Harm reduction is a concept used by healthcare professionals to minimize the negative health impacts of drug abuse. The principles of harm reduction acknowledge the existence of illegal drugs in society, both good and bad. Harm reduction practitioners do not ignore drug users; instead, they actively work with them, providing safer use strategies to reduce health damage from drug abuse. Harm reduction efforts are helpful to individuals and are not merely speculative. Although initially focused on narcotic abuse, harm reduction principles can (and should) be applied to steroid users, who often lack full medical oversight in their drug regimens. To further this goal, the following principles of harm reduction for steroid use are outlined. By following these principles, the negative health impacts of steroid use can be significantly reduced, making it safer (though not completely safe).

Principles of Harm Reduction for Anabolic Steroids

1. Avoid Counterfeit and Underground Steroids

   Steroids produced by illegal manufacturers are often of poor quality and may pose health risks beyond those of the steroids themselves. Even if they contain appropriate doses of actual steroids, underground drugs may be contaminated with toxic heavy metals, dirty raw materials, bacteria, viruses, and other contaminants. The purity of pharmaceuticals is guaranteed through an expensive, thorough, and regulated government process. Most underground drug manufacturers lack the funds to produce such high-purity products. Counterfeit and underground drugs should not be considered equivalent substitutes for actual pharmaceuticals and should be avoided.

2. Avoid Toxic Oral Steroids

   Except for Andriol, 1-methyl-androstenediol acetate, and Proviron, every oral steroid discussed in this guide is a C-17α alkylated compound and should be avoided whenever possible. While these drugs may be prescribed for clinical reasons, when used at higher doses for muscle growth, they often have significant negative effects on health markers. The most notable effect is the increased ratio of LDL to HDL cholesterol, promoting plaque deposition in arteries, potentially increasing heart disease risk over time. C-17α alkylated steroids are also associated with significant liver stress and (rarely) liver cancer. If injectables are tolerated and the goal is moderate physique or performance enhancement, all the same results can be achieved without oral steroids. Note that injectable forms of other oral steroids, such as stanozolol and methandrostenolone, should also be avoided as they present similar levels of liver and cardiovascular strain, regardless of the administration route.

3. Consider Testosterone First

   Among all anabolic/androgenic steroids, testosterone esters like propionate, enanthate, and Sustanon generally have the least negative impact on health when building muscle and enhancing performance. Testosterone drugs provide the same hormones produced in the body, with identical physical and physiological effects. In addition to being one of the most effective muscle builders, testosterone typically has a positive effect on libido, promotes a positive mood, and provides necessary estrogen to maintain cholesterol levels less negatively. If possible, using testosterone exclusively for body or performance enhancement is recommended.

4. Limit Yourself to the “Safest” Drugs

   If using injectable testosterone alone is not feasible, limited combinations of the safest steroids are recommended. Among injectables, the following drugs have the lowest cardiovascular strain and are recommended: nandrolone decanoate (Deca-Durabolin), nandrolone phenylpropionate (Durabolin), boldenone undecylenate (Equipoise), and methenolone enanthate (Primobolan). For oral steroids, only Andriol, 1-methyl-androstenediol acetate, or Proviron should be used. These drugs are not C-17α alkylated and provide additional steroid activity without the similar levels of cardiovascular and liver strain associated with other common oral steroids, including oxymetholone (Anadrol), oxandrolone (Anavar), methandrostenolone (Dianabol), and stanozolol (Winstrol).

5. Use Health-Supportive Supplements

   Natural health-supportive supplements can help reduce the negative health impacts of anabolic/androgenic steroids. First, the negative cardiovascular effects of these drugs can be offset (at least to some extent) with cholesterol supplements. Fish oil is recommended as a base, stacked with many other clinically researched cholesterol support ingredients, including green tea, garlic powder, resveratrol, phytosterols, niacin, and policosanol. The mixed product Lipid Stabil (Molecular Nutrition) includes these ingredients and is also recommended. Cholesterol support supplements should always be taken during anabolic steroid therapy. Additionally, those using oral steroids should use liver support supplements to reduce liver stress. Recommended products include Liver Stabil (Molecular Nutrition), Liv-52 (Himalaya Drug Company), and Essentiale Forte (Aventis). Any of these products should be taken during hepatotoxic therapy.

