a calorie, no nights out — for just a glimmer of success in the industry. Keeping quiet about use, she says, is part of the job.

For male actors especially, getting a part in action and especially superhero movies is the way to become a star. With a few rare exceptions, that means your body has to look superheroic: abs so sharp and defined that their valleys could catch water, torsos like pyramids turned upside down, shoulders that look more like boulders, butts that have their own gravitational pull.

The public notices the gains. There are entire sections of BuzzFeed devoted to ogling male stars’ bodies, but the media also turns to concern and shaming when stars get a little too big for their taste; speculation about how stars beef up runs rampant among fans as well.

“I’ve been amazed when I watch movies that famous actors are very muscular in. They’ve got more muscle mass than some athletes who have been training for years. Interesting,” Rabin, the WADA director, said. “They say they train two or three hours every day? Sure, I can believe that. But what else are they doing?

The “what else” is sometimes PEDs, insiders say.

Aaron Williamson is one of Hollywood’s top trainers. A US Army veteran, stunt performer, and bodybuilder, he has worked as a trainer and consultant for movies like The Fantastic Four, G.I. Joe Retaliation, Terminator Genisys, and Neighbors. Williamson said he had personally used PEDs in the past while competing but no longer does. He also firmly said he does not encourage the use of PEDs when training his clients, “but I know it’s a thing.”

According to a 2013 report from the Hollywood Reporter, fellow celebrity trainer Happy Hill estimated that roughly 20 percent of actors use PEDs to achieve their physiques. I asked Williamson about that estimate, and he said he believes the number has gone up due to increased industry demands.

“Actors are trying to get on camera and blow everyone away,” Williamson said. “Everyone’s just maxed out, doing everything possible to look superhuman.”

An illustration of a torso and an outstretched arm.

PED use is not just a Hollywood trend.

Social media influencers, particularly fitness influencers, use the drugs, too, Williamson said. Fitness influencers’ followings are based in large part on how fit they look, and the more popular the fitness influencer, the more sponsorships and money come their way. Using steroids and other PEDs to achieve that look could give them an edge.

Amateur influencers’ use of these drugs can do a disservice and present danger to their followers, Williamson said. “Those are typically the guys who are completely ignorant about it, and who don’t know their ass from a hole in the ground.”

Experts I spoke to said they believe some actors and influencers are on PEDs because of how fast their bodies change, how big they are, and how old some of them are. The older we get, the more difficult it is to put on and maintain muscle without help; hormone decline is one of the reasons cited for the loss of muscle mass in aging bodies. The quicker and more dramatic the transformation, the less likely it’s just diet and exercise.

“Someone might do a film where they have to look like a ‘normal’ person,” Williamson said, “and then for their next project, they’ve got to look like this bulked-up, crazy-looking superhero guy. It’s impossible to go from one extreme to the other overnight without some type of help.”

These physical metamorphoses are themselves a selling point for movies. Big blockbusters have traditionally been accompanied by stars appearing on covers of men’s fitness magazines, touting the workouts (usually lots of abs and arms) and diets (vegetables, egg whites, chicken breasts) that got them there. Big, bold letters will proclaim how you too can go from zero to hero. After transformation, a lot of those stars are also implicitly supposed to maintain some semblance of their physiques in their next projects.

None of this happens in a vacuum. PED-enhanced bodies trickle down into our psyches, pushing and pulling our sense of “normal” and tweaking our sense of desirability. “I think the saddest thing is that I spent most of my physical life being like, ‘What am I doing wrong?’” Timothy, the TV actor, tells me. “I did the exercise. I’ve been going to the gym since I was 15. I wish I just had known this is actually not possible through hard work, determination, and merit.”

If movies, television shows, Instagram posts, magazine covers, and everything in between keep telling us these bodies are sexy without saying they’re unrealistic, it can do a number on men’s brains. For some, this is confounding, leaving them stuck and unhappy with their results. Others who are savvy enough to know that gaining 25 pounds of muscle isn’t really realistic may seek out the drugs to emulate the look.

And it’s often easy to find them.

