The manosphere will drive a liver disease crisis in men - Castle Craig calls on doctors to act this World Liver Day

This Sunday marks World Liver Day. Alcohol will rightly dominate the conversation as it remains the single biggest cause of liver disease in the UK, and deaths have risen fourfold over the past 50 years alone. But Castle Craig, a leading rehab clinic, is using the occasion to call on the medical community to widen its lens. Dr Giedre Putelyte, Specialty Doctor at Castle Craig, said;

“Over the past few years, I’ve seen a marked increase in men presenting with body dysmorphia and related steroid use. This trend appears closely tied to the rise of manosphere content and excessive social media exposure, where unrealistic, hyper-muscular ideals are constantly reinforced. For many, it’s no longer just about fitness - it’s about chasing an unattainable standard that is harming both mental and physical health.”

According to BEAT, around one in four people with an eating disorder in the UK is male. It is a figure that speaks to something broader: conditions affecting men's relationships with their bodies are far more widespread than is often assumed. For clinicians, understanding these trends is vital to avoiding missed diagnoses and seizing opportunities for early intervention. Today, Castle Craig wants to focus on one specific part of that picture: the damage anabolic steroids can do to the liver, and why clinicians should be alert to this risk in their own daily practice.

Steroid use has been part of gym culture for decades. What has changed is the scale and who is driving it. Estimates on the exact number vary - figures cited range from 330,000 to close to one million men in the UK - but what clinicians and researchers broadly agree on is that use has been climbing for decades and shows no sign of slowing.

Muscle dysmorphia, or bigorexia, is characterised by an obsessive preoccupation with not being muscular enough. A 2025 systematic review and meta-analysis found that steroid users show significantly higher levels of muscle dysmorphia than non-users, and that over half of those with muscle dysmorphia have used steroids. The manosphere and social media have accelerated this, with research showing steroids are now openly sold on Instagram and TikTok through the same influencer networks that create the pressure to use them in the first place.

“As clinicians, we’re increasingly concerned that what was once a relatively niche presentation is becoming mainstream, driven by digital environments that reward extreme physiques and reinforce body dissatisfaction,” says Dr Putelyte.
What a lot of online content doesn’t address is what steroids do to the liver.
Long-term anabolic steroid use is associated with serious liver injury, including fibrosis and scarring of liver tissue, cirrhosis, hepatocellular carcinoma, hepatic adenoma, and a condition called peliosis hepatis, where blood-filled cysts form in the liver that can rupture and cause fatal internal bleeding. Abnormal liver function is the single most common adverse health event found in men using non-prescribed steroids, who are 51% more likely to have liver abnormalities than men using prescribed testosterone. The damage is typically silent. No pain, no obvious symptoms, just findings on a blood panel that most of these men have never had done.

“In practice, many of these men feel completely well,” says Dr Putelyte, “which is why the liver damage is so often missed. When we do test, we’re looking at liver function markers such as ALT, AST, ALP, GGT, Bilirubin and others. It’s striking how often this comes as a surprise. These are typically otherwise healthy, active men who don’t associate their steroid use with internal harm, particularly because the effects are silent at first.

The concern is that by the time symptoms develop, the damage may already be advanced. Earlier and routine screening could make a significant difference. Identifying abnormal liver function at an early stage gives us a chance to intervene, whether that’s stopping steroid use, monitoring more closely, or preventing progression to more serious conditions. Without that, we’re often catching problems much later than we’d like.”

Castle Craig assesses liver function for every patient where there are clinical indications, regardless of what they are presenting with. We regularly identify damage that has been building quietly for months or years. We are asking clinicians across the UK to consider doing the same - and to start asking their male patients about steroid use with the same routine they apply to questions about alcohol.

World Liver Day is this Sunday. If you are a clinician who would like to discuss screening for steroid-related liver damage, or if you are concerned about your own health or that of someone you know, visit Castle Craig's website on www.castlecraig.co.uk or call on 01721 546 263.