I met James after he ended up in the intensive care unit where I was the cardiologist on call. He had injected himself with tainted steroids bought on the internet from the comfort of his home in South Wales. I was asked to see him because he had a grossly enlarged heart.

A charming, tall and muscular 35-year-old, James (not his real name) is part of a growing epidemic of image- and performance-enhancing drug (Iped) use in the region where I work. We are accustomed to the doping scandals of professional sportsmen and women but little is known of the huge increase in the use of Ipeds, particularly in South Wales.

Known locally as the “Valley Soldiers”, the users’ appearance is unmistakable. Buff men, ranging from their teens through to middle age, they have an image-conscious lifestyle that is centred around the gym, eating high-protein diets and using Ipeds.

James first started using the drugs at his local gym because they gave him quick results and helped him bulk up. “Once you’ve started, you need to continue with the drugs to maintain your baseline,” he told me. In time, he fell in with a group of like-minded men and soon began participating in bodybuilding competitions. He felt energised and stronger and he found that stopping led to his feeling depressed.

That’s when things started to get more serious and his Iped use became an integral part of his life. He spends as much as £200 a month on a cocktail of drugs from a dealer in his local gym. He has access to testosterone, hCG, stanozolol, insulin, growth factor, ephedrine and much more.

The widespread use of Ipeds has normalised them within a growing subculture that doesn’t regard itself as having anything in common with the stereotype of the emaciated drug addict. Rather, the Valley Soldiers see themselves as living healthy and safe lifestyles. They hold down jobs, they feel well, so what’s the problem?

In fact, serious problems do occur with Iped use, such as depression, mania and psychosis. The physical manifestations include an increased risk of kidney, liver and heart failure, heart attacks, strokes, shrunken testicles, infertility, high blood pressure and osteoporosis. The transmission risk of HIV and hepatitis through the sharing of contaminated needles is the same in Iped users as in those injecting heroin. In adolescents, Ipeds can stunt growth.

Zaheer Yousef, professor of cardiology at the University Hospital of Wales, conducted research on the effects of Ipeds on the cardiovascular health of users by recruiting them directly from gyms in South Wales. The results were shocking: in one gym alone, he found three men with severe heart failure directly caused by illegal steroid use. One man ended up with an implantable cardiac defibrillator and another can never drive again because of the advanced nature of his heart failure. In spite of this, none of the men wanted to stop using.

As with most substance misuse services in the NHS, help for Iped users is scant and under-resourced; locally there is only one steroid drop-in clinic in Newport staffed by volunteer doctors and nurses. It provides a non-judgemental approach to Iped users and is somewhere that they can have blood tests and physical examinations. However, there is a limit to what the clinic can offer. Many of the users have medical and psychiatric complications requiring specialist care.

As a cardiologist, I’ve seen an increase in referrals from both the steroid drop-in clinic and from GPs seeking help for young men who frequently have advanced cardiovascular disease. The worrying increase in Iped use has led to diseases often seen in the old manifesting in the young, alongside more novel problems, and this has caught an already stretched NHS off-guard.

I asked James if he had any intention of stopping the use of Ipeds. “I’d rather have 50 years of looking good than living till I’m 90,” he said.

Dr Nishat Siddiqi is a cardiologist based in South Wales