The number of people who are injecting themselves with steroids or other image enhancing drugs is "rapidly increasing", health experts have warned.
More must be done to help the rising tide of people, including teenagers, who use these drugs, the National Institute for Health and Care Excellence (Nice) said.
Outreach programmes should be set up in gyms to try to reach this group of drug users, Nice said. They also warned that people who use steroids do not seem themselves as having a drug problem.
The health authority also said that needle and syringe programmes - which were set up in the 1980s and 1990s to stem the spread of HIV - should also make sure that these drug users have the sterile equipment they need to prevent the spread of blood-borne viruses.
Meanwhile, local health bodies need to increase the proportion of these drug users who are tested for HIV, hepatitis B and C and other viruses.