6. Steroid Cycles

   Steroid cycles usually involve 6 to 12 weeks of drug use, followed by an equal or longer period off anabolic/androgenic steroids. There are many reasons for this practice. Firstly, when you supplement with male androgen hormones, your body reduces its own testosterone production. Cycling steroids reduces the risk of fertility problems and hormonal issues, which can sometimes result from continuous steroid use over months or years. Steroid cycles also allow your health markers (like cholesterol levels, hematocrit, and blood pressure) to periodically return to normal, reducing the impact of temporary changes. Continuous long-term use of anabolic/androgenic steroids carries greater risks, as negative changes in these health markers can lead to long-term health problems.

7. Use Reasonable Doses

   High doses of steroids do not achieve significant muscle growth, especially if moderate physique or performance enhancement is needed. It is recommended to limit the dose to 400 mg per week. For testosterone, a dose of 400 mg per week is at least four to five times the hormone level produced naturally in a healthy male body. When combined with appropriate training and diet, this level of use will yield significant muscle gains. In the 70s and 80s, doses of 200-400 mg per week were considered the "standard" for bodybuilders using testosterone, nandrolone, or boldenone. Extreme doses of 750-1,000 mg per week or more are rarely necessary, nor is the addition of oral steroids. High doses may produce faster gains but usually offer less muscle for the cost and significantly increase the occurrence of cardiovascular strain and other side effects.

8. Avoid Aromatase Inhibitors

   Aromatase inhibitors counter estrogenic side effects by preventing estrogen production. While effective, they also deprive the body of an important hormone. Estrogen supports the production of good (HDL) cholesterol, meaning aromatase inhibitors can inadvertently increase cardiovascular strain during steroid cycles. If estrogenic side effects are significant and reducing or eliminating steroids is not considered, selective estrogen receptor modulators (SERMs) like tamoxifen citrate can be used. This drug provides partial estrogen activity in the liver, which may help counteract estrogenic side effects without negatively shifting cholesterol.

9. Regular Blood Tests

   Comprehensive blood tests, including hormones, cholesterol, hematocrit, and enzyme levels, are the most useful tools for assessing the negative health impacts of steroid use. For example, changes in cholesterol can help users quantify the cardiovascular impact of specific drug regimens. If you plan to repeat a cycle, you have the opportunity to better assess long-term risks. Blood tests should be done at least three times: before starting the cycle, three to four weeks into the cycle, and a few months after the cycle ends. This provides: 1) a baseline before the cycle; 2) a snapshot of health impacts during the cycle; and 3) an opportunity to assess if the body's natural balance is restored after the cycle.

10. Use Proper Injection Procedures

Correct injection procedures can help eliminate some complications associated with non-medical steroid use. Steroids should be administered via deep intramuscular injection. The most common injection site is the upper outer quadrant of the gluteal muscles, though the outer thigh and upper shoulder are also common. Injection into smaller muscle groups (such as the biceps, triceps, or calf muscles) is not recommended due to technical difficulty and higher complication rates. Use a comfortable injection volume, typically not exceeding 3 mL per injection. Rotate injection sites to avoid injecting the same muscle more than once every two weeks. Emphasize cleanliness, using alcohol pads on the vial and skin before injection, and properly dispose of all needles and empty vials/ampoules after use.

11. Sterilize

Although not recommended, if you choose to use underground steroid injections, sterilize the solution before use. This will reduce the likelihood of disease or infection caused by microorganisms.

12. Watch Your Diet

Anabolic/androgenic steroid use can lead to a larger physique compared to normal diets. Due to the effects of these drugs on muscle mass and metabolism, caloric needs often increase, allowing more calories to be consumed without increasing fat mass. It is important to ensure this increased intake does not negatively impact your health. Remember that using steroids at doses for physique and performance enhancement is expected to cause adverse shifts in cholesterol levels and other cardiovascular health markers, increasing cardiovascular disease risk. Feeding your body more saturated fat, cholesterol, and simple carbohydrates can exacerbate these effects. A diet low in saturated fat, cholesterol, and simple sugars is recommended to reduce cardiovascular disease risk. However, diet alone is not effective in countering the negative cardiovascular effects of steroid use; dietary restrictions can reduce these risks.

13. Maintain a Risk-Benefit Perspective

It is easy to overlook the potential health impacts of steroid use when the benefits are so immediate and the consequences seem distant. However, it is crucial to remember that doses supporting short-term muscle gains will always have some negative impact on your body. Your cholesterol will shift unfavorably, your blood pressure may rise slightly, and your heart's ventricles may thicken a bit. When using steroids, your hormones are out of balance, often leading to other imbalances. Steroid use is rarely dangerous in the short term. These hormonal drugs are very safe. However, with increasing use and time, these effects accumulate, and cycle durations become longer. Always weigh the risks and benefits of each cycle. Carefully select your drug regimen and maintain steroid use in the short term to minimize long-term risks.