Hunks on steroids might look strong on the outside, but many have shrivelled up testicles and a diseased heart.
The drugs do enormous damage, says Professor Shane Darke, leader of a team that has investigated steroid-related deaths in NSW.
It's simply not true that steroids are a healthy body-building supplement.
Steroid abusers who take other drugs are at particular risk of dying from heart disease, according to the study by the National Drug and Alcohol Research Centre at the University of NSW and the NSW Department of Forensic Medicine.
Of the 24 steroid-related deaths his team studied, all were men and the average age was 32. All but one took other drugs as well as steroids.
Two thirds died from accidental drug poisoning, close to 17 per cent committed suicide and 12.5 per cent were killed by someone else.
"Extensive cardiovascular disease was particularly notable," says a paper on the study published in the Journal of Forensic Science.
Nearly all had diseased testicles.
"Roid rage is also a major factor," Prof Darke told AAP.
"People on steroids not only do damage to other people, but there is also a high rate of suicide."
Prof Darke noted similarities between steroid users and people with anorexia.
"They look in the mirror and they are never big enough.
"Despite the harms they are doing to themselves, they continue because what they are seeing is not what other people are seeing."
Prof Darke said it was ironic that many steroid users were also keen health and fitness enthusiasts.
"I honestly think they are doing it as part of what they see as a healthy lifestyle."
Steroids can cause heart attack and heart failure by increasing blood pressure and directly attacking heart muscle, said the Heart Foundation's Dr Robert Grenfell.
"A shortened life span is a very good reason not to use them."
The study found that about 10 per cent of the dead men had kidney disease.
"This is a remarkable figure for people in their 30s," said kidney specialist Vlado Perkovic of Sydney's George Institute of Global Health.
"Along with the cardiovascular disease, this is quite shocking."
With the increasing focus on appearance that has been developing for many years there are growing numbers of young men who are using steroids, he said.
"The paper shows that once people start using one drug they are at greater risk of using others.
"People need to think about the risks. It's like crossing a road blindfolded when you take these drugs."
