Navigating Risks and Reducing Harm: A Gendered Analysis of Anabolic–Androgenic Steroid Users Within the Risk Environment Framework

Abstract

Introduction: The existing body of literature on harm reduction for those who use anabolic–androgenic steroids (AASs) predominantly concentrates on men, thereby neglecting the unique challenges faced by women in this context. Using a risk environment framework, the aim of this study was to examine the gendered harm reduction practices of male and female AAS users. The study explores their awareness of the potential harms associated with AAS use, the strategies they employ to manage those risks, and the support systems they utilize for harm reduction. Methods: The study employed purposive sampling to recruit 25 individuals (16 females and nine males) who used AAS. In-depth, semi-structured interviews were conducted and transcribed; thematic analysis was employed. Results: Both male and female users were aware of the risks and side effects of AAS. They also often trusted coaches for advice regarding AAS use, and some found peer support for open discussions. Participants also indicated the importance of verifying the legitimacy and safety of AAS. Men considered these to be manageable while women aimed to avoid them, particularly the masculinizing effects. Women downplayed the persistence of side effects and fertility challenges. Harm reduction strategies involved both men and women monitoring their health through personal cues and blood tests. However, women placed a greater emphasis on various physiological measures in their health monitoring practices. Post-cycle therapy was less discussed among women. Discussion: Overall, the study provides insights into the awareness, strategies, and support systems employed by men and women who use AAS for harm reduction purposes. There is a need to adopt a comprehensive harm reduction approach that recognizes the unique needs and experiences of women who use AAS. We emphasize the need for comprehensive education, supportive healthcare providers, and responsible coaching to minimize potential risks and ensure the well-being of individuals using AAS.

Performance and Image Enhancing Drug Use Among Australian Women: The Role of Interpersonal Relationships in Facilitating Use

“…Women who use AAS are at risk of developing masculinizing side effects, such as voice deepening, facial hair, acne, and clitoral enlargement, as indicated among South American, U.S., and Scandinavian cohorts (Abrahin et al, 2017;Havnes, Jørstad, Innerdal et al, 2021;Ip et al, 2010). Thus, for women who use AAS, there are concerns about negative impacts on their perceived "femininity" as linked to their health (Börjesson et al, 2016;Havnes, Jørstad, Innerdal et al, 2021;Kotzé et al, 2020;Piatkowski & Dunn, 2024;Piatkowski et al, 2023b;Scarth et al, 2022).…”