Treatments for people who use anabolic androgenic steroids: a scoping review

Abstract

Background: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems.Methods: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. Results: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided.Conclusion: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health-or drug-related journals, will support development of the evidence base.

Looking Beyond the Provision of Injecting Equipment to People Who Use Anabolic Androgenic Steroids: Harm Reduction and Behavior Change Goals for UK Policy

“…The priorities identified provide clear objectives for behavior change interventions targeting people who use AAS from the perspectives of those who work with them, and highlight that current UK public health approaches are only tackling some of what stakeholders in this study perceive to be important policy goals. The increasing evidence base on physical and mental health harms associated with AAS use (Pope et al, 2014) and examples of treatments given in response to these (Bates et al, 2019) supports the needs identified here to not only tackle the risk of BBVs, but to reduce risks of poor health outcomes associated with long term use. The findings suggest that health professionals and other stakeholders who work with people who use AAS believe that an expanded approach is required that is designed in response to the needs of this population; one that includes interventions to support them to manage their risk through moderation and support their health following cessation, as well as interventions to motivate cessation and prevent initiation.…”

Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review

“…The scientific community should intensify its efforts to assess the pathophysiology of behavior and cognitive impairment due to long term AAS exposure. Moreover, evidence is urgently required to support the development of a reliable diagnostic tool to identify precociously AAS abuse as well as evidence-based therapy [ 57 , 125 , 126 , 127 , 128 , 129 , 130 , 131 ].…”

The Impact of the COVID-19 Pandemic on Male Strength Athletes Who Use Non-prescribed Anabolic-Androgenic Steroids

“…The links between AAS use and mental health identified here highlights the importance of people who use AAS having access to health services to obtain treatment. It is, however, well-established that access to health services for this sub-population is generally limited; not only due to the lack of treatment available ( 73 ) but also due to a lack of knowledge amongst health professionals about these substances ( 74 , 75 ). This lack of access has been exacerbated due to the COVID-19 pandemic with health services, including alcohol and other drugs services, needing to close down or restricting their access ( 76 , 77 ).…”