By Thomas Moore, Sky News Health and Science Correspondent
The number of people who inject themselves with steroids to "bulk up" is rising so fast that drug services risk being left behind, health experts warn.
Conservative estimates by the Home Office suggest around 60,000 people aged between 16 and 59 in England and Wales have injected anabolic steroids in the last year.
And one health worker told Sky News he was seeing "at least" seven new users every week - on top of his existing workload.
The National Institute of Health and Care Excellence (Nice) says in new NHS guidance that drug services should set up clinics in gyms to reach mainly young men who are injecting steroids.
Prof Mike Kelly, Director for Public Health at Nice, said they are at significant risk of HIV and other blood-borne viruses from sharing needles, yet they do not use existing needle exchange schemes that were set up in the 1980s for other drug users.
"They do not think of themselves as drug addicts," he said.
"They are fit and healthy. They are doing it to improve their appearance.
"We have to make sure they understand that the risks of injecting those substances are the same as injecting heroin or crack or anything like that.
Nice has recommended that clinics are set up in gyms"When people share needles they pass on blood to blood and the infection is passed on quickly."
According to Nice 1.5% of people who inject image or performance enhancing drugs have HIV.
David Rourke, harm reduction lead for the Arundel Street Project in Sheffield, said he saw at least seven new steroid injectors every week.
"They lead very normal lives - the majority are working, they have families," he said.
"So it's not looked at like heroin or crack where it can affect your entire life."
He said some parts of the country have no services at all that are aimed at steroid users.
"Those who inject steroids are potentially using them without the correct education or the correct equipment and this can lead to more people injecting unsafely, which can put not just their own life, but the lives of those around them, at risk," he added.
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