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Brisbane: Eighteen-year-old Mark scrolls Instagram late at night, watching videos of fitness influencers showing off muscle gains and lifting the equivalent of a baby elephant off the gym floor.

Spurred on by hashtags and usernames indicating these feats involve steroids, soon Mark is online, ordering his first “steroid cycle”. No script, no warnings, just vials in the mail and the promise of “gains”.

A few weeks later, he’s posting progress shots and getting tagged as #MegaMark. He’s pleased. But what if I told you Mark was unknowingly injecting toxic chemicals?

In our new research we tested products sold in Australia’s underground steroid market and found many were mislabelled or missing the expected steroid entirely.

Even more concerning, several contained heavy metals such as lead, arsenic and cadmium. These substances are known to cause cancer, heart disease and organ failure.

What are anabolic steroids, and who is using them?

Anabolic steroids are synthetic drugs designed to mimic the effects of testosterone. Medical professionals sometimes prescribe them for specific health conditions (for example, hypogonadism, where the body isn’t making enough sex hormones). But they are more commonly taken by people looking to increase muscle size, improve athletic performance, or elevate feelings of wellbeing.

In Australia, it’s illegal to possess steroids without a prescription. This offence can attract large fines and prison terms (up to 25 years in Queensland).

Despite this, they’re widely available online and from your local “gym bro”. So it’s not surprising we’re seeing escalating use, particularly among young men and women.

People usually take steroids as pills and capsules or injectable oil- or water-based products. But while many people assume these products are safe if used correctly, they’re made outside regulated settings, with no official quality checks.

Our research

For this new study, we analysed 28 steroid products acquired from people all over Australia which they’d purchased either online or from peers in the gym. These included 16 injectable oils, ten varieties of oral tablets, and two “raw” powders.

An independent forensic lab tested the samples for active ingredients, contaminants and heavy metals. We then compared the results against what people thought they were taking.

More than half of the samples were mislabelled or contained the wrong drug. For example, one product labelled as testosterone enanthate (200mg/mL) contained 159mg/mL of trenbolone (a potent type of steroid) and no detectable testosterone. Oxandrolone (also known as “Anavar”, another type of steroid) tablets were sold claiming a strength of 10mg but actually contained 6.8mg, showing a disparity in purity.

Just four products matched their expected compound and purity within a 5% margin.

But the biggest concern was that all steroids we analysed were contaminated with some level of heavy metals, including lead, arsenic and cadmium.

While all of the concentrations we detected were within daily exposure limits regarded as safe by health authorities, more frequent and heavier use of these drugs would quickly see people who use steroids exceed safe thresholds. And we know this happens.

If consumed above safe limits, research suggests lead can damage the brain and heart. Arsenic is a proven carcinogen, having been linked to the development of skin, liver and lung cancers.

People who use steroids often dose for weeks or months, and sometimes stack multiple drugs, so these metals would build up. This means long‑term steroid use could be quietly fuelling cognitive decline, organ failure, and even cancer.

What needs to happen next?

Heavy metals such as lead, arsenic and cadmium often contaminate anabolic steroid products because raw powders sourced from some manufacturers, particularly those in China, may be produced with poor quality control and impure starting materials. These metals can enter the supply chain during synthesis, handling, or from contaminated equipment and solvents, leading to their presence in the final products.

Steroid use isn’t going away, so we need to address the potential health harms from these contaminants.

While pill testing is now common at festivals for drugs such as ecstasy, testing anabolic steroids requires more complex chemical analysis that cannot be conducted on-site. Current steroid testing relies on advanced laboratory techniques, which limits availability mostly to specialised research programs such as those in Australia and Switzerland.

We need to invest properly in a national steroid surveillance and testing network, which will give us data-driven insights to inform targeted interventions.

This should involve nationwide steroid testing programs integrated with needle-and-syringe programmes and community health services which steroid-using communities are aware of and engage with.

We also need to see peer-led support through trusted programs to educate people who use steroids around the risks. The programs should be based in real evidence, and developed by people with lived experience of steroid use, in partnership with researchers and clinicians. (The Conversation)

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New five-year results from the phase 3 GENEr8-1 trial show that BioMarin’s gene therapy Roctavian (valoctocogene roxaparvovec-rvox) continues to provide long-term control of bleeding and sustained factor VIII (FVIII) expression, with more than 80% of participants remaining off routine prophylaxis.

