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

Men who test positive on a gym doping check have 3 times the risk of death of people the same age, and they go to the hospital more than twice as often each year. Acne, male breast growth, and trouble getting an erection each hit at least 1 in 10 of the people who use these drugs. In China these drugs are prescription drugs, and a channel that sells them to you without a prescription is itself breaking the law.

Cost

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

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 5450 controls. An additional validation used 644 refusers and 6440 controls. Results showed a three‑fold increase in mortality among users (HR = 3.0; 95 % CI 1.3–7.0). The true multiple sits roughly between 1.3 and 7. 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.

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.

Sources · 2

1. Horwitz H et al. (2019). Health consequences of androgenic anabolic steroid use. J Intern Med. doi.org/10.1111/joim.12850
2. 国务院 (2004). 反兴奋剂条例（国务院令第 398 号，第七条、第九条）. gov.cn/gongbao/content/2004/content_63129.htm