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Alex, who requested to use a pseudonym for this piece, says he felt like a “skinny, shy nerd” for the majority of his teens. He didn’t start working out until the end of high school, which is also when he realized he was gay.
“I definitely started to have this little conflict, which I think is pretty common for a lot of us gay guys: you have this image of what you think is attractive, and you're also very capable of comparing that image to what you see in the mirror,” he says.
Still, building muscle wasn’t a priority for him, at least until the pandemic hit. In 2020, he began to fill his days with the kinds of exercises that would make his biceps and body look good in tight T-shirts. “Exercise felt productive, like something I could fill the empty time with and not feel guilty about,” he says. The meditative reps started producing results: he saw, for the first time, changes in his body that he liked.
He also started searching for shortcuts toward getting the body he wanted. By 2021, his social media feeds began filling up with content from bodybuilders, weightlifters, and fitness stars — many of whom openly acknowledged their use of steroids.
“If I hadn’t known how widespread they were, I probably never would have bothered looking into them,” he says. “You pretty quickly stumble across the open secret that steroids are very, very common.”
That seems especially true in the gay community. While steroids — a word used to describe natural hormones like testosterone and estrogen, as well as synthetic chemicals that can mimic their effects — are used by 3.3% of the global population, some research suggests significantly higher rates among queer men. One 2002 study found that 13.5% of gay gym goers in London were actively using anabolic androgenic steroids, or the synthetic versions of testosterone. Another, from 2017, found that 5.2% of gay and bi men in Australia were on the drugs. And a 2019 survey of gay and bi gym goers in San Francisco’s Castro neighborhood discovered 21.6% had used steroids at some point.
Alex liked the extra attention he received from other guys as he was bulking up. “There’s a pretty universal awareness that muscular guys have an advantage in the gay community and on Grindr,” he says. On Reddit he also found a community of steroid users who cared about harm reduction, or injecting the drugs as safely as possible. He relied on message boards to vet potential steroid manufacturers, trying to pick the most reliable suppliers. He currently uses testosterone that’s been mixed by a supplier after being imported from China.
He’s convinced he’s been able to dodge some of the most debilitating side effects by testing his blood regularly — lab work made essential by the fact that side effects can be deadly. Anabolic steroids can cause severe, long-lasting and occasionally irreversible damage, according to the National Institutes of Health, including an increased risk of heart attacks and strokes, high cholesterol, high blood pressure, and an inability to recreate one’s own testosterone after using them. Mental health effects are also common: studies have found increased rates of paranoia, depression, violence, and risk-taking behaviors among regular steroid users. One study, from 2021, found that prolonged use of anabolic steroids can even cause the brain to age prematurely.
Alex says he’s been “conservative” with his testosterone doses and takes medication to lower his blood pressure, and says that his experience using them has been almost wholly positive. “I like the part where cute guys come up to me in clubs,” he says. “At the moment, I’m very happy making out with strangers, which is an opportunity I never had before.”
He’s far from alone in having done extensive research into the best practices and risks associated with steroid use; many steroid users are surprisingly well-educated about side-effects, perhaps due to the proliferation of forums in which they’re able to share their experiences.
He’s also far from alone in what brought him to use the drugs in the first place. Social media, bodily insecurities, intracommunity pressure, and more have driven hundreds of thousands of gay men to turn to steroids to attain a more muscular body. And while the drugs are nothing new within the gay community, modern phenomena — from a burgeoning industry of online testosterone doctors, who make getting on T easier than ever, to the rise of OnlyFans and its proliferation of buff content creators — has fueled their normalization and continued usage.
Doctors say that a lack of medical education about the drugs can leave patients to manage sometimes serious side effects on their own. “There are important health effects of steroid use that appear to be worsened through longer use and higher doses,” says Eric Kutscher, a primary care and addiction medicine physician at the Icahn School of Medicine at Mount Sinai.
He adds that “doctors do not necessarily have a robust curriculum around steroids in medical school and residency, whereas many of our patients who are using steroids have spent a lot of time trying to learn about them.” This imbalance can make doctors feel ill-equipped to answer questions and provide counseling, while leaving patients feeling frustrated and misunderstood.
Kutscher is currently leading a study on how doctors can treat gay, bi, and queer male steroid users more collaboratively and with less judgment. He believes using a harm-reduction model that centers patients’ lived experiences with steroids could boost the number of patients that feel comfortable disclosing their usage to doctors.
Historically, doctors have been prescribing steroids to gay men to prevent muscle wasting caused by HIV since the 1980’s. Use of the drug is still more prevalent among gay men living with HIV than those who are not; one study found that 31% of HIV positive gym-goers were on steroids, and were far more likely to use the drug for medical purposes. Today, testosterone replacement therapy continues to be recommended for some men with HIV because the virus can diminish one’s ability to produce the hormone.
But the medical establishment’s familiarity with testosterone therapy doesn’t usually translate to better care for those who take the drug recreationally. Often, insurance doesn’t cover the lab work necessary to stay safe while using, and heavy users that want to quit are stuck in a dangerous game of trial and error when they try to taper down from high doses.