Roctavian is a gene therapy designed to treat adults with severe hemophilia A, a genetic disorder caused by a deficiency of FVIII, a protein necessary for blood clotting. Without enough FVIII, people with hemophilia A experience frequent bleeding episodes, often requiring regular intravenous infusions of the missing clotting factor to prevent life-threatening bleeds and joint damage.

The therapy uses an adeno-associated virus (AAV5) vector to deliver a working copy of the FVIII gene to liver cells, enabling the body to produce its own clotting factor. This approach offers the potential for a long-lasting effect from a single infusion, reducing or eliminating the need for ongoing preventive (prophylactic) treatments.

In June, BioMarin presented the five-year data at the 33rd Congress of the International Society on Thrombosis and Haemostasis (ISTH) in Washington, D.C. The GENEr8-1 trial is the largest and longest-running clinical study of a gene therapy in hemophilia A. It included 134 participants, most who had been previously enrolled in a lead-in study where their baseline bleeding rates were measured while on standard FVIII prophylaxis.

Five years after receiving Roctavian, participants continued to experience reduced bleeding and stable FVIII levels. FVIII activity remained in the mild hemophilia range, with average levels of 24.0 IU/dL by one-stage assay and 13.7 IU/dL by chromogenic assay. In addition, 73.5% of participants had FVIII levels in the mild to normal range.

A single dose of Roctavian maintained FVIII levels at near-normal or normal levels for most participants, significantly reducing the need for regular FVIII infusions. The data reinforce the therapy’s ability to lessen the daily burden of living with hemophilia A and improve patients’ overall quality of life.

The mean annualized bleeding rate (ABR) for treated bleeds in the rollover population was 0.6 bleeds per year at year five. Most participants (77.8%) had no treated bleeds during that fifth year. At the same time, 81.3% of participants remained off routine prophylaxis.

Safety outcomes were also positive.

Over the five years of follow-up, there were no new safety signals, no development of FVIII inhibitors (antibodies that block the therapy’s effect), and no treatment-related malignancies or thromboembolic events.

Beyond the clinical results, the study also tracked improvements in quality of life. Participants reported better outcomes across several measures, including reduced joint pain, fewer limitations on physical activity and travel, and reduced impact on work, education, and family life.

“We hope these results demonstrating the long-term durability of gene therapy equip individuals with severe hemophilia A with the knowledge to make informed decisions regarding treatment,” Dawn Rotellini, chief operating officer at the National Bleeding Disorders Foundation, said in a news release. “It is meaningful for the bleeding disorders community to see a continued commitment to highlighting the benefits of hemophilia A gene therapy.”

Researchers also introduced the concept of a “hemophilia-free mind”—a shift in how people with hemophilia perceive their disease. Using clinical data and patient questionnaires, they evaluated changes in psychological and emotional well-being over time. The report showed improvements across all categories, reflecting a reduced daily burden of the disease.

Hemophilia A affects about 1 in 10,000 people and is usually inherited, although about one-third of cases are caused by spontaneous mutations. Roctavian is approved for use in adults with severe hemophilia A who do not have antibodies to the AAV5 vector used in the therapy.

New brain imaging research reveals that optimistic people not only see the future more brightly, but their brains also process future events in strikingly similar ways, unlocking the science behind optimism’s social and emotional power.

Study: Optimistic people are all alike: Shared neural representations supporting episodic future thinking among optimistic individuals. Image Credit: saepul_bahri / Shutterstock

In a recent article published in the journal PNAS, researchers investigated how optimism shapes the brain’s representation of imagined future events. They found that optimistic individuals exhibited similar brain activity patterns while imagining future events, especially when differentiating between positive and negative scenarios. Conversely, less optimistic individuals displayed idiosyncratic and varied brain responses.

Background

Optimism, the tendency to expect positive future outcomes, is a powerful psychological trait associated with enhanced emotional well-being, reduced stress, and improved physical and mental health. Optimists not only imagine positive events more vividly but also treat them as more immediate and likely. Despite growing evidence of its benefits, little is known about how optimism shapes the brain’s representation of imagined future scenarios, a process known as episodic future thinking.

