Seven years and about 18 kilograms ago, I decided to get a gym membership; a determined ‘F-You’ to a lifetime of being scrawny and short. While the latter never changed, getting bigger quite literally turned my life around. It pushed me out of my shell and into the world of young adulthood; I’ll never quite forget that feeling.  

That said, my approach towards fitness wasn’t as zen early on. My early attempts at pumping iron were, for lack of a better term, angry. I was frustrated with both my body and mind, and with every step forward, the odd drinking binge or midnight snack attack would push me back a couple of places. If only there was a way, I wondered, to take three… hell, four or five steps forward with each session at the gym. Beyond the bad habits and the impulsive cravings, it seems it is all gain and not as much pain. 

It turns out that several other young Indians come across this very same thought and have found their salvation in anabolic steroids — the many synthetic derivatives of testosterone. Developed in 1935 by a group of German scientists led by Nobel laureate Adolf Butenandt, the substance was first used as a treatment for hypogonadism or testosterone deficiency — a technique that is still used today. Opinions on their usage have been split down the line of history; early compounds were used by Nazi soldiers and concentration camp survivors alike to build muscular strength during and after World War II.

However, the popular notion of steroid use as a tool to develop and hone physique in athletics, sports and bodybuilding skyrocketed in the 1960s. According to his autobiography, Total Recall, Arnold Schwarzenegger appears to have started using steroids in 1967 at age 19. Three years later, the ‘Austrian Oak’ became the youngest bodybuilder to win the coveted Mr Olympia title — a record that he still holds nearly six decades later. 

Like the natural hormone they imitate, anabolic steroids work by activating androgen receptors in the body. Apart from various other effects, this triggers a phase of the metabolic cycle known as anabolism (hence the name), which notably increases the growth rate of cells in a user’s skeletal muscles, giving them increased muscle mass, especially in the upper body. The result can be life-changing for all kinds of people — from cancer and post-operative patients to pro wrestlers, action heroes and athletes, men and women have used the drug to great effect.  

Can’t Stop, Won’t Stop 

Despite their potential for performance enhancement and physical recovery, steroids have quite a bad rap for being attached to countless instances of abuse. Some of these have resulted in (frankly unsurprising) scandals in the world of sport, while others have played out in grislier fashion, with a heart attack or stroke claiming the lives of several high-profile individuals associated with entertainment and pro bodybuilding. 

While this might suggest that steroid abuse is relegated to the upper echelons of muscledom, the problem is pervasive throughout India’s Tier 2 and 3 cities as well. A 2019 paper, published in the International Journal of Preventive Medicine, for instance, casts a lens over the realities of steroid abuse in Bhubaneswar amongst a group of 84 bodybuilders, 88 per cent of whom used a variety of anabolic steroids. Injectable form of abuse was described as ‘rampant’. Closer inspection revealed a clear degree of misinformation, misdirection and negligence — a shocking 70 per cent of abusers claimed that they were largely hooked by their trainers, with just 6.7 per cent relying on consultations with healthcare professionals. 

“Trainers in India are underpaid,” remarks actor and model Vivan Bhathena, who runs a fitness consultancy firm and has been a victim of steroid abuse in the past. “They’re trying to make money as fast as they can,” he says. “I didn’t have very high DHT (dihydrotestosterone) levels. It was very difficult for me to build muscle, so I came across [anabolic steroids] at the age of say 36-37. They put me on some rubbish, which kind of screwed me up completely; made me a fat ball where I didn’t look aesthetically pleasing or anything of that sort, you know? After that, I realised that I’m at the mercy of these coaches — I hadn’t gone to some ‘gym bro’, rather I went to one of the biggest trainers in India.”

While there’s no shortage of side effects, Bhathena conjures up images of users suffering from back acne and accelerated hair loss, whereas many of the truly life-threatening issues happen with the cardiovascular system. “Just last year, the European Journal of Medicine published two papers linking anabolic steroids to heart problems,” says Dr Prashant Pawar, an interventional cardiology consultant at Fortis Hiranandani Hospital, Vashi, noting how heart sonographies revealed an increase in the thickness of the heart muscle in steroid users. This, in combination with elevated cholesterol levels, creates a hotbed for heart attacks and strokes — even as early as one’s late twenties.

