Like weight loss, dieting or fitness, steroids can become an obsession for some gay men -- and there are potential health risks involved. While some men take steroids for a legitimate health problem, most illegally purchase steroids without a prescription in order to "bulk up" and combat feelings of inadequacy about their size, which is also known as muscle or body dysmorphia.

Size is only one of several reasons why some gay men use steroids. The great irony of steroids is that while many gay men use them in order to gain size, many also report that they don't think they have actually gotten much larger. "For some gay men there is peer pressure to obtain the gym look -- a bulked up image of musculature. However, one of the many problems with this type of high megadose steroid use is that when usage stops, you lose the weight, and then feel diminished physically and mentally," explains Dan William, M.D., a New York City-based physician with a large gay practice.

In the last three decades, men have increasingly become concerned with body image and diets that were previously considered issues only for women. For gay men, HIV has certainly played a role in the growing preoccupation with body size. Some men may use steroids to treat HIV-related wasting, while other men (both HIV-positive and -negative) associate a small body with a sick body. "I've realized my size gives me the façade of health; I'm starting to understand that I equate being smaller and losing weight with being ill," says Glen, a thirty-eight year old HIV-positive gay man. "There is this common misperception that if a man's body is large and perfect, he couldn't possibly have HIV," says Jeff Huyett, a nurse practitioner at Callen Lorde.

Body image and size are often connected to whether or not gay men feel attractive and desirable. "We perpetually see gay men on heavy steroid doses who perceive themselves as skinny boys yet think that perfect strangers will find them attractive at a larger size," notes Charles Franchino, M.D., a chiropractor with a large gay male practice. Dr. Franchino treats men who have experienced rotator cuff syndrome -- tears or injuries to the rotator cuff as a result of lifting heavy weights. "The healing curve with these types of injuries can be lengthy and requires long periods of time away from the gym, which will lead to a reduction in body size," says Dr. Franchino.

Know Your Risks

Here are some side effects and risks associated with steroid use:

• Liver problems, especially for gay men taking other drugs that interact with the liver and for men who consume alcohol or have chronic hepatitis B or C infections.
  
• Change in blood pressure.
  
• Diabetes.
  
• Muscular weakness.
  
• Sharing needles can be dangerous.
  
• Osteoporosis and, sometimes, joint damage result.
  
• Skin bruises more easily. Wounds heal slowly.
  
• Your body produces fewer disease-fighting antibodies, making you more susceptible to viral, bacterial and fungal infections.
  
• Some people develop agitation, euphoria, insomnia, and, rarely, psychosis, feelings of anger, rage and anxiety.
  
• Urinary and bowel problems, such as diarrhea.
  
• Headaches, aching joints, and muscle cramps.
  
• Nausea and vomiting.
  
• Increased risk of ligament and tendon injuries.
  
• Severe acne and/or baldness.

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Emotional Issues

In addition to some of the physical side effects that can result from steroid usage, there are numerous psychological problems that can also result. Some men report a feeling of increased energy during a cycle, especially in the beginning. However, this can lead to increased amounts of anger and rage, commonly referred to as "roid rages" that can occur as more of the substance builds up in your system.

Whether you are thinking about trying steroids, or if you are looking to quit the juice, it is important you consider these and other risks associated with steroid use. If there is someone you trust, try talking about some of the issues with him or her. Here are some questions to ask yourself:

• What do you like about the idea of having or possessing a larger body?
  
• What excites you about it?
  
• What do you like about using?
  
• How does it make you feel about yourself?
  
• How do the steroids make you feel?
  
• How do you think you look?
  
• Do you feel you have gained in size?
  
• Are there healthier ways of changing your body?

Now ask yourself what you consider the risks of steroids to be. Most importantly, which are the risks that you feel apply to you?

• Are there risks related to gaining access to clean needles or quality steroids?
  
• How do you feel after you stop using?
  
• What do you think when your size changes?
  
• Do you suffer from withdrawal symptoms, like depression, reduced sexual drive or insomnia?
  
• What are your other concerns?

How could you consider making some changes?

• Could you reduce the number of cycles per year?
  
• Could you consider less potent steroids?
  
• How about reducing the length of your cycle?
  
• Could you talk to your doctor about your usage, and have him perform liver enzyme and blood tests during your cycles?
  
• Could you cut down on your substance use during cycles to decrease liver stress and maximize your results?

For some, change can be as easy as: "I'm stopping steroids." However, other gay men may require a different approach. What if you want to reduce your risks without going cold turkey? Try limiting your dosage and take less potent steroids. Taking steps to become healthier is more important than saying, "I'm going to stop doing steroids," and then starting a new cycle just in time for Gay Pride.