The 23-year-old injected the steroids deep into his muscle tissue. As the needle penetrated his skin, he remembers feeling frightened but ready to take the next step in his career as a competitive bodybuilder. For the next 15 years, Mark* shot up steroids in the tanning booth of local gyms, lived at home and spent thousands of dollars on steroids.

Mark is not alone. He estimates that 40 percent to 60 percent of members in weight training gyms use steroids. While the bodybuilders may not toss their needles in the trash can or openly inject the steroids in the locker room, steroid use is still rampant in many U.S. cities, he says. The Substance Abuse and Mental Health Services Administration estimates that a million Americans, or .5 percent of the adult population, have used anabolic steroids, which are synthetically produced variants of testosterone. Users swallow pills, inject steroids intramuscularly, or rub gels or creams on the skin to build muscle, enhance performance and improve appearance.

“Steroids are a tremendous business,” Mark says. “There are dealers everywhere, and bodybuilders often sell them in health clubs. If you start training with anyone who has crazy muscles and say that you want to try out some steroids, he'll send you to a friend who'll sell some to you. If you're an average guy in a gym, you'll get charged double, but once you make some connections, you can stock up on them.”

Mark, who has been in the fitness training business since 1987, says he often bought a one- or two-month supply. Rather than continuously using steroids, users “cycle” the drugs — using for a set time, stopping and then starting again. Some users also combine steroids with other types of drugs through stacking.

Anabolic steroids are psychologically addicting, which makes them as difficult to quit as cocaine, Mark says. In return for the feel-good nature and physical effects of the drugs, Mark experienced hair loss, liver dysfunction, dehydration, acne and psychotic aggression commonly called “roid rage.” For his use, Mark eventually was arrested and sentenced to a stint in a narcotic rehab center rather than the state penitentiary. Since anabolic steroids became illegal to sell or possess without a prescription in 1990, users of steroids and other controlled substances, such as cocaine or heroin, are treated the same under federal law. Possession of illegally obtained steroids carries a maximum penalty of one year in prison and a $1,000 fine for a first felony drug offense. If the user is caught a second time, the fine and the maximum period of imprisonment doubles. Traffickers are charged a maximum of five years in prison along with a $250,000 fine.

Twenty years ago before steroids became illegal, bodybuilders and athletes used them for strength, power and size, says John Hansen, a natural bodybuilding champion in Chicago. At that time, the gyms weren't as well equipped, each gym was independently owned, and the clubs appealed to bodybuilders.

“If you went to some of these hard-core gyms, it wasn't unusual to see people shooting up in locker rooms,” he says. “The owners of these clubs were probably also using steroids.”

Today, much of the fitness world has changed. Many fitness centers are run by management teams, charge expensive fees and target a broader audience, pushing steroid use underground. However, these illegal substances are still finding their way into health clubs.

The Route into Clubs

While some health club owners may think steroid use has plummeted since it became illegal, a recent online survey on Fitness Business Pro's Web site shows otherwise. Seventy-nine percent of the 212 respondents think steroid use by fitness enthusiasts is on the rise. Many health club owners may have dealers selling steroids right under their noses.

By asking the right questions to the right people at a club, a member can often find a source for steroids, says Dr. Jay Hoffman, vice president of the Colorado, Springs, CO-based National Strength and Conditioning Association. These dealers often buy steroids in Mexico or European countries that don't regulate the sale of the drugs. Dealers can cross the border, purchase several types of steroids, slip the vials into their pockets or suitcases, and pass through customs undetected (photo above).

More than 100 different anabolic steroids are smuggled into the country, synthesized in clandestine laboratories or sold by black market dealers over the Internet despite federal laws regulating the shipment of controlled substances into the United States. The unmarked packages often slip into the country unnoticed and then end up in health clubs nationwide.

“Anytime there's a market, people are willing to supply them legally or illegally,” says Rob Bishop, owner of Elevations Health Club, an 8,000-square-foot club with 700 members in Scot Run, PA. “The Internet makes everything more accessible. If you're buying drugs illegally, you never know what you're getting. Users can be injecting themselves or swallowing just about anything.”

To get a better price on steroids and to avoid federal prosecution, some steroid users try to obtain a prescription for the drugs, which can be used legally for certain medical conditions. For the right price some medical doctors will write a steroids prescription for a recreational user, Hoffman says.

“On the black market, it can cost several thousand dollars for one shot, but if you have a prescription, it may only cost $20 to $100,” he says.

