That applies to his clients as well, many of whom are middle-aged guys whose doctors prescribe hormone-replacement therapy (HRT). “I can tell you this,” he says. “It’s not usually the guy you would suspect who’s on HRT.” The supplemental testosterone they receive isn’t enough to change their physiques in noticeable ways. But it does give them more energy for their workouts and quicker recovery. That, combined with a better mood and a higher sex drive, are all his clients want or feel they need from the drugs.
“Most are just looking for a way to feel good, not necessarily to get jacked,” Benda says. For that, “they go full-pharma and get the true gear.”
Even then, the ones who are using the industrial-strength drugs may not be obvious. “Of all the people I’ve seen who admit using steroids, I’d say 90 percent don’t even look like bodybuilders,” says Michael Scally, M.D., a physician who has treated more than a thousand current and former steroid users, and consulted with doctors around the world on many more. “They aren’t 6 to 8 percent body fat. They aren’t huge. They look like 20-, 30-, 40-year-old men. They’re just using steroids to try to get in shape faster.”
Let’s start with the obvious: It’s easy to tell if someone is using steroidssuccessfully. Harrison Pope, M.D., a professor of psychiatry at Harvard Medical School, developed the fat-free-mass index, or FFMI. It’s a calculation of your height, weight, and body-fat percentage that gives you an idea of how close you are to your physiological ceiling. (You can calculate yours here.)
He came up with it after years of studying steroid users in Boston-area gyms and comparing them not just to non-steroid users in the same gyms, but also to bodybuilders from different eras. For a 1995 study, Pope and his coauthors estimated the FFMIs of Mr. America winners from 1939 to 1959, before steroids were readily available. The group includes future B-movie star Steve Reeves, whose physique was so iconic that he was name-checked in The Rocky Horror Picture Show. The average FFMI was 25.4. (One of the highest was George Eiferman, Mr. America 1948, with a 27.7 FFMI. His upper body was later the model for George of the Jungle, a 1960s cartoon character.) Even today, with all we’ve learned about training and nutrition, an FFMI in the mid 20s is still considered the ceiling for natural bodybuilders. Anything above 26 or 27 is suspect.
So that’s the easiest call: If you see someone who’s extremely lean but substantially bigger than pre-steroid-era bodybuilding champions, he’s probably using drugs those guys didn’t have.
But just because someone is below a 25 FFMI doesn’t mean he hasn’tbeen topping off the tank. A 2011 study by Pope and his colleagues found that the average FFMI of steroid users was 23.3, which wasn’t much higher than the 22.8 average of non-users. The study included lifters who used human growth hormone and/or IGF-1 in addition to steroids. Their average FFMI was 26.2.
Thus, if you want to build a physique that’s only possible with steroids, you probably need more than steroids.
Pope’s research also shows the clearest difference between users and non-users. Steroids preferentially increase the size of the muscles that attach to the shoulder joints: the lats, trapezius, pectorals, deltoids, and upper arms. (Interestingly, that’s also where steroid-induced acne is most likely to appear.) A guy who’s “yoked,” with traps big enough to support their own ecosystems, almost certainly had pharmaceutical assistance.
So far we’ve looked at the intentional effects of steroid use, and only in lifters who used them successfully to get impressively jacked. But it’s the unintended effects that are often the most obvious signs.
An example from my own experience:
In the mid-1990s, as I opened the door to my gym in suburban L.A., I heard someone with a voice an octave lower than mine talking on one of the pay phones in the hallway. I didn’t think anything of it, until I looked over and realized the deep-voiced person was actually Heather Tristany, a competitive bodybuilder. (And later a porn star, as I unfortunately discovered when I Googled her name.)
The drugs that thickened Heather’s vocal cords, giving her not only a manly voice but also impressive muscles and a chiseled jaw, are technically known as AAS, for anabolic-androgenic steroids. They’re all chemical derivatives of testosterone, which explains the anabolic (muscle-building) features as well as the androgenic (masculinizing) bugs.
