Drugs in sport

Esquire (UK) - - Contents - Words by Alex Moshakis

Bri­tain’s gyms are im­mersed in an epi­demic of an­abolic steroid abuse by ama­teur ath­letes

at his most pow­er­ful, Alec Wil­son’s bi­ceps mea­sured a foot-and-a-half around, and his quads were each three hands wide. On a good day he could dead­lift 212kg, the equiv­a­lent of a lion, and bench press 158kg, not far off twice his own weight. In the mo­ments be­fore he heaved an almighty load, he would sum­mon a rough growl up from his stom­ach and out of his throat, shock­ing his body into the pro­duc­tion of adren­a­line. Other men knew when he’d ar­rived at the gym. They could hear him roar.

It was half­way through 2012. Wil­son was 36. He was not a pro­fes­sional body­builder, like other men he knew, or a strong­man, the kind that jerks boul­ders and tugs trucks for a liv­ing. He wasn’t even the strong­est man at his gym, though it was close. He was an aca­demic with a cou­ple of science de­grees. Most days, his of­fice was a lab. And yet his train­ing had be­come re­lent­less. Al­most ev­ery night, as soon as his young son had gone to bed, he would head to the lo­cal weights room, lift hard, and chat game with other big men, many of whom had be­come close friends. Of­ten he felt he could go all night. Lift­ing. Talk­ing. Lift­ing. Talk­ing. “I’d stay un­til they kicked me out,” he told me. “And go back the next night.”

Wil­son and I first met at a bar in cen­tral Birm­ing­ham, not far from where he lives. (His name has been changed here, at his re­quest.) In­stantly, he struck me as a kind of con­tra­dic­tion. At 5ft 10in he isn’t tall, though he looks big. His shoul­ders are broad and his neck is thick. His back mus­cles were prom­i­nent be­neath his shirt, and his chest re­sem­bled a whisky cask. In many ways he was large enough to make me feel like a small boy.

And yet at times he spoke so softly I found him dif­fi­cult to un­der­stand, and when we first in­tro­duced our­selves his right hand was trem­bling. It was a Mon­day morn­ing in March, and the bar was quiet save for a few early lunch­ers, but more than once I found my­self lean­ing in in or­der to hear what he was say­ing.

Near the start of our con­ver­sa­tion, Wil­son told me he hadn’t al­ways been so big. Un­til 2014, he’d had trou­ble lift­ing any­thing close to his 212kg record. He’d trained for years, but his power had plateaued and he’d be­come frus­trated. Dur­ing ses­sions at the gym, he and oth­ers would dis­cuss tech­nique, nu­tri­tion and hu­man anatomy — some­times a new piece of in­for­ma­tion could lead to gains. But they’d also chat about steroids, whose use was be­com­ing more com­mon. Men would re­veal the com­pounds they were us­ing and in what amounts, reg­u­larly slip­ping into a semi-med­i­cal lan­guage that to out­siders was hard to un­der­stand. When they mixed com­pounds, a process called “stack­ing”, they shared their ex­pe­ri­ence, tak­ing ques­tions from oth­ers. How did it feel? What side ef­fects did you suf­fer? What might you do dif­fer­ently next time? Al­most ev­ery week some­one would re­port a dif­fer­ent pro or con: rapid mus­cle gain, raised blood pres­sure, a feel­ing of com­plete men­tal clar­ity, spots.

Wil­son was proud of the fact he was privy to these con­ver­sa­tions. “It wasn’t easy to be­come ab­sorbed into this cul­ture,” he told me. “You re­ally had to earn re­spect. If you waited your turn, let the big guys go first, knew your po­si­tion in the peck­ing or­der, you’d get your place. And once you were in that cir­cle, you were em­bed­ded in it.” Later, he added, “It be­came part of my iden­tity, that I was part of this group.”

be­fore long, wil­son de­cided to use steroids, too. A friend rec­om­mended testos­terone enan­thate, a sub­stance that steroid.com, a site that pro­vides in­for­ma­tion about the dif­fer­ent types (and how to use them), de­scribes as “per­haps the most com­monly used an­abolic steroid of all time”, and sup­plied him with 10ml vials. He sourced nee­dles from a clinic two towns away, where no­body would recog­nise him, and be­gan to in­ject 500mg once a week in his bath­room, mak­ing sure to re­main out of sight.