Prior studies suggest that individuals with positive traits, such as strong social ties, exhibit similar brain activity in the medial prefrontal cortex (MPFC), a region involved in self-referential and future-oriented thought. Drawing on the Anna Karenina principle, which posits that positive outcomes are more similar than negative ones, the researchers hypothesized that optimistic individuals would exhibit more convergent MPFC activity, while less optimistic individuals would have more diverse neural responses.

About the Study

To test their hypothesis, researchers conducted two functional magnetic resonance imaging (fMRI) studies where participants imagined positive, neutral, and negative future events for themselves or their partners. The first study also included death-related scenarios, but these were excluded from the second study to create a more balanced experimental design.

The researchers employed intersubject representational similarity analysis to assess the similarity between participants’ brain patterns and determine whether this relationship was related to their levels of optimism. A second method, individual differences multidimensional scaling, helped map how optimism influenced emotional differentiation in brain activity. Together, these approaches aimed to uncover the neural basis of optimism-driven future thinking.

The study involved two groups of married, right-handed adults without neurological or psychiatric conditions. The first group consisted of 37 participants, and the second group consisted of 50. All participants completed a test to measure their level of optimism. The second group of participants also provided demographic information and completed intelligence tests.

During the fMRI session, participants imagined detailed future scenarios happening either to themselves or their partners, based on written prompts describing positive, neutral, negative, and (in the first study only) death-related events. Each event appeared for ten seconds, and participants were instructed to vividly imagine the scenario that followed. The trials were randomized, and events were shown in both the self and partner conditions. A surprise memory test after scanning confirmed participants had paid close attention.

Brain scans were collected using an MRI scanner. The researchers focused on brain areas involved in future thinking, mainly within the default mode network (DMN). Two main analyses were employed: intersubject representational similarity analysis, to examine the degree of similarity between participants’ brain responses, and individual differences multidimensional scaling, to identify the underlying structure of brain representations and how optimism influenced individual differences in processing emotional events.

Key Findings

The study found that individuals with more optimistic attitudes showed more similar brain activity patterns in the MPFC when imagining future events, while those with less optimistic attitudes displayed more varied neural responses. This pattern was evident across two fMRI studies, which used intersubject representational similarity analysis and were visualized through multidimensional scaling. The analysis revealed that highly optimistic participants clustered together in brain activity space. A strong negative correlation between optimism scores and distance from the most densely clustered region confirmed that greater optimism was associated with greater neural similarity.

Further analyses compared two models: a general similarity model and the Anna Karenina model, which predicted convergence only among optimistic individuals. The Anna Karenina model provided a more comprehensive explanation of neural similarity in the MPFC and other brain regions involved in future thinking. These effects were strongest for self-referential thinking, where participants imagined events happening to themselves, but weaker for partner-referential scenarios. Additional analyses confirmed that these patterns were not simply due to differences in overall brain activity levels but reflected multivariate patterns of neural representation.

Using a second method, the researchers found that optimistic individuals showed greater weights along the emotional dimension, indicating that positive events were represented as more neurally distinct from negative events in their brain activity patterns.

Conclusions

This study found that individuals with optimistic attitudes exhibit similar brain activity patterns in the MPFC when imagining future events, whereas less optimistic individuals display more varied neural responses. The neural data suggested that optimistic individuals represented positive and negative future events as more distinct from one another. These effects were consistent across two studies, using both methods, and offered robust support for the “neural convergence of optimism” hypothesis.

The use of both methods enabled the researchers not only to assess neural similarity but also to uncover the emotional and referential dimensions that shape cognitive representations. The relationship between optimism and emphasis on self versus partner differentiation was inconsistent across studies and requires further investigation.

The authors note that these findings may have implications for understanding how optimism influences social relationships, as shared neural processing patterns could contribute to better social connections, though this connection requires further research.

A key limitation was the weaker effect in partner-related scenarios, possibly due to design constraints. Overall, the study demonstrates that optimism shapes neural representations of emotional content during future thinking.