‘Why are my biceps so small?’ The boys and young men turning to steroids | Body image

One month ago, Nick*, an 18-year-old university student living in the United States, got some devastating news: his little brother has cancer. It’s one of the worst times of Nick’s life, he says, but he’s “still positive”.

“I wake up with a smile on my face,” he says. Not because of family support or a miracle cure, but because he has a potent combination of chemicals coursing through his veins: steroids.

At the same time that his brother was diagnosed, Nick started taking testosterone and metandienone (dbol). He began using the drugs to change himself, physically. “I hate the idea of being average,” Nick says.

The physical side effects arrived quickly. Days after his first injection, his benching weight, already about 147kg, increased by nearly 7kg. Within weeks, his voice deepened and hair started growing faster. But the mental side effects were even more dramatic.

“You just feel like a soldier when you’re on it,” Nick says. “If it was the old me without running testosterone and stuff, I would be beat up over it [my brother’s cancer], but on testosterone and dbol, I feel great. Every day I’m stronger than I was yesterday.”

However, Nick also experiences out-of-control emotions, snapping at his girlfriend and yelling at other drivers on the road. Fed up with these outbursts, Nick’s girlfriend broke up with him – although she was not aware that steroids might have been driving this behaviour. Even still, Nick has no plans to stop.

“I don’t really care about risk,” Nick says. “If God wants me to overdose on steroids, then that’s my story. I’m gonna go out doing what I love.”

Nick is one of many adolescent boys and young men using steroids. Once largely limited to some bodybuilders and elite athletes, these chemical cocktails, known as performance and image-enhancing drugs (PIEDs), are popping up across suburban gyms, youth sports teams and teenagers’ TikTok feeds.

It’s not just the Arnold Schwarzeneggers of the world using PIEDs; it’s the boys next door.

In an increasingly body image-focused culture, fitness influencers are showing off their shredded physiques and tactics to get them – and reaching millions across social media in the process.

Between 2020 and 2024, TikTok videos tagged with hashtags promoting steroid-like drugs racked up more than 580m views among users in the US alone, according to one report – 72% by young adults between 18 and 24. Such TikTok videos garnered nearly 90m views among the same age group in the UK over the same period. (The report was criticised at the time by TikTok for not distinguishing between pro and anti-steroid-related content, and a spokesperson told Guardian Australia that it proactively removes 99% of drug-promoting content before it is reported to them).

This exposure can have real-world consequences. A systematic review released last month by Flinders University researchers found that appearance-related social media use in adolescent boys and young men was linked to higher chances of steroid use.

In Australia alone, 2.3% of young people aged 12-17 have taken PIEDs at some point in their life according to data from a 2022-23 survey of more than 10,000 students by the National Drug and Alcohol Research Centre.

Overall, non-medical anabolic steroid lifetime use in Australia almost tripled, from 0.3% to 0.8% of the population, in the 18 years between 2001 and 2019.

PIEDs are banned or illegal without a prescription in many countries, including Australia, but walk into any gym or do a quick Google search and you can track them down. And due to some troubling physical and psychological side effects, experts are concerned, particularly for young people.

“Unlike adults who have matured, adolescents are in a fragile developmental stage,” Dominic Sagoe, a professor at the University of Bergen who leads the Human Enhancement and Body Image Lab, says. “Some effects of PIEDs can be irreversible in ways that are damaging to growth and development.”

Add together this generation’s escalating social pressure to be muscular, the ease of sourcing, and the movement to maximise human performance, and you’ve got a “perfect storm”, Tim Piatkowski, a lecturer at Griffith University who studies PIED use, says.

“The real risk is that there are 15-year-olds all over the place who think tren [trenbolone] is great, buy it on Alibaba, and try it,” Piatkowski says. “That is not a drug that anybody outside of a serious elite competition prep should be reaching for, if even then.”

Muscles and masculinity

Reversing the typically feminine cultural pressure to shrink thinner, rising steroid use reflects a masculine pressure to build muscle and get lean – a phenomenon dubbed the “Adonis Complex” by Katharine Phillips, Harrison Pope and Roberto Olivardia in their landmark book on the topic. This pressure can develop into muscle dysmorphia, a form of body dysmorphic disorder involving warped body image around muscles and leanness, and sometimes, full-blown eating disorders.

