Safer injecting for steroid users

How to inject more safely for steroid users

Using steroids will always carry risk. If you’re injecting steroids, these tips can help you to reduce harm.

Key things to remember

Steroids alone will not lead to increased muscle mass. Proper food, training and rest are needed. 

Using steroids for prolonged periods of time, or at a dose that is too high, can cause your muscles to stop growing, regardless of how much training is completed or the quality of your diet.

Take regular (and long) breaks from steroids - taking at least the same length of time off as you use for is the best way to reduce harm. This is sometimes referred to as a steroid ‘cycle’.

Using steroids for more than 12 weeks in a row can increase your chance of risk. 

How steroids can impact your body

Using steroids can cause:

• Acne
• Liver damage
• Water retention
• Aggression 
• Blood-borne viruses (if needles are shared or reused) 
• Hair loss

Most steroids purchased illicitly are made in underground labs, which makes it difficult to know what you are taking.

Before you inject steroids

• Check the contents of the vial or amp before you draw up – the steroids you buy are often not what they say on the label. If you see bits in the fluid and it’s meant to be clear, for example, throw it away as it could be dangerous to use

• Remember - the ingredients, strength and purity can vary between manufacturers, so even if you take steroids regularly, the actual dose may differ from batch to batch

• Rotate which muscles you inject into – this gives your body time to heal between injections. Injecting into broken, irritated or lumpy skin can increase your risk of infection

Always use the right needle and the right barrel

• Use a new, sterile needle every time – this reduces your risk of injuries and infections

• Stick to your own needles, vials and amps – using your own equipment can prevent the spread of blood-borne viruses (BBVS) like hep B, hep C and HIV. You can get clean equipment from any substance use service and many pharmacies

• Greens for drawing up, blues for injecting – for injecting steroids, use a green needle to draw up then swap it for a blue needle to inject. A blue needle is long enough to get the fluid into your muscle without hitting a bone

• Don't use barrels bigger than 2ml – if you use bigger barrels, you may draw up too much liquid. Injecting too much liquid can cause problems like scarring and abscesses (a pus-filled lump under your skin)

Make sure you’re injecting steroids in the right place

Steroids work on your whole body, not just the area you're injecting into.

The safest places to inject are your glutes, quads and delts.

It’s easier to inject into these bigger muscles, but the below information can help to reduce the risk of hitting blood vessels or nerves.

• Glutes – your glutes are the safest place to inject. Imagining that your buttock is divided into four,  inject into the upper, outer quarter (see diagram). This is so you don’t hit the sciatic nerve, which runs down the centre of your buttock.
• Quads – your quads are the next safest area to inject after the glutes. Inject into your outer thigh, half way between your knee and the top of your leg.
• Delts – injecting into your delts carries more risk because the muscle is smaller.

Avoid injecting into other muscles, as this increases your risk of problems like nerve damage which can affect your training. 

Visit your local needle and syringe service

Needles and syringe services are free services where steroid users are welcome.

Find a needle and syringe service near you

They’re completely confidential. Staff won’t tell anyone that you’ve been there, including your work or GP.

Some services have specialists in steroids and other image and performance-enhancing drugs (IPEDs). Ask if a specialist is available when you go in.

As well as new needles, barrels, swabs and bins, staff can help with:

• safer injecting advice
• advice on sore or infected injecting sites
• testing for hepatitis C and HIV
• hepatitis B vaccinations
• free condoms and sexual health advice
• disposal bins

What to expect when you visit a needle and syringe service

When you’re injecting steroids

Clean your injecting site properly

Cleaning your injecting site correctly helps to prevent infections.

• Always wash your hands with soap and water before you inject. If you don’t have soap and water, you can use new alcohol swabs, or hand sanitiser gel
• Wash your injecting site with soap and water too, or clean it with a single wipe of an alcohol swab.  Use a swiping motion in one direction. Rubbing in a circular or back-and-forth motion can spread dirt and bacteria around
• Allow your skin about a minute to dry before you inject
• If you’re using a multi-dose vial, use a swab to wipe the top of the vial before you draw up

Injecting into a muscle step-by-step

1. Draw up with a green needle, then swap to a blue for injecting
2. Insert the needle at 90 degrees to your body. It needs to go in most of the way
3. Draw the plunger back slightly to check you haven’t hit a vein or artery. If you have, you’ll see blood in the barrel. If this happens remove the needle and apply pressure with a clean tissue or cotton wool
4. Only inject up to 2ml of fluid into each site – if you inject more it raises your risk of infection
5. Inject slowly – 10 seconds per 1ml is about right
6. Remove the needle carefully and apply pressure with a clean tissue or cotton wool
7. Use a proper sharps bin to dispose of needles. You can get these free from needle and syringe services

After a cycle

Some people take steroid doses in a "cycle". This means that over a period of time, they take multiple doses of steroids, pause, and then start up again. 

Your natural hormone production usually stops a few weeks into a cycle.

Some people take post-cycle therapy (PCT) drugs to help kickstart their natural hormones again. These drugs can have side effects and they aren’t always needed – your hormone levels should gradually recover on their own.

In some cases, hormone levels don’t return to normal. If you have signs of steroid crash that aren’t improving, such as lack of sex drive or difficulty getting an erection, get some medical advice.

Remember – time off should equal time on.