Are one million people in the UK using anabolic steroids?

“According to the UK Anti-Doping Agency, there are more than one million, predominantly male (around 98%), steroid users in the UK.”

“There are … 1 million people using steroids.”

“According to the UK Anti-Doping Agency there are around one million regular UK steroid users.”Metro, 2 July 2022

A report published by the cross-party Health and Social Care Committee titled “The impact of body image on mental and physical health” says that: “According to the UK Anti-Doping Agency, there are more than one million, predominantly male (around 98%), steroid users in the UK.”

The report refers specifically to the use of anabolic steroids, which can be used to increase muscle mass, and not the use of corticosteroids, which are used to treat a wide range of medical conditions. 

This is not a new claim. In fact, the same figure has been quoted multiple times in recent years by politicians and in the media. Conservative MP Dr Luke Evans, who is campaigning to require advertisers and influencers to label images of bodies which have been digitally altered, and who also sits on the Health and Social Care Committee, has cited the figure at least four times—most recently at Prime Minister’s Questions on 18 May and previously on 12 January 2022, 21 April 2021 and 15 September 2020.

However, while the widely-circulated figure is often attributed to the UK Anti-Doping Agency, it isn’t based on original research by that body. While it’s not certain exactly when the figure was first cited, Full Fact has been able to trace it back to an estimate given by a researcher in 2015, which was based on an extrapolation of data from studies at a number of needle and syringe exchanges. 

Other data suggests the true number of steroid users may be significantly lower, with a study published in May based on a review by 55 experts concluding it could be closer to half a million. 

Where did the one million estimate come from?

The earliest report of the “one million” figure Full Fact has found comes from an item broadcast and published in January 2015 by Sky News. This noted that, while there were no nationwide statistics for steroid use, “informed estimates based on the evidence of local drug services put the number possibly as high as one million”.

The report included an interview with Joe Kean, an alcohol and illicit drug worker who is also a leading researcher in the use of such steroids. Mr Kean told Sky News the number of steroid users was likely to be twice the number of cocaine, heroin and cannabis users combined, and added: “If you work out the percentages in local areas, you’re looking [at] around between 1% and 1.4% of general populations, and I guess if you extrapolate that to the national population, you’re looking somewhere in the region of a million.”

Mr Kean told Full Fact that 1%-1.4% estimate was based on studies that he and others conducted at needle and syringe exchanges around the country. In a paper he co-authored in 2014, Mr Kean wrote: “We know (and have hard data to support it) that in areas which have been proactive in service provision for some time, the numbers of registered steroid users usually accounts for somewhere in the region of 1% to 1.45% of that population (1600 registered users in a city or town of 110,000 for example).” We’ve not seen more details of the data that estimate is based on, though according to the National Institute for Healthcare Excellence: “Users of image- and performance- enhancing drugs may represent a significant proportion of the people who use some needle and syringe programmes.”

The one million figure Mr Kean came up with, which has been circulated ever since, was an upper estimate. Applying 1.4% to the total UK population in 2015 (65.1 million) gives a total of 910,000, while 1.45% would equate to 942,000—close to one million users. But this is a theoretical maximum estimate which assumed the 1.4% figure applied in every region of the UK. Using the lower figure of 1% would reduce the nationwide estimate significantly, to 650,000.

Speaking to Full Fact recently, Mr Kean admitted his estimation of one million users was “crude”, though said that in his experience, he had visited a number of gyms where “pretty much 90%” of members were using image and performance enhancing drugs (IPEDs)”. Asked if he still believed the one million estimate was a good estimate in 2022, he told us: “If I was pushed I’d have another look, but I still think it’s relatively accurate.”

Although the one million figure is often cited in relation to the number of steroid users, he told us his figure was actually an estimate for the number of IPED users, which would include people taking things like growth hormones, and not just steroids. However, a 2016 survey conducted by researchers from Liverpool John Moores University in conjunction with Public Health Wales, including Mr Kean, found the vast majority of IPED users who responded reported using steroids. 

Professor James McVeigh, from the Department of Sociology at Manchester Metropolitan University, has been involved in the story of steroids for more than 30 years and has previously co-authored papers on the topic with Mr Kean. 

He told Full Fact that extrapolating the 1.4% figure across the whole country did not produce a figure that could be relied upon because it fails to take into account inconsistent levels of steroid usage across the UK. “We know that there are considerable differences between different areas of the country. It's not an opinion that I'd support,” he said.

How the figure has spread

Despite uncertainty around the estimate, it was quickly adopted as a statement of fact and has been widely repeated in the media in the seven years since Mr Kean’s interview with Sky News.

