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Abscess related to anabolic-androgen steroid injection



Staff Member
Aug 11, 2010
Med. Sci. Sports Exerc. 31(2) 207-209, 1999


A case report is presented of a 26 year old anabolic steroid user who did not use sterile injection techniques and wound up with an injection-related thigh abscess. This individual reported sharing multidosage vials with two other weightlifting colleagues who also developed infections. It took approximately 3-4 months and a trip to the emergency room to control the infection and begin healing.


I do not usually focus on case reports in this column. I wanted to make an exception in this instance because I felt it was important to draw readers attention to one of the risks involved with using injectable steroids.

Two factors put American bodybuilders and strength athletes at risk of injection-related infections. One, strict government policies established in the 1980's regarding the legal consequences of using and/or possessing anabolic/androgenic steroids has greatly curtailed their availability through medical channels. Two, many novice steroid users are unfamiliar with the risks involved in improper injection methods as well as the risks involved with sharing needles and/or vials.

Physicians have been put under tremendous pressure not to prescribe steroids to individuals for purposes of physical enhancement, thus diminishing the availability of steroids through proper channels. American pharmaceutical companies have also greatly decreased production of anabolic/androgenic steroids. It just isn’t financially practical if physicians can no longer prescribe them to a broader market. This has lead to a boom in black market products, most of which are of questionable quality and are often produced under unsterile manufacturing conditions. Most bodybuilders do not have the means or education necessary to recognize counterfeits or have all of their drugs tested in a laboratory for purity. As a result, people are gambling with their health by using steroids they procure from black market sources. Sometimes the product is fairly pure and the user experiences the expected results. Then again, how often do you hear about a bodybuilder doing a cycle and experiencing none of the expected gains? Usually the guy feels too foolish to tell everybody, "Hey everybody, look at what a fool I am. I just spent a ton of money on steroids, bought them from someone I didn’t know personally, and they turned out to be fake! In fact, I have no idea what I just injected into my body over the last several weeks!" This is not the kind of thing an aspiring young bodybuilder brags about.

Sometimes the mysterious oil in the bottle is innocuous, sometimes it contains infectious agents such as rare bacteria and toxic chemicals. There are several reports in the literature of bodybuilders getting abscess’ from "atypical bacteria". Atypical bacteria are ubiquitous in the environment, are able to survive for prolonged periods without nutrients, such as in a vial of steroids, and are very capable of causing difficult to treat infections at the site of injection.

If you surf the bodybuilding message boards you will undoubtedly find numerous questions from novice drug users. The anonymous writer usually wants to know, "how much should I take?", "When will I start seeing gains?", or "what should I combine with it?". It is not very often that someone asks, "how do I avoid infecting myself with my own skin flora?" or "what should I tell my physician to test for when this thing gets infected?". All to often the excitement of having that precious little bottle of dreams in their hands makes them throw caution to the wind.

There is also the matter of secrecy. I often get the sense that some bodybuilders get a sort of juvenile titillation from just talking about steroids and just can’t keep the secret to themselves. When they just can’t stand the excitement of being so sneaky anymore and begin to talk about using them, they seldom ask intelligent questions. Those who are more mature yet equally uninformed face another dilemma, how do you ask questions relating to self administering injectable drugs without incurring other’s curiosity as to why you would want to know.... "Well,...I have this friend who...", anyway, you get the picture.

Then there are the experienced users who simply get careless. It is this population that is perhaps more at risk simply because of the greater volume of drugs they use throughout their bodybuilding career. You will not usually get wind of a well known bodybuilder suffering from injection related infections. It’s not that they don’t happen, it’s simply that you don’t hear about them. Drug paraphernalia and prescription laws in many states, which are intended to curtail illicit drug use, decrease access to sterile injection equipment even for experienced users. Many times when darts and vials are scarce, they are shared. This greatly increases the risk of contracting blood born pathogens such as HIV, hepatitis C and hepatitis B. There are documented cases of each of these diseases being contracted after injecting steroids.

A word of caution is all I offer. There are proper ways of administering injectable drugs that reduce the risk of infection. There are also life saving precautions that must be taken by bodybuilders using steroids such as not sharing needles and not sharing multi-dose vials. If you are willing to put in the effort and pay the price to get illegal injectable steroids, at least take the time to educate yourself about the proper way to administer them as well as the risks involved with their use.