1 John Campbell

 Poor UK survey Data  Small area or location studies  Glasgow accurate NEO data

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4 New Registrations GDCC 2012 – 2013 (drugs injected)

 Established in 2009  Drop in service – 1 evening per week  Staffed by 2 workers and nurse ( supported by lead medical officer)  Based in the GDCC and supported by Turning Point 5

 Needles and paraphernalia provision, including water for injection.  Condoms  Consultations/assessments  Discussions on; ‘harmful’ doses, understanding ‘labels’ and syringe markings  Safer injecting advice and demonstrations  Alternatives such as diet and exercise  Wound identification  Product identification  Blood tests 6

They are synthetically produced variants of the naturally occurring male sex hormone testosterone. “Anabolic” refers to muscle- building, and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS.

Stop a catabolic state – cortisol Increase protein synthesis

10 Testosterone production

 Anabolic/Androgenic steroids : to increase bulk, strength and power  Oestrogen-blockers: to block symptoms of feminisation  Diuretics: to remove excess water  Fat-burners: to remove excess fat and “cut up”  Growth Enhancers: to promote new cell growth  Post-cycle treatments: to stimulate natural testosterone production  Injectable tanning agents: to stimulate pigmentation

13 Date Collected HIV NEG HEP B NEG HEP C NEG Test Declined No Abnormal U&E No Yes No Abnormal LFT No Yes No Yes No Abnormal Cholesterol No Yes No Yes No Abnormal Hormones Yes Repeat Test No

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This is potentially our most ‘at risk’ group STI’s & BBv’s

 Reasons for use  On cycle  Post Cycle  Side effects  Permanent changes 16

 Image enhancing to become more attractive to the opposite sex?  To look the part when partying?  Low self esteem?  Negative body image? 17

 For most increases in libido become evident after the first few weeks.  Melanotan – uncontrollable spontaneous erections  However, some steroids can cause erectile dysfunction  Nandralone Deconate is the best example of this………’deca dick’  No one really knows why this happens. prolactin? 18

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 Take AA steroids libido and erections will be effected  Things will return to normal but…….  Main reason for ‘jumping back on’ ‘bridging’, ‘cruzing’  Free Viagra! 20

21 8 Week Cycle

 After the cycle comes the crash  The body enters a ‘catabolic’ state  Testes become de-sensitised  FSH and LH are not produced/released  Estrogen level rise  Lethargy and low mood can set in  Sexual dysfunction will happen  Most choose to start PCT 22

 Idea is to accelerate and restore the body’s endogenous test production  There are many different views on how this can be achieved  However, most involve the same drugs……….. 23

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MALEFEMALE  Shrinking of testes  Erectile dysfunction  Low sperm count  High Estrogen  Feminisation  Early maturation  Virilisation  Reduction in menstrual cycles  Infertility – usually temp 25

 Acne  High Blood Pressure  Mood swings  Jaundice/liver damage  Pain in the joints (esp with Winny or hGH)  Urinary problems  Increases in LDL (bad cholesterol) and decreases in HDL (good cholesterol)  Modification in the left ventricle of the heart, with serious implications  Increased risk of developing heart related complications/stroke  Stunting of growth (YP)

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 1 in 18 injectors have been exposed to hepatitis C  1 in 11 have been exposed to hepatitis B  1 in 65 have HIV.  10% of people (surveyed) who use injectable image or performance enhancers have been exposed to one or more BBV  These infections can either result from unsafe injecting practises or unprotected sex.  Use of psychoactive drugs such as cocaine was also high in this population (46%)  Sexual risk behaviours are also high – only 20% of those having sex in the preceding year reported always using condoms.  This is why it is essential to provide PIED’s users with injecting equipment, condoms and lots of advice! 29