Performance and Image Enhancing Drugs (PIEDs)
Anabolic-Androgenic Steroids (AAS) are comprised of testosterone and its derivatives (Haupt & Rovere, 1983). AAS were specifically developed in an attempt to maximise the anabolic effects of testosterone so that the androgenic effects were not as apparent (Kanayama & Pope, 2018). The two most widely acceptable uses for AAS are their ability to assist in treatment of certain types of anaemia and their ability to stimulate sexual development in hypogonadal males (Kanayama & Pope, 2018). AAS can be categorised into either oral or parental (injectable; see Table 1).
STREET NAMES/ OTHER NAMES: PIEDs comprise a range of substance including Anabolic-Androgenic Steroids (AAS), Human Growth Hormone (HGH), Other hormones such as Insulin, Thyroid Hormone (T3), Stimulants such as clenbuterol or amphetamine-based stimulants, Prohormones, SARMs, Peptides and so on.
As AAS are the most common, the next sections will give a brief overview of these substances.
Know Your Body & Mind — ‘Set’
Know Your Environment — ‘Setting’
Know Your Drug — Practice Harm Reduction
DESCRIPTION
The two most widely acceptable (medical) uses for AAS are their ability to assist in treatment of certain types of anaemia and their ability to stimulate sexual development in hypogonadal males (Kanayama & Pope, 2018).
The benefits of these drugs with regards to increased muscle growth and strength are well established (Fahey & Brown, 1973; Freed et al., 1975; Kokkevi et al., 2008). In samples of weightlifters treated with AAS results have consistently demonstrated increased strength beyond what could be expected from weight training alone (Hartgens & Kuipers, 2004).
Table 1. Injectable and Oral Anabolic-androgenic steroid options, as well as other PIEDs
INJECTABLES
Testosterone C-17 esters |
19-Nortestosterones |
Dihydrotestosterone
|
| Testosterone cypionate
(Test C) |
Nandrolone compounds
(Deca Durabolin, NPP) |
Mesterolone (Proviron) |
| Testosterone enanthate
(Test E) |
Trenbolone compounds
(“Tren,”) |
Drostanolone (Masteron) |
| Testosterone propionate (test prop) | Stanozolol (Winstrol) | |
| Testosterone decanoate | Metenolone (Primobolan, “Primo”) | |
| Boldenone undecylenate (Equipoise, EQ) | ||
| Sustanon 250 (Blend of testosterone esters) |
ORALS
Methylated testosterone
|
Dihydrotestosterone (DHT) derivatives |
Prohormones + Other PIEDS |
| Methyltestosterone(“M1T”, MethylTest”) | Oxandrolone (Anavar) | Methasterone (Superdrol) |
| Metandienone(“Dianabol”, “D-bol”) | Oxymetholone(Anadrol, “A-bombs”) | Insulin |
| Fluoxymesterone (halotestin) | Metenolone(Primobolan, “Primo”) | Dehydroepiandrosterone (DHEA) |
| Chlorodehydromethyltestosterone (Turinabol) | Stanozolol (Winstrol) | Human Growth Hormone |
ADMINISTRATION
AAS – Injected Intramuscularly, Taken Orally.
HGH, other peptides and hormones – Subcutaneous.
SAFER DOSING
AAS are often used in two ways:
1) cycling (time on cycle using AAS vs. time off cycle to give the body a break), and
2) blast-cruise (periods of higher dosages interspersed with periods of lower or maintenance dosages, but without cessation of use).
Both methods of use are often accompanied by a combination of substances to augment the effects of the drugs, to manage unpleasant side effects (Brower, 2009). This combination may mean a variety of different administration methods might be necessary to effectively incorporate all the drugs necessary. Although some AAS are taken orally, a common route of administration is via injection (Brower, 2009).
Unlike other recreationally used substances (e.g. ecstasy), the effects of most AAS are not felt instantly (the exception being compounds like testosterone suspension); they often take several weeks to be metabolised by the body and for the desired effects to be noticed. In the case of AAS, the body shuts down its own testosterone production in the presence of exogenous testosterone, which may take several weeks.
Consequently, it may take some time, up to several years, for the body to start producing testosterone again once a person ceases exogenous AAS use. Due to this lag-time, people who use these substances will plan their use to coincide with a time when the desired effects will be optimal, such as a bodybuilding competition. A specific regime of substances may be used to help lose body fat and to promote muscle growth, and to assist the body ‘kick start’ its own production of these hormones once this regime is finished.
