Government health advisers have urged local councils and organisations to increase the help available to anabolic steroid users, after warnings that the country faces an epidemic of abuse of the drug, especially among image-conscious young men.

Public Health England warns that no one really knows how many people are using steroids and other so-called image and performance enhancing drugs, or IPEDs, but that users of the substances now make up a “significant proportion” of people going to needle exchanges.

The organisation also warns of spiralling HIV rates among injectors of steroids, which mimic the effects of testosterone and boost muscle growth. Studies have shown an infection rate of about 1.5%, the same as for users of drugs such as heroin, as well as fast-rising rates of hepatitis B and C.

The new advice notes figures from the British Crime Survey suggesting 66,000 people in England and Wales had used steroids in the previous year, but that the real figure could well be higher, with 70% of clients at some needle exchanges using the drugs.

Jim McVeigh, an expert on steroid use at Liverpool John Moores University, who was one of the advisers who helped draft the advice, said he believed the true figure was “in the hundreds of thousands”, and that the public health impact was significant, particularly with many people also using other image-enhancing drugs.

“There are significant numbers of young men injecting a range of drugs including anabolic steroids and growth hormone,” he said.

“In addition to the risks associated with injecting, including HIV transmission, the users of these drugs are taking higher dosages, using for longer periods and in larger combinations. Additionally, the vast majority of products are manufactured illicitly, with no guarantee as to their contents or levels of contamination.

“It’s essential this population of drug users are engaged with effectively by health practitioners to reduce the potential harms associated with this form of drug use.”

The Public Health England advice notes the difficulties of engaging with people who often do not see themselves as drug users . It urges local health groups to be as welcoming as possible and to liaise with gyms that might have a steroid problem among their members.

Organisations that work with steroid users said last month that the UK faced a potential health timebomb as a result of the increased use of steroids and associated drugs. As well as the drugs’ immediate effects, which can include high blood pressure and aggression, those who work with users say people are taking increasingly high doses and for longer periods, putting them at risk of depression, heart problems and even long-term cognitive damage.

McVeigh said that when he started researching the subject in the early 90s, steroid users were mainly bodybuilders, who generally obtained the drugs via proper pharmaceutical supply channels. This had changed, with many young men taking steroids as a perceived shortcut to bigger muscles.

“It’s done a lot more on a whim, sometimes even prior to weight training,” he said. “It’s seen that if you want to increase your muscle mass you take steroids, and need to go to the gym as well, whereas before, with the majority of people, steroids were seen as the next step if you’re taking it seriously.”

The drugs themselves, often bought via the internet, were far more variable, he added: “Most will contain an active agent of some sort, but it might not be the actual steroid, and it’s usually not close to the actual dosage it’s meant to be. They’re not legitimate laboratories, so there’s a lot of contamination. That’s a concern.”

Dosages had increased notably, he said: “The dosages among elite bodybuilders in the 1990s were lower than a lot of people’s first regime now. They’re completely naive going into it. The steroids could be weaker now, but it’s just as likely they could be stronger. It’s just random, as it’s not made in a proper lab.”

Users were also much more prone to take other drugs, such as human growth hormone, McVeigh said. Studies from the US had shown signs of serious long-term health problems, including cardiac-related deaths, from people who had used high steroid doses for prolonged periods.