Adolescence is a “critical risk period” for body image issues in boys and young men, says Jason Nagata, an adolescent medicine specialist at the University of California San Francisco who specialises in eating disorders in boys and men. “Boys feel that they’re puny, even if they are objectively big and muscular,” he says.

During puberty, teen boys experience significant changes in growth and muscle distribution, which can trigger concerns about their appearance, he says. It is a period when young people are forming their identities and are especially vulnerable to social input from peers, family and the media.

In 2024, almost two-thirds of young Australians reported that social media made them feel dissatisfied with their body – 12% more than in 2022. A 2023 study found two out of three Australians aged 12 to 18 expressed a desire to be more muscular, while analysis by researchers from Western Sydney University found that 1.8% met the criteria for muscle dysmorphia in 2017.

“We live in a more muscularised world today, where the ordinary guy would be on par with the Mr Universe of a few decades back,” Sagoe says. “Muscularity is becoming a synonym for masculinity.”

Phillips, a psychiatrist and co-author of The Adonis Complex, has been studying these issues for three decades and describes the current situation of steroids and social media as “very worrisome”.

“The pressure on boys and young men to attain an overly muscular look is inescapable,” she says. “A generation of young people is developing body image problems and dangerous behaviours such as not eating enough food or using drugs like anabolic steroids, which can have serious health consequences.”

Nick says social media has made the pressure to get bigger “way worse”.

“If I lived in the 70s or 80s when there wasn’t social media, I would not be running steroids right now,” he says. “But I look at these guys online who are a couple years older than me, and they’re quadruple me.

“I look in the mirror and think: Why don’t I have a biceps vein? Why are my biceps so small? Why are my shoulders lacking?”

While some fitness influencers share content aimed toward harm reduction, many others glaze over the negatives while putting the high-octane physical gains on blast. Some creators detail their bulk days or “shredathons”, make jokes about SARMS (selective androgen receptor modulators), saying “just tell your parents they’re vitamins”, pair #tren related content with memes of Dwayne “The Rock” Johnson, and taunt young viewers too “scared” to try SARMs.

“There’s been a huge boom of people who use steroids, basically, for social media capital,” Sagoe says.

In addition to being potential distortions of reality, Nagata says it’s important for young people to understand: “Who is posting this content and what are their secondary gains?”

Research by the US-based Center for Countering Digital Hate found that influencers are often backed by advertising deals and affiliate commissions with supplement companies or websites selling PIEDs.

“Remember that a vast industry makes money by making you feel insecure about how you look,” Phillips cautions.

Sam*, a PIED user and bodybuilder in his mid-30s based in the United States, moderates Reddit’s r/SteroidGuide, a forum with more than 50,000 members. He claims to focus on harm reduction and dissuade anyone under the age of 25 from using PIEDs.

Social media has pushed PIEDs to be more mainstream, Sam says. “Those who consume media are simply fed the idea that the ideal male physique requires PIEDs to achieve.”

Yet Sam says that quality fitness influencers – especially those in any competitive sphere – do not glamorise steroids to young people. “The trash ones who do this for ‘rage bait’ or just simply to generate clicks are the absolute worst. We spend a lot of time on this subreddit ‘un-fucking’ the ideas that they have put in people’s minds.”

In a statement to Guardian Australia, a TikTok spokesperson said it does not allow the trade or promotion of drugs on its platform. “We proactively remove 99% of content found to break these rules, before it is reported to us.

“TikTok is often a place for support, with people able to discuss issues that may have impacted them. But, with all sensitive content on TikTok, anyone under 18 is unable to view content if it discusses drugs or promotes weight management.

“If users search for steroids, they are shown information that outlines the dangers of drug use and are provided with a link to our safety centre.”

Aggression and violence

PIEDs can’t be lumped together. Some are well-studied medications, used to treat things such as hypogonadism or muscle wastage, but there is a constant churn of untested and unregulated ingredients on top of more closely-studied compounds, including anabolic-androgenic steroids, peptides, SARMs, insulin and human growth hormone. Most mimic or boost various naturally occurring hormones like testosterone and each has varying side effects.

Users often source steroids through a third party, buying from underground labs or dark web purveyors. It’s as simple as walking up to the biggest guy at any gym or giving your doctor a list of fake symptoms, one user tells Guardian Australia.