When he first began taking steroids in 2017, Sharok, a gay porn star who lives in Los Angeles, relied on what he calls “bro science” to avoid potential complications. This meant trawling Reddit and talking to people he knew at his gym.
“I was buying testosterone from a guy at the gym who was making it himself, and I was getting chills and a fever,” he says. “It somehow didn’t occur to me at the time that I was injecting poison into my body.”
After cycling off the homemade steroids, his natural testosterone plummeted. Because of his newly low levels, he was then able to get a prescription from a doctor for testosterone replacement therapy while continuing to use steroids he was getting from different friends.
Sharok then ended up combining steroids with human growth hormones, which caused fluid to build up in his lungs and extremities. “My ankles were swollen, but I looked amazing otherwise,” he says. “I’d never looked better in my life than I did two years ago.”
Throughout the years, more side effects have emerged, including infections, debilitating bouts of depression, and high red blood cell counts that require routine blood draws.
“We all sort of deal with different consequences,” he says, referring to other gay male porn stars. “I have had to be on antibiotics when I had abscesses in places where I inject. I’ve had hair fall out. Everyone’s lasering the hair off their back while using finasteride for the hair that falls off your head. I have a freezer full of Trimex that I inject in my dick before a porn scene because of my erectile dysfunction.”
“If you go to a porn set, it’s just guys talking about all the different side effects they’re experiencing from steroids and strategizing ways to mitigate them,” he adds.
Now that his body has stopped producing enough testosterone naturally, he’s worried he’ll never be able to quit the drugs. “The health risks become greater as I get older, so I need to figure something out,” he says.
The desire among gay men to get big no matter what is not so baffling to psychotherapist Adam Blum. As the founder and director of Gay Therapy Center, a nationwide LGBTQ+ therapy practice, Blum has counseled numerous gay men over the past sixteen years who felt they needed to bulk up in order to receive society’s stamp of approval.
“Most gay men are humiliated by cultural standards of masculinity,” he told me. “The worst thing about gay men in the eyes of the culture is that we often have more feminine qualities, so in some ways it makes total sense that we’d try to compensate for the shame that we’ve experienced by creating bodies that are the masculine ideal.”
“But the problem, as we all know, is that it becomes addictive,” he adds. “And then we want more and more attention, which can get increasingly dangerous.”
The steroid users he’s counseled often discover that buff male social circles aren’t exactly affirming environments for self-growth. “I can tell you the inside view,” he says, ”which is that many of these people aren’t very happy, and they don’t feel good about themselves, and their cliques aren’t so warm and friendly. They’re more competitive.”
They also tend to be elitist. Being able to use testosterone safely is a privilege that requires access to capital, says the writer and Them contributor Alexander Cheves, himself an avid user of testosterone.
“Add testosterone to unrestrained capitalism and you do find profound body modifications across the rich,” he says. “It is an unregulated, technically illegal industry that’s seen very little enforcement.”
While many steroid users rely on dubious suppliers online, those who can afford it often seek out doctors in gayborhoods amenable to their desire for extra testosterone, Cheves says. “And those doctors are very expensive,” he adds.
Meanwhile, a surfeit of direct-to-consumer companies offering testosterone therapy have emerged online. While treatments for low testosterone have been increasing in popularity over the past two decades, the pandemic gave rise to a surge in telehealth clinics offering prescriptions for the drug. Many feature photos of buff men, not-so-subtly implying that you can blame low-testosterone if you’re not getting shredded at the gym. A well-publicized investigation by a Northwestern University urologist posing as a “secret shopper” found that six of seven platforms offered him testosterone therapy, even when he submitted lab work showing his testosterone levels were normal.
Despite the influx of testosterone suppliers clearly profiting off bodily insecurities, Cheves isn’t cynical about testosterone, which he calls “the nectar of life.”
Cheves was first prescribed testosterone replacement therapy after being diagnosed with HIV as a 21-year-old. He now augments his doctor-approved testosterone with some extra, off-label testosterone layered on top.
“For people who don't make enough testosterone, it is the best thing in the world. They live and die by it and it literally saves their sex lives,” he says. “It’s made me feel self-possessed, riled by youth, and given me the sense that I’m beautiful for the first time in my life.”
As an author, sex columnist, and kink expert, Cheves says the impacts on his libido are especially important. “I would be fine without it. Like, I wouldn't die,” he continues. “But the thing I love — sex — would be lost in the process. So I’ll probably always be on some testosterone because it’s my access code to sex.”
Cheves’ experiences, like those of Alex and many other gay steroid users, illustrate the physical and psychological complexity of such a powerful drug. Many men use steroids, perhaps more than we think, and for some, it can bring untold self-confidence, sexual satisfaction, and a newfound comfort with their own masculinity. Many users I spoke with for this piece described how being on steroids made them feel protected from homophobic attacks — providing a shield, in the form of muscles, from the straight men who abhor them.
For many other users, however, their drawbacks and side effects aren’t discussed often enough.
Sharok, for what it’s worth, sounds like he wants to return to the days in which he didn’t know testosterone existed.
“Taking steroids has produced psychological and physical effects that feel unbearable,” he says. “When young guys ask me about it, I always tell them: don’t even try it.”
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