In a UK survey of 366 men injecting performance drugs, 42% had had redness, swelling and pain at a site and 7% an abscess or open wound. Almost all of it is avoidable: new sterile equipment every time, a separate needle to draw and to inject, clean skin and vial, rotate sites, never share, and treat spreading redness after 48 hours as a medical problem.
- 42% of 366 UK men injecting image- and performance-enhancing drugs reported injection-site redness, swelling and tenderness; 6.8% an abscess or open wound (Hope et al., 2015).
- Only 17% of those with redness and swelling had sought treatment. Delay is what turns a cellulitis into an abscess.
- The gluteal (upper outer quadrant or ventrogluteal), deltoid and lateral thigh are the standard intramuscular sites; the sciatic nerve runs through the lower inner buttock and must be avoided.
- Two needles per injection: one to draw, one fresh to inject. Drawing blunts the tip and pulls in rubber particles.
- Sharing or reusing needles carries hepatitis B, hepatitis C and HIV risk exactly as it does with any injected drug.
Injection-site infections are the most common harm from injectable steroids and the most avoidable. This is the technique clinics teach.
Equipment
- New, sealed, sterile syringe and needles every time. Never reuse, never share, not even a vial with someone else.
- Two needles: a larger one to draw (rubber stoppers blunt the tip and shed particles), a fresh one to inject.
- Alcohol swabs, a sharps container, clean hands.
Sites
| Site | Where | Notes |
|---|---|---|
| Ventrogluteal | Side of the hip, between the bony landmarks | Preferred: thick muscle, no major nerves or vessels |
| Dorsogluteal | Upper outer quadrant of the buttock | Stay high and lateral; the sciatic nerve runs lower and inner |
| Deltoid | Lateral upper arm, below the shoulder bone | Small muscle: small volumes only |
| Vastus lateralis | Outer thigh, middle third | Easy to see; more soreness |
Rotate: at least four sites, alternate sides, no site more than once a week. Repeated use of one spot scars the muscle, forms lumps and slows absorption.
Technique
- Wash hands. Swab the vial top, let it dry.
- Draw with the drawing needle. Swap to the injecting needle. Expel air.
- Swab the skin, let it dry (wet alcohol stings and does not disinfect).
- Insert at 90 degrees in one motion, full depth for the site.
- Optional: pull back briefly. Blood means withdraw, fresh needle, other site.
- Inject slowly. Withdraw, light pressure with clean gauze, no rubbing.
- Needle straight into the sharps container.
What normal looks like
Mild soreness and a small firm area for one to three days, fading. Oil-based compounds are thicker and ache more. Warmth and gentle movement help.
What infection looks like
Redness, heat, swelling and pain that get worse after 48 hours instead of better. A hot, hard, growing lump. Fever, chills, red streaks toward the body. Any of these is a doctor visit today. Cellulitis responds to antibiotics early; an abscess needs draining and does not go away by waiting. In the UK survey only one in six with symptoms sought care, and that delay is where the abscesses come from.
Counterfeits and contamination
Unsterile products cause infections that perfect technique cannot prevent. Pharmaceutical-grade, sealed, in-date, from a verifiable source. Cloudy oil, particles, or a vial that stings unusually is a vial to stop using.
Nerve and vessel injuries
Sharp shooting pain down the leg during a gluteal injection means the needle is near the sciatic nerve: withdraw immediately. Persistent numbness or weakness after an injection is a doctor visit. Hitting a vessel produces immediate bleeding or a spreading bruise; pressure, and choose another site next time.
Where to get help without judgement
Needle exchanges and harm-reduction services in the UK, Australia, the Netherlands, Scandinavia and many other countries provide sterile equipment, sharps disposal and advice to people injecting performance drugs, and they are used to it. In countries without them, a pharmacy sells syringes and sharps bins, and a GP treats an infection as an infection.
Frequently asked questions
Which injection sites are safest?
Ventrogluteal (side of the hip, away from the sciatic nerve), upper outer quadrant of the buttock, and the lateral deltoid for smaller volumes. Rotate between sites and sides so no site is used more than once a week.
Do I need to aspirate?
Guidelines no longer require it for standard sites, but pulling back briefly to check for blood costs nothing and is common practice. If blood appears, withdraw and use a fresh needle at another site.
What does an infection look like?
Redness, warmth, swelling and pain that increase after 48 hours instead of fading; a hard, hot lump; fever; red streaks. Any of these means a doctor today. Abscesses do not resolve on their own and may need draining plus antibiotics.
Can I inject the same spot repeatedly?
No. Repeated use scars muscle, creates lumps, slows absorption and raises infection risk. Rotate through at least four sites.
How do I dispose of needles?
In a sharps container, available from pharmacies, needle exchanges or online. Never in household waste. Many countries have free needle-exchange services that also give harm-reduction advice without judgement.
Sources
- Hope VD et al. Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risk factors, and healthcare seeking. Epidemiology and Infection, 2015.
- Piatkowski T et al. Making safer injecting matter for people who inject image and performance enhancing drugs. 2026.
- Harm reduction techniques among men using anabolic androgenic steroids: a qualitative study. 2024.