Users might also get prescriptions by requesting testosterone therapy from their medical doctors. Doctors often test men's testosterone levels if they complain of rapid weight gain, depression, a low sex drive or low energy. Men typically have a certain level of testosterone, but if the tests report that they're at the low end of the scale, the doctor may prescribe patches or creams to elevate their level into the normal range. In some cases, however, the doctors may neglect to test the patient's testosterone level before writing them a prescription. In these cases, the testosterone patches will have a “super compensation” effect similar to an oral or injectable anabolic steroid. The body will stop producing as much natural testosterone and will convert testosterone into estrogen, which will lead to secondary effects such as increased libido, shrinking testicles or breast enlargement in men.

“When the user sticks the patch on his skin, the testosterone is slowly released and absorbed into the body until it wears off, similar to a birth control patch,” Bishop says.

How to Deal with Users

Andy Bostinto of the Coconut Creek, FL-based National Gym Association, which promotes natural bodybuilding, says it's easy for health club owners to spot potential users (see sidebar on p. 24). If a member gains an excessive amount of weight in 30 to 60 days, becomes erratic, aggressive or has a short temper or a swollen chest, it's likely that he or she is shooting up steroids.

“They have a physical look about them,” he says. “You can't weigh 200 pounds at 5 foot 11 with 3 percent body fat.”

Along with looking for certain physical attributes, club owners can also keep their ear to the ground and listen for any conversations about steroid use. You may be familiar with one slang word for steroids — roids — but you should also be aware of less common street terms such as Arnolds, Arnies, A's, anabolics, gym candy, juice, pumpers, stackers, balls, bulls or weight trainers.

That's how Joe Hotwagner, owner of Pulse Fitness and Health in Dorr, MI, discovered steroid use at his club three years ago. While on the club floor, he overheard three of his members in their early 20s openly talk about steroids. When Hotwagner confronted the individuals, they all denied using steroids. However, one day when Hotwagner walked into the club's locker room, one of the young men had his shirt off, revealing acne all over his body — a common side effect of steroid use. Along with breaking out in acne, the young members had become muscular in a short period of time, had experienced a significant change in their mood and attitude, and had become very “into themselves,” Hotwagner says.

“I try to run a non-intimidating health club that is open to average and middle-aged people, but these guys were absolutely focused on their workouts,” Hotwagner says. “It was intimidating to my other members when they screamed like they were about to deliver a child [during] that last repetition.”

Based on this evidence, Hotwagner terminated the man's membership. Since then, he says he hasn't had a problem with steroid use in his club.

“I don't need a customer that badly to have them here,” Hotwagner says. “Unfortunately, if someone looks good, someone is going to ask them how they got there. They'll either flat out lie or promote steroids.”

Bishop's club has a zero tolerance policy against any illegal activity including drug use. If any of the members are caught with steroids, they're dismissed immediately. Because his club charges higher dues than other facilities and caters to the 35- to 55-year-old crowd, he says steroid use isn't as prevalent as it is at clubs with a high percentage of younger members. Only 2 percent of his members are between the ages of 18 and 22, which is one of the fastest growing usage groups for steroids.

“High school and college kids want that extra charge for their work to build more muscles,” he says. “That may sound silly to people in their 40s or 50s, but for younger people, strength is a large part of their workout. Kids want to get bigger, stronger and faster, and often use steroids as a shortcut.”

But for many users, steroids can ruin their lives, Mark says, draining their bank accounts and causing long-term health problems. When Mark thinks back to the day that he shot up steroids for the first time, he wishes he could turn back the clock. For many steroid users who don't go through rehab, it can be too late by the time they get help. The longer that a user is on steroids and the higher the dose, the more side effects they'll experience such as water retention, chronic headaches, depression, kidney or liver damage, high blood pressure and heart disease and premature death.

“Sometimes I think about all of the years I lost when I was on steroids,” he says. “I went through hell and got fed up. I was lucky I turned my life around, but some don't come out of it like I did.”

What Health Clubs Can Do About Steroid Use

  • Promote a zero tolerance drug policy. Any members caught using or in possession of steroids should lose their membership immediately.
  • Educate your members by distributing free anti-steroid literature and sell books on the dangers of steroid use.
  • Sponsor drug-free competitions and make sure your club name is associated with these contests.
  • Put signs up that you support and promote drug-free natural training.
  • Sponsor seminars with anti-steroid speakers.
  • Be on the lookout for the pushers and distributors in your health clubs because users may target the younger members.
  • Encourage the use of natural supplements in your pro shops (see sidebar on supplement safety on p. 22).