Steroids pose significant risks to the entire musculoskeletal system, not just the heart. Dr Swapnil Keny, an orthopaedic surgeon at Fortis Hospital, Kalyan, highlights that steroid abuse can lead to various issues. One such problem is osteoporosis, where bones weaken due to the drug’s interference with the natural metabolic cycle, though long-term use presents a series of dangerous consequences.

“A patient of mine who suffered from a torn tendon turned out to have a past history of using anabolic steroids,” notes Dr Keny. “Some patients who are thin and desperately wanted to build muscle mass first went to the gym, and then took protein supplements and other substances — eventually developing ligament or tendon tears, after which they have to approach an orthopaedic surgeon. Even in normal cases, these take an extended time to heal, and with steroid use, post-operative rehab may require more time and even more add-on medications.”

Mind over Muscle 

It’s interesting to note that both fitness experts and doctors exist at opposite ends of the timeframe of steroid use — the former at the beginning of a bodybuilding career the latter at the end of it. The result is a wide variety of opinions about whether or not steroids should be used as a competitive aid. What both parties agree on is that as pervasive as their physical effects are, steroids ultimately have a profound impact on a user’s psychology — both directly and indirectly.
“People get dependent,” says Dr Pawar. “In our society, even disclosing details of steroid abuse to a patient’s family can be difficult. We get a lot of patients who develop a clot in the lungs — what we call a pulmonary embolism — and sometimes, an orthodox family may not take the patient’s situation well… they don’t accept it, you know? Recovery requires teamwork — apart from the team of four to five doctors on a case, we also have a dedicated nurse and psychologist to counsel both the patient and their family members,” he continues. “While my work may take just 20 minutes, going through rehab and depression can take weeks or months.”

It all comes from the beginning, right from our school days,” says Dr Keny. “We are now [as a society] starting to accept different skin colours. Why not accept body sizes as well? The body-shaming aspect is what really coaxes people — either too thin or too fat — who fall prey to steroid abuse. Healthcare workers need to be more sensitive too; as a member of the medical fraternity, it’s important to avoid being judgemental and learn how to identify early markers [of abuse].”

Bhathena echoes the sentiment as well, referring to his own first-hand experience. “People don’t go off these things because of ‘bigorexia’ — a condition that I’ve gone through myself. You want to look a certain way and always hold a certain amount of muscle because others are impressed by it,” he says.
Despite these alarming concerns, it’s important to note that steroids themselves can offer benefits to those who require them for health or competitive/sports related reasons — they just can’t be taken lightly. “Stay away from underground gear,” cautions Bhathena, pointing at the dangers of relying on unregulated providers and pushy, under qualified coaches. “Unless you’re an athlete or going on stage, you have no business using these [compounds] in the first place,” he continues. “Blood work is very important and needs to be monitored frequently — one will need to manage their kidney health via Glomerular Filtration Rate (GFR) tests and keep an eye on inflammation levels.”  

Fundamentally, Bhathena, whose fitness firm encourages regular testing and helps manage both users and non-users maximise their fitness potential, urges younger men to stay clear of the substance. Age is one of the greatest markers of testosterone levels, and while using under the age of 25 can cause long-term side effects, he recommends that potential users ‘should look at it after the age of 35 to 40.’ “You do not need a supraphysiological dose. A lot of people jump on dangerous programmes of a thousand milligrams per week,” he notes, describing how impatient abusers can develop bloating and easily fall off the wagon. “Building your body is about discipline, is about willpower. But at the same time, you don’t need to abuse drugs to do that. You can achieve very good aesthetics with just good fat loss, a clean diet and basic [supplements].” 

Ultimately, steroid use is a complex issue with no easy answers. While they provide significant benefits for those looking to build muscle, they come with no dearth of physical and psychological health concerns; many of which the average coach or trainer is underequipped or unwilling to manage. Like many of the true core tenets of bodybuilding, it is one’s own willpower, discipline, humility and knowledge that seals the deal — and determines whether one will abstain, use responsibly, or crash and burn like many others have.