Once you give your body testosterone, it stops producing it. This is most apparent below the belt. Unlike the human body as a whole, which tends to gain weight when it has nothing to do but hang around, testicles shrink.
Dramatically increasing the amount of testosterone in your body means more of it gets converted into other types of steroid hormones, like estrogen. That can lead to gynecomastia—an accumulation of glandular breast tissue behind the nipple.
It might also convert to dihydrotestosterone, a chemical associated with baldness and non-cancerous growth of the prostate (benign prostatic hyperplasia, or BPH).
But the most pronounced signs of steroid use are the ones you can’t see.
The telltale test
Scally took an unusual path to his steroid expertise. It started when, at 35, his waist measured 40 inches. He remembered a warning he’d heard in medical school: As you get older, your health is at risk if your waist size exceeds your age. That got him into the gym, where he began to hear a lot of questions about steroids.
They weren’t asking about how to use them—as an anesthesiologist, he knew less than even the entry-level juicers—but about how to handle the many consequences of having used them. “The biggest question I got was, ‘How do I get my body to come back on after I come off anabolic steroids?’ ”
The conventional wisdom in the 1990s said that steroid users would eventually return to normal hormone production, and restore their physical and emotional equilibrium. Scally, however, saw it wasn’t that simple or predictable.
Many of them suffered from a condition doctors now recognize as anabolic steroid-induced hypogonadism, or ASIH. Symptoms include muscle and strength loss, fat gain, bone loss, poor sleep, sexual dysfunction, depression, irritability, and fatigue. Because the body has stopped producing sperm, former steroid users are often sterile for months after they quit, and often years.
Sometimes, Scally says, that’s a tipoff for a doctor or close friend that someone has used steroids: he and his wife are trying to start a family but unable to conceive, especially if he’s shooting blanks from shrunken testicles, or if he also has gynecomastia and/or post-teenage acne.
But there could be other explanations for some of those problems. Acne and infertility aren’t limited to steroid users, and gyno occurs in about 50 percent of boys in early puberty. It goes away most of the time, but for some it never does.
The absolute best way to tell is a blood test. “If you find hCG, you can bet almost 100 percent they’re using anabolic steroids,” Scally says. That’s because hCG (human chorionic gonadotropin) is a hormone produced by pregnant women, and commonly used to un-shrink balls and restore normal testosterone levels.
The eyeball test
You, of course, aren’t going to issue a blood test to a guy in your gym you suspect of using steroids. Nor are you going to check for BB balls, gyno, or bacne. But you’re probably still curious. In fact, when I searched Google for “how to tell if someone …”, “ … is on steroids” was the #2 suggestion, right after “ … is lying” and ahead of “ … is gay,” “ … likes you,” and “ … is high.”
So what should flip the switch on your ’roid-dar?
“Faster than normal progress is always the obvious indicator,” Benda says. “After about three years of lifting, the ability to gain muscle significantly drops. If someone tells me they gained 25 pounds of muscle in a year, I know they’re either new to lifting, they’re juicing, or they’re full of crap.”
Another tell: someone looks like a near-contest-ready bodybuilder or cover model for months on end, without gaining fat or losing muscle.
But even that isn’t a perfect sign. It’s possible the guy is simply a genetic freak. “I’ve run across one person in the last 15 years of training who exhibited all the signs of steroid use, but I know for a fact wasn’t on anything,” Benda says. “He never got tired, built muscle easily, and stayed lean year-round. Now, that’s one person out of hundreds of athletes I’ve trained, so it is rare.”
There is, however, one sneaky-effective way to tell if a guy is juicing, or has in the past: Talk to him about steroids. “The average anabolic steroid user is more knowledgeable about androgens than most doctors,” Scally says.
Unless the guy is a doctor, you can guess that his deep knowledge of male hormones came about through enlightened self-interest.
This article originally appeared on Men's Health