When his friend’s stock dried up, he found a phar­macy in Ser­bia, where steroids could be bought over the counter and on­line, and or­dered phar­ma­ceu­ti­cal-grade testos­terone. Soon he be­gan to ex­per­i­ment with other com­pounds, gen­tly in­creas­ing doses to over­come his body’s ac­cli­ma­ti­sa­tion. At one point, to counter the ef­fects of se­vere joint pain, he be­gan us­ing small doses of nan­drolone de­canoate, an an­abolic steroid known among users as “deca”, which is some­times pre­scribed for os­teo­poro­sis and is used dur­ing the treat­ment of breast cancer.

Within weeks, Wil­son’s mus­cles bal­looned and, though he put on close to a stone, his body fat plum­meted. In the bar, he showed me a cou­ple of pic­tures on his phone. He was stand­ing in the sal­low light of his kitchen. His head was shaved, and it was dif­fi­cult to pin­point where his back mus­cles ended and his neck mus­cles be­gan. Be­cause there was next to noth­ing be­tween his skin and his mus­cles, his veins were vis­i­ble, and you could make out stri­a­tions in his chest.

Wil­son be­gan to lift heav­ier weights. Pre­vi­ously, when­ever he’d at­tempted to make large gains, his body had re­sisted. But now he felt stronger, more mo­ti­vated, and bet­ter able to re­cover af­ter a gru­elling ses­sion. In the morn­ings he was filled with a store of en­ergy that usu­ally lasted all day. Later, he no­ticed a great up­surge in self-con­fi­dence, not just at the gym but at work and at home. Prob­lems didn’t dis­ap­pear so much as sud­denly be­come far eas­ier to solve. “I be­came much clearer in my thoughts,” he told me. “I be­came much hap­pier in my­self.”

Steroid cy­cles typ­i­cally last 10 weeks. To mit­i­gate their harm­ful ef­fects, in­clud­ing a “shut down”, where the body stops pro­duc­ing testos­terone nat­u­rally, users must un­dergo a process of post-cy­cle ther­apy (PCT) meant to reg­u­late the body’s or­ganic pro­cesses. But PCT is hard, and it isn’t al­ways suc­cess­ful. Those who come off cy­cles com­plain of se­vere lethargy, teari­ness, low sex drive, a deep and dark de­pres­sion. “You feel like a small man,” one user told me. “You lose 25 per cent of your weight. Most peo­ple wouldn’t no­tice. It’s all in your head. But you think your clothes are fall­ing off you.” (Wil­son re­ferred to this state as “the re­gres­sion”.) An­other user told me that, dur­ing PCT, “you just want to be held.” When we dis­cussed the man’s loss of libido, he said, “three women could be bounc­ing naked on a tram­po­line in front of you, and all you’d want is a cup of tea.”

Wil­son had heard sim­i­lar sto­ries, and he found the idea of com­ing off steroids trou­bling, so he didn’t. “That first cy­cle lasted four years,” he told me. It was a pe­riod that reaped a kind of phys­i­cal de­struc­tion. His knees, once strong, be­came frail, and they hurt when he walked. His right shoul­der was sim­i­larly dam­aged. “Be­cause your strength and mus­cu­lar­ity in­crease so rapidly,” he said, “your ten­dons and joints can’t keep up.” His body was un­able to sup­port the mus­cle he’d un­nat­u­rally con­structed, caus­ing “phys­i­cal dam­age I’m go­ing to suf­fer for the rest of my life.” Dur­ing a visit to his GP, an even more ur­gent mes­sage rang out. “My doc­tor said, ‘If you keep go­ing the way you’re go­ing, you’re not go­ing to see your son grow up. You’re go­ing to have a stroke. You’re go­ing to have a heart at­tack. Some­thing’s go­ing to hap­pen to you within the next five years.’”

Wil­son had been made aware of the risks prior to be­gin­ning his cy­cle. I asked him if he’d wor­ried about them while he was us­ing. “I’d oc­ca­sion­ally give them a fleet­ing thought,” he said. “But I was prob­a­bly ar­ro­gant enough to think I could mit­i­gate the ef­fects.” Later, he hinted at a greater un­der­stand­ing of the depth of his ex­pe­ri­ence. “Some men go to the pub and never come out,” he told me. “I went to the gym.”

a cou­ple of decades ago, steroids were al­most uniquely tied to the world of com­pet­i­tive weightlift­ing, and the as­so­ci­ated stigma was re­lent­less. To the unini­ti­ated, users were big, brash and quick to rage. The larger the man, the more likely he was sud­denly to ex­plode like a fire­cracker. It didn’t mat­ter if you were a de­voted fa­ther, a peren­nial do-gooder, or a stone-cold sweetie with a heart the size of a foot­ball, the so­cial tar­nish was in­escapable. Your tem­per­a­ment was scru­ti­nised, your mus­cles deemed un­holy. You used.