CYCLE / USAGE
Check out these videos below by Vigorous Steve
HALF LIFE
The half life of AAS varies and is generally dependent on the length of the ester. For example, the half life of testosterone enanthate is 10 days while the half life of testosterone propionate is 4 days. Details of the half life of different AAS can be found below.
Injectable steroids
Boldenone Undecanoate: 14 days
Drostanolone Propionate: 3 days
Methenolone Enanthate: 10 days
Nandrolone Decanate: 8 days
Nandrolone Phenylpropionate: 4 days
Stanozolol: 1 day
Sustanon 250: 15 days
Testosterone Cypionate: 12 days
Testosterone Enanthate: 10 days
Testosterone Propionate: 4 days
Testosterone Suspension: 1 day
Trenbolone Acetate: 3 days
Trenbolone Enanthate: 10 days
Trenbolone Hexahydrobenzylcarbonate: 10 Days
Oral steroids
4-chlorodehydromethyltestosterone: 7 hours
Fluoxymesterone: 8 hours
Methandrostenolone: 6 hours
Mesterolone: 12 hours
Oxandrolone: 9 hours
Oxymetholone: 8 hours
Stanozolol: 9 hours
Table 2. This table shows the properties of various AAS in terms of three characteristics: aromatisation (conversion to estrogen), 5α-reduction (conversion to more potent androgens), and 17α-alkylation (linked to liver toxicity). For example, testosterone undergoes both aromatisation and 5α-reduction but is not hepatotoxic.
Substance |
Aromatisation |
5a-reduction |
17-a-alkylation (hepatoxic) |
| Testosterone | x | x | |
| 19-Nortestosterone | x | x | |
| Boldenone | x | x | |
| Dihydrotestosterone | x | ||
| Mesterolone | x | ||
| Methenolone | x | ||
| Trenbolone | x | ||
| 17a-Methyltestosterone | x | x | |
| Fluoxymesterone | x | x | |
| Dehydrochloromethyl-testosterone | x | ||
| Oxandrolone | x | x | |
| Oxymetholone | x | ||
| Stanozolol | x | ||
| Metandione | x | x | x |
| Drostanolone | x |
Physical effects
- Anabolic (muscle-building) effects
- Shutdown of testosterone production
- Hair loss or growth
- Erectile dysfunction
- Increase or reduction of sex drive
- Infertility
- Breast tissue development (gyno)
- Prostate enlargement
- Acne
- Blood pressure changes
- Changes in liver enzymes
- Increase in developing cardiovascular complications
- Changes in HDL and LDL cholesterol
- Joint pain
Emotional effects
- Depression
- Mood swings
- Aggression
Psychological effects
- Generally increases in aggression (although this may not necessarily translate to violence)
- Paranoia
- Psychosis
LONG TERM EFFECTS
Individuals may develop AAS dependence through at least three etiologic mechanisms: anabolic, androgenic, and hedonic (Kanayam & Pope, 2018). Anabolic effects represent the major motivation for most individuals to begin using AAS (Sjöqvist et al., 2008). The androgenic effects of exogenous AAS may cause suppression of the hypothalamic-pituitary-gonadal (HTPG) axis, sometimes leading to hypogonadism that persists long after AAS are discontinued (Pope et al., 2014).
Hypogonadism often translates into AAS withdrawal syndrome (van Amsterdam et al., 2010) which may cause individuals to be prone to effects of dysphoria and, thus, increase the likelihood of resuming AAS to self-treat (Kanayama et al., 2009). AAS may also have direct rewarding properties, mediated directly via the effects on their metabolites on plasma membranes (Pope et al., 2014). AAS may have reinforcing psychoactive effects including increased self-confidence and aggressiveness, even though they are not generally considered intoxicating substances (Pope et al., 2017).
SAFER HANDLING
In Australia, increases in the detection of PIEDs at the border in combination with concerns about the substances links to organised crime, has led to increased law enforcement efforts. Queensland reclassified steroids a schedule-one drug in 2014 and under this legislation, the maximum penalty for possession or supply of steroids is 25 years’ imprisonment. Similar tough penalties apply in New South Wales and Victoria.