“In this environment, you run the risk that X is actually Y, and Y could be a lot more potent or toxic,” Piatkowski warns. One 2022 systematic review and meta-analysis across nine countries found that substantial proportions of anabolic androgenic steroids on the hidden market are fake – 36% of their sample of 5,382 products. Another 37% are low quality, putting the user in a position of “unpredictable uncertainty”, the authors write. A 2021 Australian Sports Drug Testing Laboratory study found high levels of contamination in Australia, estimating about 80% of PIEDs are contaminated with other PIEDs.

Still, many of these drugs work, if muscle-building is your goal. But the health costs can be high: steroid use may cause immediate effects such as mood swings and acne. In the long term, users can experience heart problems, high blood pressure, fertility collapse, testicular atrophy, hair loss or liver damage. Taking steroids can also impair the body’s natural production of testosterone. In rare cases, some physicians say the first symptom of steroids gone wrong can be sudden death from heart attacks or stroke.

“The use of anabolic steroids to build muscles is never healthy,” Phillips says.

Moreover, there are added complications in teens: PIEDs can induce early puberty or virilisation, alter brain development and suppress the HPG axis – a bodily system that controls sexual development and reproduction. These drugs can close growth plates early, preventing people from reaching their natural adult height.

These drugs can take a psychological toll, too.

A mixed bag of data links PIED use to heightened aggression, hostility and violence.

In one 2023 meta-analysis which included more than 137,000 participants, Australia and US-based researchers found a small but significant association between anabolic-androgenic steroid use and interpersonal violence. These drugs have also been linked to higher rates of intimate partner violence, which includes physical or sexual violence, stalking or psychological aggression.

Jake*, a now 26-year-old living in Sydney, suffered psychological side effects when he ran a potent stack of anabolic steroids – Test E (testosterone enanthate), DECA (Deca-Durabolin) and tren (trenbolone) – for 12 weeks at 20 years old. His gains were good, he says, but the drugs also sent his sex drive, anxiety, anger and aggression through the roof.

“You get to a point where things are frustrating you for no reason or you’re getting anxious over nothing,” Jake says.

This so-called “roid rage” isn’t equally present across PIEDs: some compounds such as tren are more strongly associated with irritability and aggression, the kind that Nick reported struggling to contain with his now-ex girlfriend. Some other compounds don’t appear to cause the same mood or behaviour changes.

Furthermore, evidence is shaky on whether these drugs actually cause aggressive or violent behaviour or if external factors – such as substance use, or being already prone towards risk, violence and low self-control – are skewing the data.

After Nick experienced heightened aggression on steroids, he sought advice for how not to lash out at his then girlfriend on r/SteroidGuide.

She was looking at me “like I’m gold,” Nick wrote in his post. But after arguing, she called him a “monster” and said “she’s never seen me like this,” he recalled in his post.

“On steroids, I feel so out of character,” Nick tells Guardian Australia.

Taking on a big brotherly tone, anonymous users on Reddit encouraged him to quit.

But the teenager is afraid to stop. Often, first-time users plan to run a single cycle of PIEDs. But that step can kick off chronic use: globally, about one in three anabolic-androgenic steroid users become dependent.

“I love my girlfriend but I’ve never felt this good in my life,” Nick says.

Turning to online communities for steroid advice is not unusual. Piatkoswki says this can happen in an environment where there is widespread stigma, few public health frameworks and little messaging towards users. He says we need open, nuanced and balanced discussions about these drugs.

“If you’re a young person, who are you going to listen to: the influencer who looks absolutely fantastic and has the ideal body that you want? Or the generic ‘Say no to drugs message’?”

Liam*, a 27-year-old trainer based in Sydney, has not tried steroids himself, but he has coached or interacted with dozens who have.

“[People] get so accustomed to the super-strength, the super-recovery, and to looking so great that it’s very difficult to go back to being a normal person, even when their health starts taking a hit,” he says.

“The people who are taking it, especially young people, are quite unhappy,” Liam says. “Their identity is consumed by their body image and any change has a massive emotional toll.”

Having watched clients use, he warns that the drugs can have a net-negative impact. “Whatever glamorous life that you think is on the other side of steroids doesn’t exist.”

* Names have been changed to protect privacy