Not so any­more. Weightlifters are still gawked at sus­pi­ciously — it’s gen­er­ally ac­cepted that, out­side of the Olympics, com­peti­tors use some kind of per­for­mance-en­hanc­ing sub­stance. But big men are no longer the drugs’ only con­sumers. In Jan­uary, The

Guardian re­ported that close to one mil­lion Bri­tons in­ject or swal­low steroids on cos­metic grounds, though the num­ber is dif­fi­cult to pin­point ex­actly, and ex­perts at the front line of the is­sue — re­searchers, doc­tors, lec­tur­ers, in­clud­ing many I spoke to — sug­gested the num­ber might be much higher. Users start young, of­ten in their early twen­ties, and some­times never stop. Most avoid in­ter­ac­tion with health pro­fes­sion­als, a com­mon prac­tice through­out the com­mu­nity, even when their bod­ies be­gin to fail. Re­searchers hop­ing to ac­cu­rately iden­tify user fig­ures quickly run into a tricky prob­lem: how do you reach peo­ple who don’t want to be found?

In any case, most users are peo­ple con­sid­ered by so­ci­ety to be rel­a­tively or­di­nary. They are young men in­tent on tailoring their physique. Mid­dle-aged men un­der pres­sure to per­form at work or at home. Pen­sion­ers crav­ing the care-free ex­pe­ri­ences of their youth. They in­ject in se­cret, though not al­ways. A per­sonal trainer I know told me steroid use was so preva­lent in the gyms at which he works that staff deem it nec­es­sary to out­fit com­mu­nal spa­ces with nee­dle bins. “I see peo­ple in­ject­ing stuff,” he said, “right there in the chang­ing room!”

Use is es­pe­cially rife among men. In a re­cent study, 94 per cent of those that took part were male: lawyers, bankers, po­lice­men, stu­dents and, in at least one re­ported case, a cleric. Steroids have breached board­rooms and snuck into churches, gate­crashed court­rooms and in­vaded class­rooms. Men source from trust­wor­thy friends, un­scrupu­lous deal­ers, or web­sites that prom­ise 48-hour de­liv­ery and do a side trade push­ing pre­scrip­tion meds that counter var­i­ous side ef­fects: Ac­cu­tane, for acne; Xanax, for anx­i­ety.

The chief med­i­cal of­fi­cer of Wales, Dr Frank Ather­ton, de­scribes steroid use as “an es­ca­lat­ing prob­lem,” and, like, other med­i­cal ex­perts I spoke to, he con­sid­ers the up­surge to be rooted in aes­thet­ics, a po­si­tion shared by the me­dia. “You need only look around to see why men want bet­ter-look­ing bod­ies,” Rick Collins, an Amer­i­can lawyer who spe­cialises in steroid use cases, wrote in an email. “We live in a cul­ture that is ab­so­lutely ob­sessed with ap­pear­ance. We are judged by our looks ev­ery day. So when we look our best, we feel more self-con­fi­dent. Are steroid users try­ing to im­press them­selves or try­ing to im­press oth­ers? Both, of course.”

But in many ways mo­ti­va­tions run deeper. An older user might care less about the way testos­terone helps him fill a T-shirt than he does about how it re­plen­ishes his en­ergy lev­els. (That at 75 years old he is able to work out to such a de­gree that his body be­comes shaped and mus­cu­lar is, more of­ten than not, a wel­come side ef­fect.) When the joints of a mid­dle-aged man be­gin to ache, and his libido plum­mets and his hair thins and his gut ex­pands, he might turn to syn­thetic testos­terone to coun­ter­act his body’s nat­u­rally de­plet­ing lev­els: not to look great in swimwear, but to ex­pe­ri­ence the dreamy sensation of be­ing young again, to be­come once more the man he was.

