Do not use anabolic steroids (“muscle‑building injections” or “oral pills”) to build muscle

5. Do not use anabolic steroids (“muscle‑building injections” or “oral pills”) to build muscle

Cost: There is no cost involved; you even save money on medication. The hard part is accepting that muscle growth will be slow.

In plain terms: A Danish study followed 545 men who tested positive for anabolic steroids and compared them with 5,450 age‑matched controls. Users had a three‑fold higher risk of death, and the median number of hospital visits per year was 0.81 versus 0.36 for controls. More than 10 % of steroid users developed acne, gynecomastia, or erectile dysfunction. In China these drugs are prescription‑only, and any source selling them illegally is breaking the law.

Benefit: The Danish researchers matched each steroid user with a control of the same age. The original cohort comprised 545 men whose androgenic steroid tests were positive between 2006‑01‑03 and 2018‑03‑01; they were paired with 5,450 controls. An additional validation used 644 refusers and 6,440 controls. Results showed a three‑fold increase in mortality among users (HR = 3.0; 95 % CI 1.3–7.0). The median yearly number of hospital visits was 0.81 versus 0.36 (P < 0.0001). Median means that half of the users had more visits and half fewer; such a low P‑value indicates this difference is highly unlikely to be random. Acne, gynecomastia, and erectile dysfunction each affected over 10 % of users – at least one in ten – a rate far above that of controls (P < 0.0001). The validation cohort yielded the same findings. Article 7 of China’s Anti‑Doping Regulations states that all substances on the prohibited list are strictly controlled; no entity may produce, sell, import, or export them illegally. The same regulation designates anabolic agents and peptide hormones as prescription drugs, meaning they may be obtained only with a doctor’s prescription; “anabolic agents” is the official term used in legislation.

Evidence grade: A

Sources: Horwitz H et al. (2019). Health consequences of androgenic anabolic steroid use. J Intern Med. <https://doi.org/10.1111/joim.12850>; State Council of China (2004). Anti-Doping Regulations (State Council of China Order No. 398, Article 7, Article 9). <http://www.gov.cn/gongbao/content/2004/content_63129.htm>

Notes: This is an observational study, not a randomized trial; steroid users may also engage in other risky behaviors, so the three‑fold risk increase may not be attributable solely to the drugs. The true effect size likely falls between 1.3 and 7.0. However, visible side effects such as acne, gynecomastia, and erectile dysfunction are less prone to bias. Legally these products are termed “anabolic agents”; any product described with that phrase contains them. Ordinary protein powder or creatine does not fall under this category. A problem is that some products marketed as “muscle‑building powders” or “nutritional supplements” may contain hidden steroids while claiming rapid results. The screening method is the same as for weight‑loss products (see item 4: avoid any weight‑loss drug promising quick results). Legitimate drugs are prescription‑only and carry verifiable approval numbers; any product sold as a “muscle‑building supplement” that promises results within weeks is probably adulterated.