Anabolic Steroid Usage, Prices & Effects

Matthew J Atha BSc MSc LL.B

Director - Independent Drug Monitoring Unit

1          Introduction

1.1       Anabolic steroids are a group of compounds which mimic sex and growth hormones in the body. They are typically used without prescription by athletes and bodybuilders in order to build up muscle mass and reduce the fatigue involved in training regimes. There are around 500 steroidal substances identified in mammals, with 5 major groups distinguished by physiological action, these are glucocorticoids, mineralocorticoids, androgens, oestrogens and progestins[1]. The classical sex steroid is testosterone, which has many derivatives, all of which are to a greater or lesser extent effective as androgens (masculinising) and anabolics (tissue-building), without separation of these two discrete effects, with the result that the class is known as anabolic-androgenic steroids. These promote tissue growth by reducing the breakdown of protein, particularly following exercise.

1.2       The effects of steroids on mood has long been recognised, from Aristotle prior to 300BC noting the psychological and behavioural aspects of maleness. In the 1800s, the testes were demonstrated to contain substances which maintained vitality, strength, energy and youthfulness, and sex-hormones were used to treat mood and mental disorders in the early part of this century, particular melancholia and depression. However, more recent studies have pointed to severe behavioural side effects, including violent psychotic episodes, associated with the use of anabolic-androgenic steroids in particular users.

1.3       IDMU deals only rarely with cases involving anaboic steroids and related bodybuilding products, and only a handful of drug users report lifetime steroid use each year in our surveys.

1.4 Unlike most controlled drugs, the majority of steroids appear on the market as pharmaceutical preparations, in blister packs of tablets, glass ampoules for injection, or multi-dose vials, labelled with brand-names and/or contents. Such products can be either legitimate - manufactured legally by pharmaceutical companies, mainly overseas - or counterfeit, where the contents do not match the description and often contain either different substances or no active ingredients.

2          Consumption of steroids

2.1       There are a number of sources on the internet which outline regimes (cycles) whereby steroids are taken as part of a training regime over a period of 6-12 weeks, gradually increasing then reducing the dose and then coming off completely (e.g. to enter a competition). These regimes commonly recommend dosages well in excess of recommended levels, sometimes 4-8 times the pharmaceutical dose[2].

2.2       The recommended route of administration for steroids is an intramuscular injection, which delivers the drug to the site of action and bypasses first-pass metabolism in the liver, as would occur with oral tablets/capsules, with an increased risk of liver damage as a result. Clearly, any medically-unsupervised injection practice carries with it the risk of blood-borne infections such as hepatitis and HIV.

2.3       A number of studies have considered steroid usage and their effects on behaviour, including the syndrome popularly known as Ãroid-rage". Pope & Katz[3], in a study of 41 bodybuilders and US Footballers using 10-100 times the medical doses of steroids (15mg-600mg per day), found 12% reported Ãmajor" psychiatric symptoms from Ãstacking" different preparations. In a controlled study using 20 healthy non-athletic male volunteers with no prior history of steroid use, Su et al[4] measured placebo baseline, low dose methyltestosterone (40mg), high dose methyltestosterone (240mg) and placebo. In a single case report, Conacher et al[5] cited the case history of a 32 year old Canadian bodybuilder convicted or murdering his partner. He had been taking steroids for 3 months before the incident, at about 6 times the medical dose (6x tablets dianabol per day plus one ÃDeca" injection per week). Corrigan[6] reports on a male bodybuilder 22 yrs who violently murdered a woman after an 8 week course of 50mg per week nandrolone (deca-durabolin, organon), increased to 85mg (of a veterinary preparation) for 3 weeks before the murder.

2.4       The dosage is complicated by the plethora of counterfeit pharmaceutical steroids available on the market. Although anabolic steroids are controlled drugs in the UK, USA and other developed countries, there are a number of countries throughout the world where these are still manufactured legitimately. Illicit steroid products will commonly mimic the appearance or packaging of legitimate products, but will often contain either a different dosage or different drug to that denoted on the label. This phenomenon is well known among regular steroid users, and there are a number of internet publications (mostly subscription only) which provide information on the content of the latest products, and warnings about faulty or counterfeit tablets.

