Staying safer if you're using steroids

We’ve been seeing more anabolic steroids being brought into our drug checking clinics over the past year. Steroids come under the umbrella of ‘performance and image-enhancing drugs’ (PIEDs), which can also include substances like peptides. We talked to Dr Tushar Srivastava, a GP from a clinic called Selfcaremen, which specialises in these substances. Check out what substances we can test at drug checking, or see more tips on looking after your physical health when you’re taking drugs.  

1. What is your name and background? What made you want to get into this area of healthcare? 

My name is Dr Tushar Srivastava. I specialise in occupational and environmental medicine and founded Selfcaremen, a national online clinic for men’s health and treating low testosterone. We've also launched Roidcare, New Zealand’s first harm reduction clinic for people who use performance and image‑enhancing drugs (PIEDs). 

When I worked as a GP, I kept seeing the same thing: men who were using testosterone or  steroids, who either hid what they were using or felt judged the moment they mentioned it. They were copying drug stacks from the internet, and nobody was checking their heart, blood pressure or mental health. 

Selfcaremen is our solution to bringing this discussion more into the mainstream.

If men are showing clinical signs of low testosterone, we can get them onto a prescription to reduce the risks of using illicit T. And if they’re using other PIEDs, we can provide advice and care. 

People are already using these drugs. The real question is whether we leave them on their own, or bring them into the health system and keep them safer. 

2. What are the most common performance/image‑enhancing drugs used by your patients? 

We’ve moved from ‘one steroid cycle’ to homemade chemistry sets of injectables, tablets, peptides and prescription medicines all running at once. 

For decades, testosterone injections and oral anabolic steroids were the most common PIEDs. Now we’re also seeing SARMs (selective androgen receptor modulators) and peptides sold online and promoted as “safer” or “legal” alternatives. They still put a strain on hormones and metabolism, often have patchy quality control, and have limited long‑term data. 

On top of that, many people now layer on prescription medicines like GLP‑1 agonists for fat loss, erectile‑dysfunction medications for blood flow and oestrogen‑blocking drugs to combat testosterone‑related side effects. 

It’s really important that people see a doctor who understands the full range of PIEDs, to plan the best harm reduction – and just as important that people know what they’re taking isn’t fake or laced with something else. 

3. What are the risks of using these substances? 

A lot of the damage from these drugs is silent until something serious happens. By the time you feel it, you may already be in trouble. 

A simple way we explain it is the HARM model – the big risks fall into four HARM areas: 

cholesterol increase the risk of heart attack, stroke, heart failure and clots. 

4. How can people stay safer when using these substances? 

If you’re going to use, take your health seriously: get checked, get your bloods done, 

and don’t do it alone. 

In clinic we focus on five basics: 

Drug checking adds another layer of safety by helping people find out more about what is really in the substances they plan to take. 

5. What are some signs that something might be going wrong, or that someone may need medical help? 

Find medical support from the very start - a preventative approach is better so you can educate and monitor yourself to help prevent life-threatening symptoms altogether. Of course if your chest, head or gut suddenly feel wrong, don’t wait to see if it passes. You don't lose your right to healthcare just because you use PIEDs. Other warning signs include persistent high blood pressure, rapid unexplained weight gain or swelling, major mood changes and sexual problems. Those still need medical review, but not necessarily an ambulance. However, support from a doctor who knows PIEDs and how to help manage your risk means you can know what to watch for in your specific situation. 

6. What should people be asking their doctor to check and how often? 

Most importantly, find a doctor you can be honest with about your PIED use. Being honest about what you’re taking lets us protect your health instead of guessing. 

Ask for a baseline health check and then regular monitoring every 3–6 months while on them, and for a while after stopping. 

Useful tests and checks include: 

If a GP isn’t comfortable managing this, services that specialise in testosterone and harm reduction can work alongside primary care so people don’t fall through the cracks. 

7. What are some emerging trends in performance and image‑enhancing drugs? 

Like we said, the era of a single steroid cycle is over. People are now running whole stacks of hormones and peptides, which makes good harm reduction healthcare more important than ever. We’re seeing three clear trends. 

More micro‑dosing plus more long‑term use: Instead of short, high‑dose blasts, some people use lower, more frequent doses for years. That smooths out the peaks and  crashes, but increases the time their body is exposed. 

More stacking: It’s now common to see steroids or SARMs stacked with prescription drugs. The more drugs added together, the easier it is for something to go wrong.