According to doctors, Hollywood insiders, and regular gym-going sources, anabolic steroids are the cheapest and most common of all PEDs. Doctors see misuse among civilian gym-goers. Meanwhile, medical-grade HGH is harder to find because of prescription controls and expense.

“Under ordinary circumstances, physicians shouldn’t be prescribing hormones for normal adult males,” said Ruth Wood, a neuroscientist who researches steroid abuse at the University of Southern California. But they are.

Across the country, you can find clinics advertising hormone replacement therapy to men diagnosed with low testosterone. Testosterone is also used in gender-affirming hormone therapy for transgender men and nonbinary people.

Testosterone is itself an anabolic steroid, its presence in the body monitored in athletic competitions, but it is usually prescribed to men over a certain age since testosterone levels decline as men get older. As a CBS investigation found in 2019, the regulation surrounding said clinics is spotty, with clinics prescribing hormones like testosterone to people with normal levels.

Testosterone prescribed to American men tripled between 2001 and 2011, the BBC reported. After the 10 years of growth, a research letter published in the Journal of the American Medical Association found that prescriptions decreased from 2013 to 2016, which coincided with a safety warning from the FDA about testosterone being linked to increased cardiovascular “adverse events” and stroke risks. (It should be noted that the researchers wrote that one of the limitations of the study is that testosterone procured without insurance was not studied.)

Because HGH prescriptions are both required and usually difficult to procure in the US, Wood said, HGH is one of the drugs that commonly go “missing” between manufacturing and shipping. The doses that never make it to pharmacies are very likely resold on the black market.

Amy, the actress with deep connections in the industry, has seen actors get what they need through “friendly” doctors and extralegal means. Procuring PEDs, Timothy said, is usually done by word of mouth, and through physicians who are willing to flout the rules.

“There’s a doctor and it’s like a two-year fucking waiting list to get with him,” Timothy said. “And this guy gives out HGH like candy — you just have to get on that list. And you have to get into his little fucking circle, which I never got through to.”

Fearing trouble, Timothy didn’t go through his business contacts when he started his regimen. Instead, he asked a friend with an impressive muscle-to-height ratio if he was on steroids. That friend put Timothy in touch with his contact, whom we’ll call David. David got him his first cycle of steroids.

David (who isn’t an actor) didn’t want to be named in this story because unauthorized steroid distribution is illegal. He began experimenting with steroids after his doctor diagnosed him with low testosterone around a decade ago.

“I never really thought about shooting myself in the butt with hormones. But here I was, doing it every week in a clinical setting,” David said. After digging around, he found that other anabolic steroids were not only a cheaper alternative to the $40 per week he was spending on testosterone but also more effective at building muscle. For example, a steroid like Trenbolone, which is used to fatten livestock and is not approved by doctors for human use, has a much more powerful muscle-building effect than testosterone in humans.

“I’ve purchased steroids from a couple different mediums. I’ve lived in the United States and Europe and done it in both places,” he told me, explaining that in America, the substances are probably created or procured across the border in Mexico, brought in, and shipped. Experts I spoke to confirmed that the legality of substances varies from country to country and that drugs can be brought across the border from Mexico. (David said he also knows a scientist who creates anabolic steroids in his own batches.)

David said it wouldn’t be impossible to find HGH on the black market or for resale, but that it comes at a high price.

“That’s just a lot more of a difficult channel and they’re far, far, far more expensive. That would be out of reach when you’re just an average person with an average expendable income to be using on steroids,” he said. People I spoke to said that the dollar amounts can range wildly, but medical-grade HGH is at least a few thousand US dollars per month.

While David and Timothy’s relationship was cultivated in person, it’s not hard to find the same conversations happening online. It happens in Reddit threads, bodybuilding forums, and even Instagram pages discussing PEDs. Some online businesses advertise supposed PEDs for purchase. It’s gotten to the point where steroids and other PEDs function as memes.

According to the scientists I spoke to who study steroids, determining how widespread their use is can be hard.

“There is a lack of extensive studies on steroid use in the US. This contributes to the sense among public health leaders that steroid use isn’t a real problem. If you don’t study the problem, you are less likely to observe it,” Wood told me.