With the help of Full Fact’s digital fact checking tools, we’ve identified at least 11 mentions of the figure since January 2021, including in this April 2022 article on the BBC News website and in this July 2022 article in the Metro. But we’ve also found a number of other examples prior to that, for instance in Men’s Health in January 2016, the i in July of that same year, in the Guardian in January 2018 and in Esquire magazine in July 2018.

Some of the articles published after 2016, such as one for the Open Access Government website, suggest the source of the one million figure is the Public Health Wales/Liverpool John Moores University 2016 report into the use of IPEDs mentioned previously. However, this report was published after the figure was used by Sky News, and does not appear to include any mention of the figure. 

In many other cases, the UK Anti-Doping Agency (UKAD) is cited as a source of the figure. For example, the article published by the BBC in April this year refers to the UKAD’s 2020 report as the source of the information, and a spokesperson for Dr Evans also told Full Fact that the figure had been provided to him by the UKAD. However, the UKAD has told Full Fact it is not the original source of the claim. It told us that the figure had been provided to it by Mr Kean, while the only source given for the figure in its 2020 report is the Guardian’s January 2018 article.

That article reported that the newspaper had “spoken to several doctors who work closely with users and said they believed there were a million users in the UK.”  It again quoted Mr Kean, who on this occasion said he was confident there were about 900,000 users in the UK.

What does the other evidence show?

Other available evidence, including a review by a panel of 55 experts published earlier this year, suggests the one million figure may be a significant overestimate—though all those we spoke to for this piece, including Mr Kean, were clear there’s no definitive data.

Crime survey data provides some insight. Liverpool John Moores University and Public Health Wales’s 2016 report noted that “data from the Crime Survey for England and Wales (CSEW) indicates that the estimated number of 16-59 year olds reporting lifetime use of anabolic steroids has increased from 194,000 in 2005/06 to 271,000 in 2015/16.”

These figures reflect lifetime use. For annual use, the survey reported that 31,000 people aged 16-59 used anabolic steroids in the year ending March 2020.

However, as the 2016 report warned: “The CSEW is likely to be unreliable for rare events like anabolic steroid use and so may under-estimate the number of people using drugs”.

Both the CSEW and its predecessor, the British Crime Survey (BCS), involve surveying householders, an approach which the Advisory Council on the Misuse of Drugs (ACMD) notes has limitations.

In 2010 it said: “Although the BCS provides the most comprehensive data on the prevalence of steroid use it has some limitations when considering steroid misuse. For example, being a household survey it does not include locations such as halls of residence, prisons or other sites of communal living; there is possible confusion in reporting between medicinal corticosteroids and illicit anabolic steroids … many steroid users belong to a closed sub culture who would be reluctant to divulge their use to outsiders; and steroid users are likely to be difficult to catch at home — most work, with some working evenings, and some can spend a high proportion of their time in the gym.” 

In an attempt to more accurately estimate the number of steroid users in the UK, a panel of 55 experts in the field recently came together to review all the available data. 

They used a technique known as a Delphi study, in which experts exchange views before each independently providing estimates and assumptions to a facilitator who then compiles a report. This report is then discussed, updated and revised and the process continues until the experts reach a consensus. 

In a paper published online in the journal Drugs: Education, Prevention and Policy, in May 2022, the panel noted that previous estimates generated through the CSEW were “implausible”, with information sourced from needle exchange programmes showing the figure to be up to ten times higher. But they also came to a much lower likely figure than that which has been so widely cited in recent years.

The Delphi study, which saw the expert panel surveyed three times, considered a range of data sources and looked at factors such as regional variation, ultimately estimated that between 328,000 and 687,000 men aged 15-64 in the UK had recently used anabolic steroids in the UK, and gave a central estimate of 447,000.

While this doesn’t include the much smaller number of women who may use the drugs (the 2016 national IPED survey put the proportion of users who were male at 95%), this total is less than half the commonly quoted “one million”. The report also noted that two fifths of the expert panel believed the central value should be lower still.

“It’s still only an estimate, but it’s the best that we’ve got until we can get some funding and are able to do a more detailed piece of work,” Professor McVeigh, who participated in the research, told Full Fact.

Dr Luke Evans told us: “I am grateful to Full Fact for sharing with me the latest estimates on this figure.

“This new study highlights the need for further research to be conducted in this important area. I am pleased that Full Fact are raising this issue and hope they will follow up with UK-Anti Doping to see if there is a further comment from them on the widely used estimate of one million users.”

The UK Anti-Doping Agency told Full Fact it would be looking at the results of the latest study but had no further comment to make at this stage. We also contacted the Health and Social Care Committee for comment but did not receive a response.