Are Steroids “Safe” for Mature Adult Males?

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Q: What’s the bottom line – is steroid use safe?

A: How do you define “safe”? Let’s explore the different meanings, all in the context of non-medical use by mature adult males (virtually everyone is against teenage use, and the side effects among women may be more profound). In my book Legal Muscle and in many past columns, I’ve examined the different specific physical and psychological potential adverse health issues associated with steroid use (e.g., liver toxicity from oral steroids, heightened aggressiveness in certain individuals, etc.). While the media seems to have generally overstated both the severity and prevalence of these issues among the population of mature adult male users, the proposition that non-medical steroid use is without the possibility of dangerous consequences is also inaccurate. This article, however, does not address the specific adverse health conditions associated with non-medical steroid use, but rather explores more generally the concept of “safe” usage of a substance.

Absolute Safety. If being “safe” means presenting no risk of illness or death under any circumstances, steroids are not safe. Then again, no prescription drug is. Adverse reactions to prescription drugs reportedly cause 100,000 deaths in the U.S. every year. Further, nothing is safe if we define “safe” as “risk-free.” Get behind the wheel or in the passenger seat and you could be one of the more than 30,000 people who die annually on American highways. Or you could be one of the 100 people who die each year from allergic reactions to eating peanuts. People have even died from drinking too much water.

Acceptable Risks. If nothing is absolutely safe, our individual choices and actions are based on judgment calls as to what risks we think are acceptable. Every time we choose to fly in a plane or drive a car we are making a judgment call to accept the inherent risks. We all have different standards as to what risks are acceptable. I have a friend who refuses to ever fly again. For him, air travel is not safe. When law-makers perceive the risks to be unacceptable for the populace, they can criminalize conduct as they did with steroids (or they can impose lesser restrictions, as they did with tobacco).

Reasonable Safety. Judging what risks are acceptable requires a standard of reasonableness. In other words, being “safe” must mean that the risks of bad effects or outcomes are reasonable in terms of factors like prevalence (they’re not too common), severity (they’re not too serious) or duration (they don’t last too long). [If we’re talking about prescribed steroids in the legitimate medical context, their use as FDA-approved drugs over many decades firmly establishes their reasonable safety.]

Risk-to-Benefit Safety. One common standard for reasonableness is looking at both the risks and the benefits. If there’s little benefit in doing something, why take the risk? But if you have a big potential upside, greater risks may be acceptable. When the benefits outweigh the risks by a wide enough margin, most people will say the thing is “safe.” For example, compare the risk that using steroids could exacerbate or accelerate a latent medical condition against the benefit that steroids provide in achieving one’s goals, such as achieving athletic potential, attaining a world-class physique, or simply shedding excess body fat (obesity, of course, carries its own health risks).

Comparative Safety. One way to judge safety is from a comparative standpoint. For example, is steroid use safer than liposuction or other cosmetic surgeries in which patients have died? How does it compare with extreme (but legal) activities like mountain climbing and hang-gliding? To make the comparison, we’d need hard statistics. The lack of long-term controlled studies on non-medical steroid use makes it hard to do anything but speculate.

The Bottom Line. Without scientific studies, we’re mostly left looking around at anecdotal evidence about non-medical steroid safety. We may read a story of a steroid user who suffered some terrible illness which he (or the media) blames on steroid use. But how helpful is that, if we don’t know key factors such as dosage, types of steroids used (orals vs. injectables), prior medical history, use of other drugs, and duration of use? Further, blaming steroids doesn’t mean there’s a shred of science to back it up. (Lyle Alzado blamed his T-cell lymphoma on steroids despite any scientific basis and contrary to his own doctor’s statements.) Or, on the other hand, we may see gym rats who’ve been using steroids for decades and yet seem healthy. (Maybe they are healthy, but, of course, present appearances can be deceiving, and/or a long-brewing health disaster may lie ahead.)

The only rational answer is that when used non-medically by mature adults (again, we are NOT talking about teen use, which is unacceptable), steroids are both safe and not safe. You can’t truthfully say they are one or the other without qualifying the answer.

Rick Collins, JD, CSCS is the lawyer that members of the bodybuilding community and nutritional supplement industry turn to when they need legal help or representation.