SAFER USING
INJECTING
When using Anabolic-Androgenic Steroids (AAS) this is likely going to be the primary mode of use. Steroids are generally suspended in oil or water, and these are injected into the muscle, where they are then released into the blood gradually. It is important to try to inject deep into the muscle belly. The main muscles used for these injections are the bum (glutes), thighs (quadriceps). Other common injection sites include shoulder (deltoid), latissimus dorsi (under the shoulder blade), and trapezius (traps).
Equipment
You will need:
-Barrels
-Needles
-Swabs
-Sharps Container
Selecting the correct needles:
Size Use
Grey 19G Drawing up oils from vials
Green 21G Drawing up oils from vials (can be used for larger muscle injections)
Blue 23G Injection into larger muscles (Glutes, Quads)
Orange 25G Injection into smaller muscles (Deltoid)
27-29G 1 mil Subcutaneous injections (fatty tissue)
Procedure
Make sure you use soap and water to wash your hands thoroughly and to also clean the site you will be injecting into before you start the process. Use a swab on the top of the vial before taking out the substance. When you have everything ready for the injection, also use a swab in one direction once on the injection site and let the alcohol dry. Once you have finished the injection, use a cotton ball or band aid to control any bleeding and manage the wound as you would a normal cut or puncture. Using a swab after injection will only encourage bleeding to continue. Make sure you watch old sites for signs of infection and see a doctor immediately if it isn’t healing.
Buttock: To find the site on the glutes/buttocks, split each cheek into four sections and use the outer-upper quarter to inject into as shown above. Generally the injection is performed lying in a prone position (on your stomach). You can perform the injection standing, although it is best to keep weight off the limb into which you are injecting.
Thigh: For the quadriceps (thigh), spread out your hands with your little finger on the knee and your thumb on your hip, spread towards the centre of the thigh. You want to inject just a little towards the outside of the leg (aiming for vastus lateralis). Again, you will want to keep your weight off the limb receiving the injection, so this is generally performed sitting with your leg out straight and relaxed.
Shoulder: For the deltoid (shoulder), the medial/lateral head (middle) is generally the preferred injection site. As shown in the image, find the middle of the shoulder, keeping the arm relaxed, and perform the injection. As this is a smaller muscle than the glutes or quads you may wish to use a 25G tip, although this is dependent on muscle size. You may also consider using a smaller amount of oil (1-1.5 mil) as compared to larger muscles.
DRUG TESTS
Professional athletes are often monitored and tested by WADA, while other at-risk groups are usually not subject to regular anti-doping testing.
Research on AAS is often focused on doping, and therefore, the analysis of biological matrices, both human and animal, such as urine, blood, plasma, and hair is common. Researchers’ interest frequently focuses on PIED identification and the determination of their major and long-term metabolites. Long-term metabolites increase the detection window for exogenous AAS, which has led to a significant increase in adverse analytical findings reported by WADA for specific compounds.
Methods that have been developed to screen for unknown AAS use information on common molecular structures and fragments, and androgenic bioactivity. Precursor ion scan experiments can be used to detect unknown steroids in human urine using LC-MS/MS. This is only the case for compounds that possess the predetermined precursor ions and other compounds may be missed.
DRUG CHECKING
A research project is currently being undertaken in Queensland regarding how steroids can be included and integrated into the current drug checking processes. People can bring in vials and tablets into the CheQpoint drug checking service and the samples received are taken to another lab for off-site testing using specialised equipment that enables the steroid community to receive comprehensive results such as presence of other substances and purity. Approximately every 1-2 months all the results will be posted online via the Hi-Ground website and socials, however these results will not be individualised (for now).
Overtime we aim to refine this process so testing steroids becomes easier, faster and the community can receive individualised results.
FOR MORE SUPPORT
Contact Dr. Timothy Piatkowski – t.piatkowski@griffith.edu.au or timp@quivaa.org.au. Tim is an ongoing researcher in the area of steroids, health, and harm reduction. He is willing to provide assistance to both consumers as well as service providers in need of training and support.
References
- Brower, K. J. (2009). Anabolic steroid abuse and dependence in clinical practice. The Physician and Sportsmedicine, 37(4), 131-140. https://doi.org/10.3810/psm.2009.12.1751
- Fahey, T. D., & Brown, C. H. (1973). The effects of an anabolic steroid on the strength, body composition, and endurance of college males when accompanied by a weight training program. Medicine & Science in Sports, 5(4), 272-276.
