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Needle-exchange programmes are helping to address this problem Extent is unknown. For clinical purposes, the administration of these drugs can be of therapeutic benefit and reasonably safe, with the physician making objective decisions based on the benefit/risk ratio in relation to a patient’s condition. By contrast, for the purposes of enhancing performance in sport or for cosmetic purposes, usually because it is a clandestine activity, the athletes and bodybuilders are making subjective decisions regarding the effect these steroids are having on their health. Many probably have an attitude of personal invulnerability because they regard themselves as smart steroid users (Perry et al. Furthermore, it may be perceived that athletes who fail a test show no obvious signs of ill-health, such as blatant gynaecomastia, severe steroid acne or hirsutism, and this may imply to others that the adverse effects of anabolic steroid use are exaggerated. These athletes could be exercising moderation in the doses they were administering, which should help to keep adverse effects to a minimum (Millar, 1994). Of note, however, is that many of the adverse effects can be difficult to recognize without a thorough medical examination (and patient’doctor confidentiality would have to be maintained) and other damaging effects are insidious where the athletes themselves will be unaware, such as the potential harmful changes to the cardiovascular system. Even so, it is important not to overstate the medical risks associated with anabolic steroid use (Hoffman and Ratamess, 2006) but to emphasize that the hazards to health are dependent on the sex, the dose, the duration of administration, whether hepatoxic 17?-alkylated steroids are being administered and the susceptibility of the individuals themselves to androgen exposure (likely to be dependent on genetic factors, age and lifestyle). The axiom, particularly among bodybuilders who can use excessively large amounts of steroids, that the ‘more you take, the more you grow’ should be accompanied with ‘the more you may damage your health’. It is difficult to gauge the prevalence of severe adverse effects of what is an underground activity, and, moreover, it would be unethical to mimic the large dose regimens in controlled studies over prolonged periods of time to evaluate the risks to health. Notwithstanding, from the records of the doping programme in the former German Democratic Republic, nowhere did the GDR doctors record a damaging effect that was not described in the ‘western’ literature. 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