The problem
Anabolic androgenic steroids (AAS) are increasingly used by the general population, particularly male gym users, for their muscle-building and aesthetic effects, but they can have a detrimental impact on physical and emotional wellbeing. There is a shortage of research exploring the experiences of AAS-users, their perceptions of the risks associated with AAS and how their complex motivations for using affect the support they require.
What are Anabolic Androgenic Steroids?
Anabolic-androgenic steroids (AAS) are synthetically produced variants of the naturally occurring male sex hormone testosterone.
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Historical roots in enhancing performance in sports, now used recreationally for anabolic effects
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Taken orally or through intra-muscular injection, often in cycles, in combination & planned
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There are over 100 known types of AAS
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Doses are typically supra-physiological – greater amounts than are usually found in the body.
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AAS are often used in combination with other substances, e.g. growth hormones, & drugs to mitigate side effects
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In the UK it is unlawful to buy or sell AAS, but not illegal to possess them for personal use.
The study
The study revealed that AAS-users access a wide range of sources to get information on the different types of AAS, how to inject them, the side-effects of their use and how to manage risks. However, it also found that there is a real lack of data on the types of information and support users actually want.
This shaped the focus for the subsequent research - to explore the experiences of recreational AAS-users and ascertain their needs and wants for information and support. The study followed a two-phase process, using questionnaires to collect quantitative data, followed by semi-structured interviews to gain deeper qualitative insight. The quantitative data was analysed using descriptive statistical analysis, while thematic analysis was used to draw out the common themes from the qualitative data.
What the study found
This study found that AAS-users had complex and interlinked motivations for using AAS, and that these could change over time. It found that those people who had used AAS for muscle gain as young men, often returned to the use of unprescribed AAS in later life. Rather than for muscle gain, they now used AAS as a form of Testosterone Replacement Therapy, with motivations aligned to maintaining their libidos.
This study suggested that the internalisation of socially-constructed ideal perceptions of masculinity could be a reason for using AAS and may impact on users’ health seeking behaviours. Most AAS-users were seeking evidence-based information but did not seek professional support due to stigma and lack of faith in the knowledge of professionals.
What does this mean for society and supporting AAS-users?
This study makes several recommendations to any support services that might interact with people who use AAS. It is recommended that a harm minimisation approach be taken; access to blood testing, substance testing, support for safer injecting, specialist medical support and wellbeing counselling could all minimise the risks of harm to AAS users.
It is also important that services consider how their advice and support is communicated, aiming to use a person-centred approach. Advice should be balanced, evidence based and non-judgmental. Professionals should explore with users their history of AAS use and their concerns, so that support can be tailored to individual needs. One-to-one and group support should include discussions around beliefs linked to masculinity and negative self-talk. Services for AAS-users should be separated from those serving other illicit drug users.
The recommendations from this study have already been shared with Public Health Dorset and the Westminster Drug Project, and it is hoped that they will be shared more widely.
The published research
Harvey, O., Parrish, M., van Teijlingen, E.,Trenoweth, S. (2021). Libido as a motivator for starting and restarting non-prescribed anabolic androgenic steroid use among men: a mixed-methods study. Drugs: Education, Prevention and Policy [online] X-XX.
Harvey, O., Parrish, M., van Teijlingen, E.,Trenoweth, S. (2020). Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs. Drugs: Education, Prevention and Policy [online], 1–10.
Harvey, O. (2020).
Male anabolic androgenic steroid-users: a mixed-methods study. The voice of the AAS-user. PhD Thesis. Bournemouth University, Faculty of Health and Social Sciences.
Harvey, O., Keen, S., Teijlingen, E. van, & Parrish, M. (2019). Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access. BMC Public Health, 19(1), 1024.
https://doi.org/10.1186/s12889-019-7288-x
Harvey, O., & Parrish, M. (2019). Social Work Implications of Anabolic – Androgenic Steroid Use, Particularly Among Young People: A Literature Review. Practice, 32(3): 1–20.
https://doi.org/10.1080/09503153.2019.1653450,
Harvey, O. (2018). ‘Shades of Grey’: The Ethics of Social Work Practice in Relation to Un-prescribed Anabolic Androgenic Steroid Use. Practice. 31(4): 239-258, https://doi.org/10.1080/09503153.2018.1510480
