Stock photo: Charlie Kwai

In April this year, former Love Island contestant Tom Powell live-streamed his breast reduction operation in an effort to reduce the stigma around enlarged male breast tissue. Gynecomastia is estimated to affect anywhere from 30 to 70 per cent of males at some stage of their lives. And “gyne”, as it’s commonly known, is not only an unwelcome (and ironic) side-effect of anabolic-androgenic – that is, muscle-building and masculinising – steroids: it can also be caused by other hormonal disruptors such as alcohol, cigarettes, cannabis, obesity, puberty (usually temporarily) and old age. But Powell says his gyne was “99 percent” likely due to steroids. 

Fitness coach Powell was awake and talking throughout the procedure last month at the Cardiff branch of Signature Clinic, a cosmetic surgery group which for the past year has averaged 100 gynecomastia patients a month across its six locations in UK and Ireland. Original Geordie Shore cast member Jay Gardner, also now a fitness coach, was treated in Signature’s Manchester clinic in December 2021. April 2022 was a bumper month for the group with 170 such procedures performed, including Powell’s. Roughly 40 to 45 percent of Signature’s gynecomastia patients, says co-founder Christian Gotti, are users of Image- and Performance-Enhancing Drugs (IPEDs).

Powell waited for two weeks after his surgery before hitting the gym, but nevertheless after working out one of his nipples became red and irritated. Complication rates with gynecomastia treatment are, says Gotti, “very, very low”. Over more than three years and 3,000 patients, the clinics have reported only a couple of cases of “indents” (which are then filled in with a fat transfer) or of nipples dying (these are replaced by one created from skin grafts, usually from the thigh). Five percent of gyne patients, says Gotti, develop “unfortunate” infections, usually caused by returning to training too soon, which are “easily” resolved by antibiotics. When I spoke to Powell, his infection wasn’t improving after five days of antibiotics and he was starting to regret the operation. But, he said, he’d made the decision: “Now I’ve got to carry on with it.”

Love Island has been blamed, by the Mental Health Foundation and UK Anti-Doping among others, for increasing body image pressure and IPED use. Powell, who was already in cover-model shape before becoming a contestant, says he didn’t take steroids until after his 2016 appearance on the show. Powell met his idols growing up, “shredded” influencers the Harrison twins, who he says told him that “everyone” in the fitness industry was on steroids. Powell “ended up taking” human growth hormone – not a steroid but a Class-C drug (illegal to supply), with its own potential side effects including enlarged jaw, forehead, hands and feet – after he got injured playing rugby for Wales U16s, but claims to have taken nothing between then and leaving Love Island. Still, if he wanted to be a fitness influencer, he reasoned, he had to take steroids too.

Powell estimates 50 percent – if not more – of male gym-goers in his native South Wales are on steroids, which have been “a part of culture” in the area since he was growing up. Still, he’s never heard of so many young lads being on them: “Oh, crazy.” Powell didn’t take steroids until he was 25; the other day, one of his clients (barely 18 and training for just six months) announced he was going on his first “cycle”.

“I’m like, ‘Shit,’” says Powell, now 30. “If all the boys are on it, at [that] age, where are we going?”

The pandemic made keeping tabs on steroid use even more difficult for researchers, although one study showed lockdowns limited dosages and training, impacting users’ mental health. And COVID-19 anxiety has been associated with greater muscularity dissatisfaction in men, the researchers speculated because of increased screen time and restricted opportunities to lift weights in gyms, play sports or otherwise derive “masculine capital” (read: man points). Hegemonic masculinity, that study’s authors wrote, “emphasises toughness, self-reliance and pursuit of status”, so pandemic stress may lead men to place greater emphasis on muscularity. 

Joe Kean, Northamptonshire services manager for national drug and alcohol treatment provider Change Grow Live, says he and his colleagues across the country are now seeing more young steroid users – under 30, if not 25 – coming into needle exchanges. The rise is  thought to be in anticipation of a post-pandemic summer when they can finally go out and go on holiday.

Kean is also an independent researcher into steroids, and a former user who started after he was sent down in 2003 for smuggling other drugs (heroin, cocaine, amphetamines, cannabis) and got injured playing for the prison rugby team. Young steroid users are, he says, driven primarily by aesthetics and appealing to prospective sexual partners. Despite often feeling confident – even invincible – steroid users are also, he says, at greater risk of contracting a sexually transmitted disease.

For young steroid users, it’s all about body image and confidence, says Andrew Richardson, a researcher at Teesside University, himself a former (clean) powerlifter for Ireland. Older users he’s spoken to meanwhile lament that gym culture has changed, complaining about “kids” who come in, headphones on, and engage more with their phones than other lifters. Instead of “paying their dues” by training for years to max out their natural muscle-building potential, these kids want to go straight on steroids. And they can get them online, no questions asked, rather than having to brave a backstreet gym where the local dealer might give them a small dose to start and some advice, however anecdotal or scientifically unsound. That “pastoral” care (as researchers have termed it) and gatekeeping can now be bypassed.