The National Institute on Drug Abuse wrote in 2018 that it’s difficult to ascertain “the true prevalence of steroid misuse in the United States because many surveys that ask about illicit drug use do not include questions about steroids,” and that usage studies in the past have focused on youths in high school and middle school, leaving out broad swaths of the population.

An illustration of a man working out with a ball and a dotted line connecting them to a muscled torso.

Rabin said that WADA has seen a decrease in positive PED tests among athletes because of how frequently testing occurs. WADA has, with each year, increased the number of tests on athletes and improved the technology needed to detect them. The testing isn’t perfect. WADA and the Olympics were criticized over some of their decisions, including disqualifications on two Namibian female sprinters for having high amounts of natural testosterone. But, Rabin thinks, the extensive testing has helped deter the use of PEDs and made the sport cleaner.

With the public, though, there is no such protocol.

Rabin said people seeking steroids “have got access to a lot of different drugs on the internet. And it’s so easy, you’re just a couple of clicks away from ordering all sorts of substances, legal or illegal.”

Thanks to my school’s D.A.R.E. program, steroids conjured up a nightmare kaleidoscope of shrunken testicles, premature balding, excessive acne, uncontrollable rage, and death. These effects, the program taught, happen quickly — you basically get buff and then you die.

That kind of education is misleading, and even detrimental to preventing use.

“It’s like the way that we were told as kids that if you smoked weed once you would be a drug addict for the rest of your life. They lie to us,” Timothy, the actor, said of how he was taught about steroids and whether he’s nervous about the risk involved. “Like, movie stars do steroids all the time. More and more of my friends are taking steroids; they’re not dead yet.”

Drug education in the US has historically used fear to drive the point home, but that can lead to skepticism when the fears are revealed to be exaggerated. PEDs can lead to grim consequences, but they usually don’t happen instantly. Not every nightmare scenario happens, and not all at the same time.

The illegality of some PEDs is part of the problem in determining side effects and how dangerous they may be. While there are studies of anabolic steroid use in patients, it does not extend to the wide array of PEDs, nor can you conduct a study simulating heavy use over time. Pumping volunteers full of steroids isn’t ethical and would put them in danger. People can be hesitant to disclose their use, as they’d be admitting to breaking the law. When doctors like Harrison Pope study steroids and PEDs, then, they rely on volunteers with past or current drug use coming forward, sometimes to varying degrees.

The use of anabolic steroids is still fairly new, Pope said. The bodybuilders who popularized them in the ’80s and ’90s were mostly in their 20s and 30s. That means the first batch of heavy steroid users are just now coming out of middle age, and Pope and his cohort have only been able to study long-term effects for the past decade or so, and only with this select group of people. HGH is even more difficult to study, as its use as a PED is even more recent.

Pope uses smoking to illustrate our relative lack of knowledge. In 2021, it’s impossible to consider smoking without thinking about its connection to lung cancer. This was not always the case, however. Even though lung cancer had surged alongside the popularity of cigarettes at the turn of the 20th century enough to become an epidemic, it would take decades until scientists in the 1950s and ’60s found a concrete connection and made the public aware of it.

PEDs have barely begun that arc, and what doctors and scientists are seeing now, he fears, is akin to pulmonary doctors finding the first few cases of lung cancer in heavy smokers, having “no idea of what was about to hit us.”

“We may see a substantial increase in cases of cardiac complications over the next decade or two, as this group moves into older ages,” Pope said.

Steroids make muscles in your body stronger and bigger, but something funny can happen to your heart, arguably your most important muscle. With heavy steroid use, your heart may become weaker, more inefficient at pumping blood. Inefficient hearts can lead to heart failure. Steroids can also harden arteries and increase the risk of heart attacks and stroke.

Pope and his colleagues recently completed a study involving long-term steroid-using weightlifters and weightlifters who didn’t use steroids, to establish the risks of long-term use.

“Of the 86 steroid users, three had a heart attack prior to the age of 45. Whereas of the 54 comparison weightlifters, none of them had had a heart attack,” Pope said.

