Don't use anabolic steroids (“muscle-building injections,” “oral pills”) to build muscle

Cost

Free, and you save the cost of the drugs. The hard part is accepting that muscle grows slowly.

What you get

Denmark looked back through records and matched each user with controls of the same age. The users were 545 men who tested positive for androgenic anabolic steroids in gym doping tests from January 3, 2006 to March 1, 2018, matched with 5,450 controls. A second check used 644 men who refused testing and 6,440 controls. Result: the death rate in users was 3 times that of controls, HR 3.0 (95% CI 1.3–7.0), so the true multiple likely lies between 1.3 and 7. The median number of hospitalizations or visits a year was 0.81 vs 0.36 (P<0.0001). The median is the number that half the people are above and half below. This P value means the difference is almost impossible to be due to chance. Acne (pimples), enlarged breasts in men (gynecomastia) and erectile dysfunction each affected more than 10% of users, that is, at least 1 in every 10 people who took the drugs, all clearly higher than in controls (P<0.0001). The second check gave consistent results. Article 7 of the Anti-Doping Regulations (《反兴奋剂条例》): the state strictly controls the banned substances on the doping list, and no organization or individual may illegally produce, sell, import or export them. The same regulations provide that anabolic agents (蛋白同化制剂) and peptide hormones are managed as prescription drugs, meaning they can only be bought with a doctor's prescription; “anabolic agents” is what the regulations call this class of drugs.

Notes

Disputed: this is a study that follows a group of people to see the outcome, not a randomized trial. The people who use the drugs may take more risks in other ways too, so the 3 times cannot all be blamed on the drugs. The true multiple could be as low as 1.3 or as high as 7.0, a wide range. But “acne, enlarged breasts and erectile dysfunction each affect more than 1 in 10” are side effects you can see with your eyes, and are less affected by that kind of bias. The regulations call this class of drugs “蛋白同化制剂” (anabolic agents); when you see those four characters, this is what is meant. Ordinary protein powder and creatine are not covered by this item. The trouble is that products that “claim especially fast muscle gain” may have ingredients secretly added. The way to judge is the same as in the item on diet products (§28.4, don't buy diet pills that promise fast weight loss): a proper drug is a prescription drug with an approval number you can look up. Something sold as a “muscle powder” or “nutritional supplement” that promises results in a few weeks, if it really works, has something added.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Horwitz H et al. (2019). Health consequences of androgenic anabolic steroid use. J Intern Med. https://doi.org/10.1111/joim.12850
2. 国务院 (2004). 反兴奋剂条例（国务院令第 398 号，第七条、第九条）. http://www.gov.cn/gongbao/content/2004/content_63129.htm

Translated from the Chinese original. Original book, section 28, tip 5. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer