The typical consumer can easily purchase synthetic anabolic androgenic steroids, injectable testosterone, and adjunctive therapies over the Internet without a prescription, a new study confirms.

James McBride, MD, Culley C. Carson III, MD, and Matt Coward, MD, of the University of North Carolina at Chapel Hill, performed Google searches for top-ranking websites selling anabolic steroids and testosterone, as well as recovery agents and erectile dysfunction medications. They also examined herbal supplements and non-steroid hormones commonly abused with steroids (e.g., human growth hormone, insulin-like growth factor, thyroid hormone, and levothyroxine). For each site, the investigators evaluated the selection of products, purchasing process, and accompanying directions for use.

According to results published online in the American Journal of Men’s Health, 87% of the top 10 direct-to-consumer websites sold commonly used forms of anabolic steroids, injectable testosterone, and hormone therapies. In addition, 75% of websites sold at least 1 post-cycle recovery agent (e.g., gonadotropins, serum estrogen receptor modulators, and aromatase inhibitors), and 62% sold 1 or more erectile dysfunction medications. Most steroid users “stack” multiple agents at high dosages, then “cycle” with recovery agents to minimize toxicity, according to other research cited in the study.

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No website required a prescription for purchase of any substance, and 75% accepted common forms of payment including credit card. Online vendors provided direct shipping to home addresses and shunted all legal responsibility to the consumer through disclaimers.

The investigators noticed that all of the sites were supplied by international pharmacies outside the jurisdiction of the FDA. Therefore, product quality was unverified and suspicious of contamination.

Three-quarters of the sites also gave potentially dangerous information, including specific cycle and stacking recommendations. Furthermore, 62% provided post-cycle recovery information. Only 1 site offered information on non-steroid alternatives. 

“Given the negative effects of these substances on normal endocrine and reproductive function resulting in commonly encountered clinical conditions such as erectile dysfunction and infertility, clinicians must be aware of the increasingly common underlying etiology of prior or current anabolic steroid usage,” Dr McBride told Renal & Urology News. He noted that just 50% of patients admit anabolic steroid use to clinicians.

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About 4 million people in the United States use anabolic steroids with a quarter drug-dependent, according to recent estimates. Increasingly, men older than 40 are abusing anabolic steroids.

“Other data have demonstrated that the development of designer anabolic steroids is on the rise to elude drug testing, but unlike traditional anabolic steroids that were initially developed for medical use, the physiologic effects of designer steroids are largely unknown, potentially resulting in a host of unknown side effects,” Dr McBride added.


  1. Abram McBride J, Carson III CC, and Coward M. The Availability and Acquisition of Illicit Anabolic Androgenic Steroids and Testosterone Preparations on the Internet. Am J Mens Health. doi:10.1177/1557988316648704.