3          Steroid Consumption -IDMU Survey Data

3.1       IDMU drug user surveys have included questions about steroid usage, prices and attitudes since 1999.

3.2       To date (Jan 2004), 10070 questionnaires have been returned and analysed, from which only 157 (1.6%) respondents have reported lifetime usage of steroids. The usage pattern shows fewer regular (weekly/monthly) than daily users, a similar ÃJ" shaped distribution to addictive drugs such as heroin or crack (Table 1). Users generally report higher ratings than non-users, a pattern common with most illicit drugs.

Table 1 - Steroid Usage Data 1999-2003
Usage Level	n	%	Rating
Experimental	50	0.50%	3.19
Occasional	11	0.11%	6.71
Regular	7	0.07%	3.33
Daily	21	0.21%	3.80
Stopped Using	68	0.68%	1.55
Might Use	75	0.74%	2.13
Would Never Use	2596	25.8%	1.00
Other/Blank	7242	71.9%	1.12
Total Ever	157	1.57%	2.97
Saturation	67.7%	Overall	1.15

3.3       The drug has an overwhelmingly negative reputation among drug users as a whole, with the average user-rating of 1.15/10, among the lowest ratings for any drug, and only 75 respondents (0.74%) who had not used the drug being willing to try it. Average monthly spending (9x respondents) was £23.57, with a maximum of £80 per month (fig 1)

Fig 1 - Steroid Ratings & Monthly Spending 1999-2003

3.4       The age of initiation data, with a surprising 30% of respondents reported first having used before age 15, suggests that many respondents may have been using prescribed steroids for medical conditions in childhood (fig 2), although the majority started between ages 14 and 23, consistent with use in connection with sporting activity.

Fig 2 - Age of Initation to Steroid Use

3.5       Summary: Usage of anabolic steroids is limited to certain niche markets, and has little appeal to drug users outside, bodybuilding/fitness, sports and Ãsecurity" personnel. Whilst the number of regular users is very small, they can use excessively - many times the therapeutic dose. There is evidence of physical and psychological dependence from prolonged use, risking a pattern of violence and aggression commonly known as ÃRoid Rage".

 

4.         UK Steroid Prices

4.1       IDMU Survey Prices: The average reported prices of steroid preparations in our suveys from 1999-2003 is shown in table 2, and the distribution of reported prices between1999 and 2003 in fig 3 below. Note that reports of steroid use or prices amongst users of illicit drugs are very rare (19 reports from 10061 respondents), and Ãtab/amp" prices do not distinguish between different drug preparations and dosages.

Table 2 - UK Steroid Prices 1999-2003*
Type	Number	Price
Amp	6	£ 9.17
Tab	13	£ 7.99
Overall	19	£ 8.37

* Provisional 2003 dataset n=2040

Fig 3 - Steroid Price Distributions 1999-2003

4.2       Internet Prices: A range of steroid products are available from internet retailers and wholesalers. The prices depend on the type of steroid or brand, the dosage, the quantity bought, and where manufactured or sold.

4.3       A Google search for named steroid compounds revealed several sites[7] offering online purchase facilities, quoting prices in Euros and/or in US Dollars. These have been converted to Sterling at approximate prevailing exchange rates of €1.40=£1 and $1.60=£1. Those entries denoted À(BNF)” are prices quoted in the British National Formulary.