New research may also lead to reversals of what doctors thought they knew about steroids, with often-discussed side effects having a more permanent effect than expected. It’s well-known that steroid use causes natural testosterone production to shut down, makes testes shrink, and can lead to a loss of sex drive and erectile dysfunction. But, Pope said, “if you asked me 20 years ago if the testes would rebound back to normal, I would have assured you that, yes, after a certain amount of time, testicular function would come back online and the testosterone levels will come back to normal. It turns out I was wrong.”

Another wrinkle with steroids is that desired results are tied to long-term use. Steroid users could quit cold turkey, but quitting abruptly throws testosterone levels into chaos and causes the user to lose any physical gains they’d made. Bodies and brains may not rev up testosterone production instantly.

Wood, the USC researcher, said that consistent users may not completely wean themselves off the drugs they’re using, and instead switch to a lower dosage. When studying athletes who used PEDs, users needed to continue their regimen to maintain their physical prowess while at the same time making up for their bodies shutting down their natural production of testosterone.

Without extensive medical trials, one of the methods doctors employ to study steroids is to test them on rodents. Wood is using this method to study the cognitive effects of steroids, including whether they’re habit-forming. Unlike humans, animals don’t seem to have body dysmorphia and aren’t swayed by the promise of getting stronger or looking better. Her initial research has found that rodents will self-administer both testosterone and anabolic steroids, possibly indicating that there is an addictive quality to them.

Her research has also shown that animals given steroids have shown less cognitive flexibility and exhibit more risk-taking behavior — a pattern that mirrors the “roid rage” symptoms sometimes seen in humans.

Wood, Pope, and their colleagues may also have to contend with emerging drugs that are more effective, seemingly with less immediate negative impact.

The full side effects of HGH as a PED are still being studied, but research suggests they include insulin resistance, increased risk of certain cancers, and increased breast tissue in men. Still, one of the hyped talking points of HGH is that it comes with fewer or less serious side effects than anabolic steroids.

And while HGH seems like the cutting edge in performance enhancement, there are even newer drugs on the rise. “We’ve also seen a new class of substances that has been called selective androgen receptor modulators (SARMs) that are anabolic-like substances, but they are said to be without some of the side effects and undesirable effects of steroids,” said Rabin, the WADA expert. “We’ve seen these new kinds of substances coming to the market, in particular the illegal market.”

The problem, said Wood and Pope, is that because these side effects don’t happen immediately, they’re not perceived as scary enough to outweigh the benefits of PEDs. Shorter-term side effects appear to be less common with new PEDs, and long-term effects — including cardiovascular, liver, and kidney issues — don’t show up until later in life. It’s hard for users to conceptualize drawbacks. The thought of getting stiff arteries in 40 years or having a heart attack at 60 might not faze someone who wants to look muscular in two months.

“I think there’s a study where they asked Olympic-level athletes if they would do something that would give them a gold medal but kill them in 10 years, and a fairly substantial fraction said, ‘Yep, I’d do it,’” Wood said, putting PEDs’ risk-reward trade-off in perspective. It’s difficult to argue instant gratification against future risk.

Roberto Olivardia, a psychologist who lectures at Harvard Medical School and specializes in treatment of body dysmorphia in boys and men, said that the combination of social media, trends in popular culture, and increased steroid use has coincided with an increase in muscle dysmorphia. The term primarily refers to boys and men who are dissatisfied with their appearance because they perceive their muscles as too small, no matter their size.

“Doing this work for 21 years, I saw a real shift in my practice when the internet and social media took off,” Olivardia told me, explaining that muscle idolization has always been a part of American culture but has exploded in the past few years. “Now young boys are getting information about the substances and have access to imagery — and it’s not only just celebrities now. It’s their peers, and they’re Photoshopping pictures of themselves. It’s definitely increasing.”

Olivardia said that his patients are getting younger and younger, which he finds worrisome. For muscle dysmorphia, the youngest patients he sees are 15 and 16 years old. The oldest patients he sees are in their 50s.

Body dysmorphia is a discussion we’ve been having culturally for decades, but mostly as it concerns women and girls. Standards of beauty for the female body have long been exacting and unrealistic. This same kind of specificity and harm may be more novel for men. One of the narratives surrounding famous women’s bodies is on using the artificial — plastic surgery, Photoshop, Instagram filters — to achieve the unrealistic. With men’s bodies, the narrative is often that unrealistic results are solely a product of hard work.