Young men, as their par­ents will at­test, are more com­pli­cated. “If you look at gen­eral the­o­ries, they’ll tell you it’s to do with Snapchat, Face­book, In­sta­gram, the so­cial me­dia ex­pe­ri­ence,” Tony Knox, a PhD stu­dent in the sports science de­part­ment of the Uni­ver­sity of Birm­ing­ham, told me. “Ev­ery­one wants to look good. Ev­ery­one wants to be im­pres­sive. These kids want to be able to show off. But I think it’s much deeper than that. I think there are un­der­ly­ing rea­sons. I think a lot of these young men who are us­ing these su­per phys­i­o­log­i­cal doses

Use is es­pe­cially rife among men. In a study, 94 per cent tak­ing part were male: lawyers, bankers, po­lice­men, a cleric. Steroids have breached board­rooms, churches, court­rooms, class­rooms

of testos­terone — they’re deeply in­se­cure. They don’t know their way in life.”

Knox and I were talk­ing in a cen­tral Birm­ing­ham restau­rant in which mu­sic blared a few lev­els too high. Knox has spent the best part of a decade re­search­ing steroid use and its harms, first at nee­dle ex­changes, now through his PhD. He talks to users weekly — men and women he recruits from gyms around the coun­try — gain­ing their trust thanks in part to the way he looks: big up top, plenty of fast­twitch mus­cle, like some­one who trains. He went on de­spite the mu­sic.

“We’ve got so many dif­fer­ent vari­a­tions of gen­der now that these kids don’t know where to sit­u­ate them­selves,” he said. “So they sit­u­ate them­selves in some­thing that is ridicu­lously mas­cu­line, rather than in­her­ently mas­cu­line. When I was a kid” — Knox is now in his for­ties — “there was no am­bi­gu­ity, no con­fu­sion. You didn’t have to be tough. You didn’t have to look a cer­tain way. You just walked into a mas­cu­line role and you did it. But it’s not easy for kids these days. It’s much more dif­fi­cult for them to de­fine them­selves as men. Steroids is one of the ways that some of them are do­ing it.”

The fol­low­ing day, Knox took me to a gym from which he reg­u­larly recruits. It sprawled across the two up­per floors of what was once an of­fice build­ing. Huge, elab­o­rate paint­ings of the gym’s most mus­cu­lar mem­bers lined the walls and floor-to-ceil­ing win­dows gave passers-by glimpses at the lay­out in­side. Much of the space was given over to free weights and mus­cle ma­chines. A small area fea­tured tread­mills and cross train­ers. It re­mained mostly empty.

Knox in­tro­duced me to a friend of his, a per­sonal trainer who had used steroids on and off for more than a decade. I asked him to ex­plain the steroid ex­pe­ri­ence. “You feel stronger,” he said. “You feel like you can hold your head up higher. You’re in the gym and you’re push­ing it. You want to have sex a lot more. Then you come off and it’s like…” He hes­i­tated, then fin­ished the thought. “You feel like less of a man.”

men have wanted to feel more like men, what­ever that no­tion en­tails, for thou­sands of years. And, some­times, steroids were avail­able to help them achieve it. In An­cient Greece, Olympic ath­letes ate sheep’s tes­ti­cles be­fore com­pe­ti­tions, in­gest­ing sec­ondary testos­terone. They found it in­creased vigour and mus­cle strength, though they weren’t sure why. This was when strength re­ally mat­tered. Many an­cient Olympic games were bru­tal. Not ev­ery com­peti­tor left the arena alive.

Still, steroids as we know them to­day weren’t de­vel­oped un­til the Thir­ties. The first batch of syn­thetic testos­terone was cre­ated in 1935, and the ex­per­i­ment was con­sid­ered a sci­en­tific break­through. (Its man­u­fac­tur­ers, Ger­man Adolf Bu­te­nandt and Swiss-Croat Leopold Ružička, won a No­bel Prize in Chem­istry in 1939.) Soon, men were in­ject­ing the hor­mone into other men. Nor­mally the re­cip­i­ents were ath­letes, first in the Soviet Union, later in Amer­ica. A kind of ath­letic arms race later de­vel­oped be­tween the two na­tions, one that be­came em­blem­atic of their po­lit­i­cal ten­sions. Who could run faster, lift heav­ier, throw fur­ther? Who could get there first?