Source: Tom Ciola, author of Steroids Kill!

The History Of Steriods

1889
A French physiologist markets the first known product containing testosterone.

1935
Two chemists win a Nobel Prize for synthesizing testosterone.

1940s
Testosterone is first introduced into the sporting arena.

1952
Russian Olympic team is accused of using steroids because of its strong performance at the games in Helsinki.

1953
The first anabolic steroid is synthesized. It has three to five times the muscle building effects of testosterone.

1954
The Soviet Union coach informs the U.S. coach that his athletes were using testosterone at the world weightlifting championships. Upon returning home, the coach uses testosterone with his weightlifters.

1950s-1970s
Steroid use spreads as more athletes begin to use them.

1975
International Olympic Committee bans steroid use.

1980s
The production and sale of steroids thrives.

1984
The first case is reported of a bodybuilder contracting AIDS after sharing a needle for steroid use.

1988
The Anti-Drug Abuse Act of 1988 makes the sale of anabolic steroids for non-medical purposes illegal. Ben Johnson, a sprinter who won the 100-meter race in the Summer Olympics, has his gold medal taken away when a steroid is found in his urine during testing.

1990
The Anabolic Steroids Control Act of 1990 makes it illegal to sell or possess anabolic steroids without a prescription in the United States.

Source: www.erowid.org

The Serious Side Of Supplements

Because supplements are legal, bodybuilders, athletes and club members are turning to pills, powders and drinks to put on muscle, lose weight and look better. However, the safety of supplements is a hotly contended issue.

Six years ago, a Long Island, NY, man sued a Manhattan health club for $320 million after his 37-year-old wife allegedly died from taking nutritional supplements. The woman reportedly told her personal trainer that she was taking medicine for high blood pressure, but the trainer reportedly recommended a performance booster, which later led to a stroke. While the club denied prescribing the nutritional supplements during the court case, the event caused some health club owners to think twice about selling supplements to their members.

“We carry almost no supplements in our club anymore,” says Rob Bishop, owner of Elevations Health Club. “All these products carry warning labels, and we didn't think it was worth the risk.”

Joe Hotwagner, owner of Pulse Fitness and Health, however, says he doesn't see a problem with supplements, which he has sold for a dozen years. Protein and energy drinks are for sale at his club along with meal replacement packets, fruit smoothies, protein bars and fat-burning products.

“Some people's bodies are deficient in certain processes and can benefit from something that their body doesn't manufacture,” he says. “But what works for one person doesn't work for everyone.”

Creatine, ephedra and andro can provide greater energy and faster recovery time during a weightlifting workout, which can result in larger muscle mass in a shorter period of time, according to an article in the Detroit Free Press. But because a user gets false signs of endurance, the tendons can't absorb the load of the new muscle mass, which can increase the chance of injury, John Wharton, former trainer for the Detroit Red Wings, says in the article.

Another problem stems from the lack of regulation. The federal law doesn't require the Food and Drug Administration (FDA) to test and certify supplements, and it's up to the manufacturers to ensure their products are safe. Supplement manufacturers also aren't required to record, investigate or forward any reports of injuries or illnesses related to their products to the FDA.

In April 2004, the FDA banned ephedra, which has been linked to 81 deaths and 1,400 incidents of heart attacks, high blood pressure and stroke since the 1990s. A recent court ruling, however, prevents the FDA from enforcing the ban on products that contain 10 milligrams or less of ephedra, according to the FDA. Andro, which topped the list of Consumer Report's “Dirty Dozen” last year, is also reported to increase the risk of cancer and decrease HDL or good cholesterol along with increasing blood levels of testosterone. For this reason, Consumer Reports labeled it “very likely hazardous” in its report. The substance, which is marketed as the natural alternative to steroids, became a household name after Mark McGwire admitted to using it when breaking the single-season Major League Baseball record. The federal government outlawed the performance-enhancing drug with the Anabolic Steroid Act of 2004.

Other supplements such as creatine still remain popular among athletes. From 1998 to 2001, creatine sales tripled, and an estimated 18 million people are using it worldwide. Studies have shown that creatine can improve performance in anaerobic, short-term, high-intensity training by speeding up the breakdown of energy sources inside muscle cells. Like any other supplement, however, it also has risks associated with its use. Blue Cross and Blue Shield reported that an increasing number of doctors are reporting negative effects from creatine, such as dehydration, high blood pressure, cramping, muscle strain, and abnormal liver and kidney function.