His younger patients often look up celebrities’ workout routines in the hope they can copy them. The hard part, Olivardia said, is making it clear to boys that it’s unrealistic to achieve those kinds of bodies without the chefs, trainers, money, and sometimes substances that those actors have access to.

“There are a number of people that I’ve worked with in Hollywood who have said steroids and PEDs are a little secret, but they see it as a necessary component of their jobs,” he said. “A lot of these young boys and young men look at this imagery, and they’re frustrated as to why they can’t look like that. They’re not taking into consideration all those factors.”

A barrier to this is that the framework to talk about mens’ and boys’ body issues doesn’t exist. There’s a lack of attention to problems like body dysmorphia and eating disorders in men and boys. Coupled with the lack of transparency around steroids and other PEDs, it raises the question of what we all think the male body is supposed to look like.

“For people who are within gym culture, it becomes very obvious what is and is not achievable without help,” Michael Collins, a bodybuilder and podcaster, told me. “These are unnatural bodies; these are not the way humans are meant by nature to look like. I don’t see a problem with that — Botox is unnatural. If you want to get Botox, go ahead. But let’s be clear, in terms of our biology, we have this trick in order to look like that.”

An illustration of a man working out in a circle of muscle images.

Collins grew up idolizing the bodies of ’80s action heroes like Jean-Claude Van Damme or Arnold Schwarzenegger. He found them sexy, and he wanted to get the same look. It’s what made him get into bodybuilding and shaped his view on steroids; he knew the only way to get the body he wanted was with PEDs.

“I think a lot of the misery that comes from our current situation [is that] steroids are everywhere, but you can’t talk about them,” he told me, explaining that he has been using steroids for four years and compared the danger to going out and taking drugs at parties. It’s a risk he’s willing to take.

“Taking some MDMA is a choice that someone can make. As far as I’m concerned, that is a perfectly fine lifestyle choice if that’s what you want to do with your life. There’s use and there is abuse. It’s similar with steroids,” he argued.

Collins gets at a bigger question of harm reduction — the way we approach substance abuse in respect to other recreational substances — with steroids and other PEDs. If abstinence-only education on PEDs hasn’t stopped people from taking them, and steroids and PEDs have risen in popularity, is there a better way to approach this subject?

Wood and Pope don’t believe there’s a risk-free experience. Pope said one of the big risks he fears is that as PEDs’ efficiency becomes more well-known, it may actually increase usage. Olivardia agreed, and said that with the patients he sees, the only path to safety is quitting the drugs.

“When I’m working with these patients with muscle dysmorphia, my position is there is no safe use available with anabolic steroids,” Olivardia said, pointing to several psychological consequences he’s seen — hypomania, psychosis, and depressive states during withdrawal — in addition to the physical risks PEDs present.

Olivardia and others in his field said there’s just too much risk with even mild use of PEDs. Plus, it’s hard to convey to young men that they’re playing Russian roulette with their health.

“You’re doing something that’s messing with your hormones,” Olivardia told me. “There’s some people that smoke cigarettes and never develop lung cancer, but we know if you smoke, you’re increasing your risk of lung cancer. For some people, that might be lung cancer in their 60s, and some people might get it in their early 40s. And so it’s painting a more accurate picture to them about the risks.”

What troubles Pope isn’t just the risk but the possibility that education would encourage even more usage. The more a layperson learns about PEDs, the more they’ll learn that the drugs are effective. That’s dangerous, experts say.

“The problem with many educational campaigns is that when guys find out just how effective these drugs really are, it may actually backfire. They’re even more tempted to take them,” Pope said. “If you’re going to educate, you have to begin by conceding that, you know, these drugs really do work.”

If you want to see what he means, open up Instagram, head to your local multiplex, or pop by the gym. The results are unmistakable.

Supreme Court

The Supreme Court seeks a middle path between following the law and blowing up the government

Supreme Court

Elon Musk’s attempt to silence his critics will be heard by one of America’s worst judges


Why Diet Coke got so expensive

View all stories in Money