Per­for­mance en­hance­ment in pro­fes­sional sports was banned in the Sev­en­ties, when anti-dop­ing tests be­came good enough (though its use among paid ath­letes en­dured). But by that point, steroids had al­ready en­tered the main­stream con­scious­ness. Ama­teur ath­letes in the UK be­gan to source testos­terone from states in which dis­tri­bu­tion was still le­gal. Most were body­builders, weightlifters — big men with

‘You feel stronger. Like you can hold your head up higher. You’re in the gym and you’re push­ing it. You want to have sex a lot more. Then you come off… and you feel less of a man’

good rea­son to crave ex­tra power. But then it hit gyms. And that’s where we are now.

cameron jef­frey runs a steroid clinic on the west coast of Scot­land. A Scot in his for­ties with colos­sal mus­cles, he’s spent a decade work­ing with steroid users. At one point in his ca­reer he toured the UK to ad­vise on best prac­tice at steroid-spe­cific nee­dle ex­changes. But over the past few years, he’s de­voted him­self to his own project, a drop-in clinic not far from where he grew up, in a com­mu­nity in which steroid use is ris­ing. (He asks that I change his name so as not to be­tray the trust of those he ad­vises.) His pa­tients in­clude lawyers, doc­tors, and mem­bers of the po­lice force. Nearly all the peo­ple he sees are pro­fes­sion­als, and their ages vary. He has seen men as young as 21, though he will turn away any­one younger. Ev­ery now and then he will treat a pen­sioner in his Sev­en­ties.

Jef­frey told me he ran the clinic in­for­mally, by which he meant he con­sid­ered it part med­i­cal cen­tre, part so­cial club. While other clin­ics of­fer for­mal ser­vices, Jef­frey’s har­nesses the essence of an in­de­pen­dent gym. Users swing by for guid­ance and stay to drink cof­fee and chat. But most turn up dur­ing a cy­cle in or­der for Jef­frey to su­per­vise or ad­min­is­ter their in­jec­tions, which he per­forms in a small, ster­ilised, win­dow­less room at the rear of the build­ing. I was told to ex­pect a carousel of users. “They’ll be in and out all day.”

When I ar­rived, Jef­frey and a cou­ple of men in their twen­ties were sit­ting at a counter, laugh­ing loudly. Be­fore long, one of the men left the clinic, and Jef­frey and the other man ex­cused them­selves into the back, where Jef­frey pre­pared 500mg of testos­terone. The laugh­ter con­tin­ued through­out the pro­ce­dure, which lasted less than five min­utes. When it was over, the young man promptly left, and Jef­frey walked into a sep­a­rate com­mu­nal area to meet me.

“Did you hear what he said?” he asked. I shook my head.

“The big kid,” Jef­frey said. “He was ask­ing for more. More, more, more. And I had to tell him no. There’s no point. It’s use­less. His body can only take so much.”

I asked him why the man thought that tak­ing more was bet­ter.

“They think it means gains,” he said. “But it doesn’t. They don’t know what they’re do­ing. They don’t know what the im­pact could be. They don’t know how to use them prop­erly. They make gains on one cy­cle — big gains — and then they go again, more, more, more, think­ing it’s OK. And it’s not.”

When I spoke to Ather­ton, the Welsh chief med­i­cal of­fi­cer, he told me one of his most im­por­tant jobs was to dis­sem­i­nate in­for­ma­tion. “There are ben­e­fits to in­di­vid­u­als who use these drugs in terms of their im­age and their per­for­mance,” he said. But “peo­ple need to go into these things with their eyes wide open.” I’d heard sto­ries of tes­tic­u­lar at­ro­phy, of hy­per­ten­sion and heart at­tacks and strokes, of men giv­ing up steroids af­ter long cy­cles and be­ing told they were no longer able to have chil­dren. Ather­ton con­tin­ued, “I be­lieve that a prop­erly in­formed per­son who knows about the side ef­fects and the risks and the harms would prob­a­bly choose to en­hance their body im­age through hard work and not through chem­i­cal en­hance­ment.”

Jef­frey echoes the sen­ti­ment, and, sim­i­larly to Ather­ton, he sees him­self as a kind of coun­sel­lor. He spends most of his day ad­vo­cat­ing re­spon­si­ble use and dish­ing out ad­vice: what to use and how much, when to start and when to stop, even in­for­ma­tion as prag­matic as how to use a nee­dle. As trust builds, men open up in ways they tend not to else­where. “It’s like a con­fes­sional,” he told me. “They can’t talk to their mis­sus or their mates, so peo­ple come in here and tell you about their lives. They spill all.”

Twenty min­utes later, an older man en­tered the clinic, walked over to a drinks ma­chine, qui­etly made him­self a cof­fee, and sat down at a counter. Jef­frey greeted him warmly and they started chat­ting. Soon, the pair walked to the back of the clinic. Again I could hear laugh­ter, al­though this time I also heard the soft jin­gle of a belt buckle. Jef­frey ad­min­is­tered 125mg of testos­terone into the top of the man’s back­side, and five min­utes later he was gone.