- Freed, D., Banks, A. J., Longson, D., & Burley, D. M. (1975). Anabolic steroids in athelics: Crossover double-blind trial on weightlifters. British Medical Journal, 2(5969), 471-473. https://doi.org/10.1136/bmj.2.5969.471
- Hartgens, F., & Kuipers, H. (2004). Effects of androgenic-anabolic steroids in athletes. Sports Medicine, 34(8), 513-554. https://doi.org/10.2165/00007256-200434080-00003
- Haupt, H. A., & Rovere, G. D. (1983). Anabolic steroids: A review of the literature. The American Journal of Sports Medicine, 12(6), 469-484. https://doi.org/10.1177/036354658401200613
- Kanayama, G., Brower, K., Wood, R., Hudson, J., & Pope, H. (2009). Anabolic–androgenic steroid dependence: An emerging disorder. Addiction, 104(12), 1966-1978. https://doi.org/10.1111/j.1360-0443.2009.02734.x
- Kanayama, G., & Pope, H. (2018). History and epidemiology of anabolic androgens in athletes and non-athletes. Molecular and Cellular Endocrinology, 464, 4-13. https://doi.org/10.1016/j.mce.2017.02.039
- Kokkevi, A., Fotiou, A., Chileva, A., Nociar, A., & Miller, P. (2008). Daily exercise and anabolic steroids use in adolescents: A cross-national European study. Substance Use & Misuse, 43(14), 2053-2065. https://doi.org/1080/10826080802279342
- Pope, H. G., Khalsa, J. H., & Bhasin, S. (2017). Body image disorders and abuse of anabolic-androgenic steroids among men. JAMA: The Journal of the American Medical Association, 317(1), 23-24. https://doi.org/10.1001/jama.2016.17441
- Pope, H. G., Wood, R. I., Rogol, A., Nyberg, F., Bowers, L., & Bhasin, S. (2014). Adverse health consequences of performance-enhancing drugs: An endocrine society scientific statement. Endocrine Reviews, 35(3), 341-375. https://doi.org/10.1210/er.2013-1058
- Sjöqvist, F., Garle, M., & Rane, A. (2008). Use of doping agents, particularly anabolic steroids, in sports and society. The Lancet, 371(9627), 1872-1882. https://doi.org/10.1016/S0140-6736(08)60801-6
- van Amsterdam, J., Opperhuizen, A., & Hartgens, F. (2010). Adverse health effects of anabolic–androgenic steroids. Regulatory Toxicology and Pharmacology, 57(1), 117-123. https://doi.org/10.1016/j.yrtph.2010.02.001
Drug combinations
Monitoring your health with your doctor is very important while using PIEDs or other substances which have an artificial effect on your body or alter your natural levels of chemicals or hormones. Not all doctors are willing to talk about non-prescribed usage of these substances but many will monitor you. It’s important not only for the duration of a cycle but at the end of a cycle as well. For example, you will need a plan for the end of your cycle in case you get extreme or unwanted side effects. Things to get monitored include liver function, testosterone and cholesterol levels with full blood tests. Keep an eye on blood pressure as well. Also talk about how much, how long, and how many combinations of substances you are using.
Unsafe combinations
Cautionary combinations
- Other performance and image enhancing drugs include: hormones (growth hormone, insulin-like growth factor 1, thyroid hormones, androstenedione, insulin)
- B-agonists (clenbuterol and albuterol)
- Stimulants (amphetamines, ephedrine, pseudoephedrine),
- Other drugs used to restore ‘normal’ function following using the prior drugs (human chorionic gonadotropin, clomiphene, tamoxifen, exemestane, arimidex, cabergoline).
Low risk effects
Check out the TripSit drug combinations chart here for info on other combinations.
Call 000 if experiencing adverse effects, feel unwell or concerned in any way
Disclaimer
This educational resource has been developed collaboratively by healthcare workers and people who use drugs for their peers and the wider community. The role of Hi-Ground is to provide practical, evidence-based, unbiased information to assist you to make educated choices and to promote harm reduction, community care, and wellbeing.
In an unregulated market it’s impossible to know the purity or dose of any substance. Taking drugs from an unregulated market carries its own risk, and you can educate yourself and practice harm reduction to reduce this risk.
Knowledge is power.
This resource is produced by DanceWize & Hi-Ground