The new generation of lifters are disparaged as “SARM goblins” for their embrace of the new generation of IPEDs called Selective Androgen Receptor Modulators, which supposedly provide most of the benefits of steroids and fewer of the side-effects, and can be bought online on sites like eBay and Depop. Only available as late as 2015 and classed as “research chemicals”, SARMs are legal to sell, but not for human consumption, the risks of which haven’t yet been extensively researched. Their pill form can nevertheless make them less daunting to newbies than injecting, much like oral steroids, which are in fact more toxic to the liver than injectables. The US Food and Drug Administration has warned that SARMs can cause liver damage, heart attacks and strokes. Powell is, in his words, “not a fan” of SARMs, and wary of the unknown long-term effects.

Steroids can enhance performance in the bedroom, says Richardson, or do the complete opposite. He’s collaborating on a paper about James, whose name has been changed to protect his identity. After starting to use steroids around the age of 25, James experienced increased sex drive and erectile dysfunction, leaving him feeling “like a hamster on a wheel”. Rather than come off steroids, James would excuse himself before sex and go to the bathroom to inject his penis with the ultra-strong erectile dysfunction drug Alprostadil, then endure the subsequent four-hour erection. As Richardson and his colleagues remark, in the pursuit of augmented manhood, James impaired his, well, manhood.

While on “tren” (trenbolone acetate), one of the most potent steroids, Powell couldn’t keep a hard-on as long as he wanted. He had night sweats and nightmares. Normally chilled, he felt jealous, worried and temperamental. And he suspects tren caused his gyne. He’d researched the side effects beforehand and believed he could mitigate them: “But it didn’t work out like I thought.” Most lads, he says, don’t think about the side effects, or think any fallout will be reversible.

What you do under the influence of steroids however may not be reversible. One on-off client of Powell’s ignored his warnings, went on tren and ended up getting into a fight at a festival; also while on tren, Kean found himself ranting and raving at a guy in an Asda car park. Not every steroid user experiences stereotypical “roid rage”, but even a slight increase in irascibility could be the difference between kicking off and walking away, as Kean ultimately did in Asda. Some users, he says, actively want more aggression, fuelling up on steroids, alcohol and cocaine to go out fighting. 

Kean says more steroid users are presenting with mental health issues ranging from low-level anxiety to full-blown breakdowns and suicidal thoughts. One user in his early thirties coming off steroids called the police to take his children away because he felt they were unsafe with him. Not to be “alarmist”, says Kean, but a seller may not exactly advertise that risk.

There’s also an increase in steroid users accessing support to come off the drugs. Steroids aren’t acutely intoxicating but do have a hedonic effect: male hamsters will self-inject testosterone (via a nose poke-hole) to death. Steroid users can get addicted to looking and feeling like a superhero, which contrasts starkly to the results when they try to stop using. A surplus of steroids from outside the body shuts down production of testosterone, nature’s own steroid, which can take weeks, months or in some cases years to restart: hypogonadism, as it’s known, can result in erectile dysfunction, low libido, decreased energy and, in some cases, depression. Unsurprisingly, users can opt to go back on steroids and never stop.

Dissuading young steroid users is difficult partly because most of the really life-limiting side effects – persistent hypogonadism, heart problems, toxicity of the liver, kidneys and brain – tend to be long-term, although more 30-year-olds are suffering heart attacks from what Kean and his colleagues call “the holy trinity” of steroids, booze and coke. An 18-year-old steroid user likely doesn’t care that they might drop dead at 50; they may care about more pressing concerns such as STDs, erectile dysfunction and breast tissue. 

A 2013 study found the HIV rate among injecting IPED users in England and Wales was 1.5 percent, comparable to 1.2 percent among users of psychoactive drugs like heroin and crack. Steroid users don’t, says Kean, see themselves as drug-users or doing something that could harm their health, so often don’t consider the risks of sharing vials, water or needles. A lot of steroid users, he says, don’t even come into needle exchanges, which they worry about the stigma around, relying instead on secondary distribution: One person might collect ‘“works” – injection equipment – for ten others who then bypass the safety information given out at exchanges.

Published last year, the second part of Professor Dame Carol Black’s independent review on drugs for the government focused on treatment and prevention, and placed an emphasis on harm reduction across the board. Steroids-wise, says Kean, the priority should be getting clean works out there, followed by good information. Needle exchanges often have dedicated clinic times for steroid users, who can learn about safer injection techniques, how to identify fake or low-quality gear and get facts from experts, rather than from a guru in a gym or online forum.

Powell doesn’t, he says, recommend steroids to anyone. But he does advise young lads about their cycles, because otherwise “they’re going to go somewhere else and do whatever they want”. Powell currently “cruises”, which is to say takes a lower dose of testosterone only; he reckons he’ll be on self-prescribed “testosterone replacement therapy” for life. When he started taking steroids, he was “obsessed” with looks and bodybuilding, whereas now he’s more into CrossFit-style functional training and “all-round health and fitness”.

“So, if I knew then what I know now, I probably wouldn’t take them.”

@mrjamiemillar