“How old do you think he was?” Jef­frey asked me when he re­turned.

“60,” I said.

“Higher.”

“65?”

“Try again.”

Doubt­fully, I of­fered, “70?”

“He’s not far off 80!” Jef­frey said. He had a sharp glint in his eye, as though he’d won a great vic­tory. “He came in com­plain­ing of lethargy. He was tired. He’d put on weight. He didn’t want to leave the house, not even to take the dog for a walk.” That was a few years ago. Jef­frey told him to get a blood test, which re­vealed stag­ger­ingly low lev­els of testos­terone, even for the man’s age. He’s been com­ing in once ev­ery 10 days ever since. “And look at him now!” Jef­frey said. “The qual­ity of life he has…” He tailed off, but the in­fer­ence was that the man was bet­ter: more alive. “He’s ac­tu­ally quite vas­cu­lar,” Jef­frey said. “He’s got a good body un­der there.”

I asked him why he thought so many older men had taken to steroids. “It used to be that a man could grow old grace­fully, maybe with a bit of a pot belly,” he said. “But that’s not hap­pen­ing any­more. The cul­ture’s chang­ing. We’re liv­ing longer. And we want to live well for longer, look beau­ti­ful for longer. We’ve learnt how to eat, how to train. There’s Bo­tox. Boob jobs. Steroids is a part of that.”

Later in the day, Jef­frey told me he uses steroids “ev­ery now and then”, and he likes to share his ex­pe­ri­ences with oth­ers. I asked him what he felt like when he was on a cy­cle. “Re­mem­ber the feel­ing you had when you were 17, 18 years old? When ev­ery­thing felt good?” I nod­ded. “That’s what it feels like.”

Just be­fore I left, af­ter 10 or so users had come and gone, a tall man walked into the clinic and slumped into a chair in one of the com­mu­nal spa­ces. Jef­frey walked over and eyed him care­fully. “You look big­ger,” he said. The man looked du­bi­ous. Jef­frey pointed to his shoul­ders and then his neck. “Here and here,” he said. And then, notic­ing the man’s con­cern: “In a good way.”

A broad grin slipped across the man’s face. He’d re­cently split up with his wife, Jef­frey told me, and he was train­ing hard to keep his mind off it. The steroids were meant to help him nav­i­gate the sin­gles mar­ket, and they seemed to be work­ing. Be­fore long, the pair be­gan to dis­cuss the man’s cho­sen sub­stance, and they de­bated the ef­fi­cacy of his cur­rent dose. Jef­frey erred on the side of cau­tion, as he tends to, and even­tu­ally he won out — the man re­lented and stuck to the same dose, though the con­ver­sa­tion didn’t seem to be en­tirely over.

one day in april, a while af­ter we’d first met, I called Alec Wil­son. The last man I’d seen at Jef­frey’s clinic had re­minded me of some­thing Wil­son had told me: that the mo­ti­va­tion be­hind his steroid use was not to do with looks, or strength, or even power, but more to do with a kind of per­sonal agency, a wrestling back of self-con­trol.

A few months be­fore he be­gan that fouryear cy­cle, Wil­son re­alised his mar­riage was break­ing down, and he slipped into a de­pres­sion. His mood, usu­ally light and sta­ble, had turned dark. Col­leagues no­ticed a sour­ing of his char­ac­ter. On the phone, Wil­son told me that his “iden­tity had frac­tured. I was no longer the worker, the provider, the lov­ing hus­band, the good fa­ther — all of the things I had as­pired to be. I felt as though the only thing I had con­trol over now was my body.”

Other users spoke sim­i­larly of per­sonal re­straint, of self-pos­ses­sion, of be­ing able to af­fect the way they looked, felt and thought while the world around them shifted in­ex­pli­ca­bly or, worse, fell en­tirely to pieces.

“In some ways I felt I did the right thing,” Wil­son told me. “I cer­tainly don’t re­gret do­ing what I did, be­cause it al­lowed me to get part of my iden­tity back.” Wil­son sep­a­rated from his wife, but the pair are now friends, and he en­joys a good re­la­tion­ship with his son.

To­wards the end of our con­ver­sa­tion, I asked him if he’d use again. “I would,” he said, in­stantly. I asked him what the ben­e­fits would be. “In­creased en­ergy lev­els,” he said. “I’m 42 now. Some days are a strug­gle.”

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