Health service engagement, side effects and concerns among men with anabolic-androgenic steroid use: a cross-sectional Norwegian study

Abstract

Background Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use. Methods The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi2 or Fisher exact tests for numerical and categorical variables, respectively. Results All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%). Conclusions Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs.

Treatment‐seeking behavior and cardiovascular morbidity among men with anabolic‐androgenic steroid use: A cross‐sectional study

“…Despite minimal differences between the TSG and the non‐TSG, we consider the potential high morbidity level in the non‐TSG to be one of the key findings of our study. From previous observations of the same sample of AAS‐using men engaging health services, 24 we know that treatment‐seeking behavior among AAS users is associated with more health concerns and a higher symptom‐burden. Hence, our primary focus for this paper was on individuals who have not sought contact with the healthcare system and who have underlying health conditions, as opposed to exploring what attracted the other group to health services.…”

“…Not seeking treatment despite experiencing userelated symptoms is not a new phenomenon among AAS users. 22,23,34 Many AAS users do not consider related side effects significant enough to seek professional help, 24,34 while others fear stigmatization from healthcare professionals or perceive physicians to be too uninformed on AAS. 22,35,36 In fact, adequate AAS knowledge among health personnel has previously shown to be a contributing factor to treatmentseeking among AAS users.…”

“…The adverse effects associated with long‐term supraphysiological AAS levels, would suggest frequent visits to health services among AAS users. However, recent studies have revealed that many are hesitant to seek healthcare assistance for AAS‐related issues, despite the evident risk of health implications associated with use 22–24 . This is concerning as underlying and potentially serious AAS risks may go undetected without targeted medical examinations.…”

Female doping: observations from a data lake study in the Hospital District of Helsinki and Uusimaa, Finland

“…Yet, the exact quantity of these patients in specialized health care services remains obscure. Previous studies indicate that the tendency to seek help from health care professionals is low among people who use AAS [ 40 , 41 ]. The experienced side effects of AAS use may not be considered severe enough to require treatment, but these patients may also be reluctant to admit doping use when confronted by medical professionals, due to stigma or lack of trust in their doctor’s knowledge on the issue [ 21 , 41 ].…”

“…Previous studies indicate that the tendency to seek help from health care professionals is low among people who use AAS [ 40 , 41 ]. The experienced side effects of AAS use may not be considered severe enough to require treatment, but these patients may also be reluctant to admit doping use when confronted by medical professionals, due to stigma or lack of trust in their doctor’s knowledge on the issue [ 21 , 41 ]. Also, only partial truth may be served: in our study, two patients were willing to disclose only previous, not current use, despite conflicting clinical findings.…”