“It's a quick fix that has risks of uncertainty as to what the long-term effect will be on your body,” Wharton says. “There's a lot of misuse and overdosage with the product.”

Jay Hoffman of the National Strength and Conditioning Association, however, asserts that creatine has no associated serious side effects apart from cramping or gastric discomfort during the loading stages. The supplement also can't be stored in the muscle — once a muscle fills its creatine supply, the rest is excreted unlike steroids, which are stored in the body for a long period of time. He says creatine has become a popular supplement among young health club members and athletes because it's cheaper and safer than steroids and is legal to buy without a prescription. Supplement users, however, need to do their research before investing in products, he says. Because these products aren't regulated by the FDA, they may be laced with an agent that will cause them to test positive during a drug test or lead to side effects.

Natural Bodybuilding

John Hansen, who won the Natural Mr. Universe title in 1992 and Natural Olympia title in 1998, remembers that when he first started training as a bodybuilder at the age of 14, he often competed against teenagers who were using steroids.

“They were available and I could have taken them at the time, but I wanted to build my body naturally,” he says.

An article in a muscle magazine inspired him to be a natural bodybuilder rather than relying on steroids to put on muscle mass. The story quoted Arnold Schwarzenegger, who said that if you build your body with drugs, you'll have nothing left when you stop using them. Instead, Schwarzenegger advised the readers to eat the right foods, put on muscle size naturally and take the drugs as a finishing touch during bodybuilding competitions.

However, Hansen decided to skip steroids all together. Rather than relying on them during bodybuilding competitions, he ate six nutritious meals a day and modified his exercise regimen from training for four hours a day six times a week to an hour a day four times a week.

“I saw many guys who built up their physiques using steroids, and when they eventually got off them, they went back to the body they had before,” Hansen says. That's when the depression set in, he says, noting that steroids affect the user not only physically, but also psychologically.

He now talks to high school students about the dangers of steroid use, hoping to stop them before they start. For a teenager who is building his or her self esteem, it can be difficult to get off of the drugs.

“A million teens are using illegal steroids, including girls,” he says. “It's a much bigger problem now than it ever was before. When a lot of the teens join a gym, they aren't looking for what exercise and diet to follow, but what drugs to take. A lot of them believe that to build your body, you have to take steroids.”

Andy Bostinto of the National Gym Association (NGA) says what steroid users don't realize is that they have to pay a price for their muscular physique. While they may try to take the easy way out by injecting themselves with steroids, there's no replacement for good genetics, hard training and a good diet, he says. At the natural bodybuilding competitions that NGA sponsors, the athletes must be drug-free for at least seven years. Rather than just testing their urine, the NGA also does polygraph testing, which will prove that a competitor is a natural athlete. Despite the dangers of steroids, he says it's been challenging to get support for natural bodybuilding competitions.

“For 25 years, I've been trying to get companies to support natural bodybuilding, but no one takes a step forward,” he says. “Everyone talks about the drugs and what we need to do about the athletes on steroids, but no one really cares. All they're concerned about is winning.”
Additional reporting by Pamela Kufahl

How to Spot Potential Users

Health club owners can look for the following physical and emotional signs of steroid use.

  • Premature balding
  • Severe acne, especially on face or back
  • Bloody nose
  • Breast enlargement (males)
  • Growth of facial hair and deepened voice (females)
  • Purplish/red spots on the body
  • Increased body hair
  • Yellowish tint in the eyes and on the skin
  • Mood swings
  • Irritability and depression

Additional Resources

Medline Plus

MedlinePlus has extensive information from the National Institutes of Health and other trusted sources on more than 700 diseases and conditions.
http://www.nlm.nih.gov/medlineplus/substanceabuseproblems.html

National Institute on Drug Abuse (NIDA)

The NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The institute carries out a variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice.
Information@lists.nida.nih.gov
888-644-6432
www.steroidabuse.org

U.S. Office of National Drug Control Policy (ONDCP)

The principal purpose of ONDCP is to establish policies, priorities and objectives for the nation's drug control program. The goals of the program are to reduce illicit drug use, manufacturing, and trafficking, drug-related crime and violence, and drug-related health consequences.
800-666-3332
www.whitehousedrugpolicy.gov

Bodybuilders aren't the only ones using steroids to enhance their performance. Today, more high school and college athletes are “juicing up.” In the June issue, Part Two of this story will examine steroid use in schools, universities and the military.