Table 3 - Online Prices of Anabolic Steroid Preparations
Trade Name and/or Drug	Preparation	Qty	Euros	Dollars	Sterling	Unit (£)
Anabol (methanenedione)	tabs (5mg)	500	€ 220.00		£ 157.14	£ 0.31
Anabol	tabs (5mg)	50		$19.00	£ 11.88	£ 0.24
Anabol	tab (10mg)	50		$85.00	£ 53.13	£ 1.06
Anabol 5 mg.	tabs (5mg)	50		$45.00	£ 28.13	£ 0.56
Dianabol/Anabol	tab	1500	€ 479.00		£ 342.14	£ 0.23
Dianabol/Anabol	tabs (5mg)	100	€ 54.00		£ 38.57	£ 0.39
Methanenedione	tabs (50mg)	300		$450.00	£ 281.25	£ 0.94
Anadrol - 50 (oxymetholone)	Tab	50		$250.00	£ 156.25	£ 3.13
Anadrol - 50 (oxymetholone)	tab	200		$350.00	£ 218.75	£ 1.09
Anadrol - Anapolone oxymetholone	tab (50mg)	20	€ 55.00		£ 39.29	£ 1.96
Anapolon (oxyymetholone)	tabs (50mg)	100		$270.00	£ 168.75	£ 1.69
Boldabol	vial (200mg)	4	€ 375.00		£ 267.86	£ 66.96
Boldenone Undeclynate	vial (200mg)	1	€ 125.00		£ 89.29	£ 89.29
Clenbuterol	tabs	150	€ 99.00		£ 70.71	£ 0.47
Clenbuterol	tab (20µg)	50		$50.00	£ 31.25	£ 0.63
Clenbuterol	tab (20µg)	200		$160.00	£ 100.00	£ 0.50
Clenbuterol	tab	50		$20.00	£ 12.50	£ 0.25
Pregnyl	amp (150µg)	1		$15.00	£ 9.38	£ 9.38
Pregnyl	amp (5mg)	1		$30.00	£ 18.75	£ 18.75
Primobolan	amp(50mg)	1		$21.39	£ 13.37	£ 13.37
Trenabol (Trenbolone)	vial (750mg)	1	€ 119.00		£ 85.00	£ 85.00
Trenabol (Trenbolone)	vial (750mg)	3		$320.00	£ 200.00	£ 66.67
Decabol (nandrolone)	vial (250mg)	1	€ 115.00		£ 82.14	£ 82.14
Deca-Durabolin	vial (200mg)	1	€ 16.00		£ 11.43	£ 11.43
Deca-Durabolin	amp(50mg)	10		$160.00	£ 100.00	£ 10.00
Deca-Durabolin	amp (100mg)	14		$266.00	£ 166.25	£ 11.88
Deca-Durabolin	amp(50mg)	1		$9.00	£ 5.63	£ 5.63
Deca-Durabolin	amp (100mg)	1		$15.00	£ 9.38	£ 9.38
Deca-Durabolin (BNF)	amp(50mg)	1			£ 3.54	£ 3.54
Tamoxifen	tab (20mg)	10		$32.00	£ 20.00	£ 2.00
Tamoxifen	tab (10mg)	10		$18.00	£ 11.25	£ 1.13
Tamoxifen	tab	30		$20.00	£ 12.50	£ 0.42
Proviron	tabs (25mg)	50		$39.00	£ 24.38	£ 0.49
Proviron	tabs (25mg)	10		$15.00	£ 9.38	£ 0.94
Proviron	tabs (25mg)	10		$15.95	£ 9.97	£ 1.00
Proviron (mesterolone) BNF	tabs (25mg)	30			£ 4.75	£ 0.16

Trade Name and/or Drug	Preparation	Qty	Euros	Dollars	Sterling	Unit (£)
Omnadren (Sustanon 250)	amp (250mg)	1	€ 11.00		£ 7.86	£ 7.86
Sten (testosterone propio/cypionate)	amp (120mg)	2		$8.15	£ 5.09	£ 2.55
Sustanon 250	amp	50	€ 550.00		£ 392.86	£ 7.86
Sustanon 250	amp	30		$300.00	£ 187.50	£ 6.25
Sustanon 250	amp (250mg)	14		$238.00	£ 148.75	£ 10.63
Sustanon 250	amp (250mg)	1		$15.00	£ 9.38	£ 9.38
Sustanon 250	amp (250mg)	1		$16.85	£ 10.53	£ 10.53
Sustanon 250 BNF	amp (100mg)	1			£ 2.74	£ 2.74
Testabol	vial (1000mg)	4		$200.00	£ 125.00	£ 31.25
Testex	amp	15	€ 199.00