Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access

Authors: Orlanda Harvey, Steve Keen, Margarete Parrish, Edwin van Teijlingen

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS.

Methods

A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered.

Results

We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought.

Discussion

AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals.

Conclusions

Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Kimergård A, McVeigh J. Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK. BMJ Open. 2014 Jun;4(6):1.CrossRef
4.
Korkia P, Stimson G. Anabolic steroid use in Great Britain: an exploratory investigation. Final report to the Department of Health for England, Scotland and Wales. London: The Centre for Research on Drugs and Health Behaviour; 1993.
5.
Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of 500 users. Med Sci Sport Exerc. 2006 Apr;38(4):644–51.CrossRef
6.
Begley E, McVeigh J, Hope V. Image and Performance Enhancing Drugs: 2016 National Survey Results. 2017;1(July):1–23.
7.
Nieschlag E, Vorona E. Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol. 2015;173(2):47.CrossRef
8.
Rowe R, Berger I, Copeland J. “No pain, no gainz”? Performance and image-enhancing drugs, health effects and information seeking. Drugs Educ Prev Policy. 2017 Oct;24(5):400–8.CrossRef
9.
Chyka PA. Health risks of selected performance-enhancing drugs. J Pharm Pract. 2003 Feb;16(1):37.CrossRef
10.
Piacentino D, Kotzalidis G, del Casale A, Aromatario MR, Pomara C, Girardi P, et al. Anabolic-androgenic steroid use and psychopathology in athletes. A Systematic Review Curr Neuropharmacol. 2015;13(1):101–21.PubMedCrossRef
11.
Petersson A, Garle M, Holmgren P, Druid H, Krantz P, Thiblin I. Toxicological findings and manner of death in autopsied users of anabolic androgenic steroids. Drug Alcohol Depend. 2006 Mar 1;81(3):241–9.PubMedCrossRef
12.
Trenton AJ, Currier GW. Behavioural manifestations of anabolic steroid use. CNS Drugs. 2005 May;19(7):571–95.PubMedCrossRef
13.
Thiblin I, Runeson B, Rajs J. Anabolic androgenic steroids and suicide. Ann Clin Psychiatry. 1999 Dec 1;11(4):223–31.PubMedCrossRef
14.
Pope H Jr, Kanayama G. Anabolic- androgenic steroids. In: Verster J, Brady K, Galanter M, Conrod P, editors. Drug abuse and addiction in medical illness: causes, consequences and treatment. New York: Springer; 2012. p. 251–74.CrossRef
15.
Seitz J, Lyall A, Kanayama G, Makris N, Hudson J, Kubicki M, et al. White matter abnormalities in long-term anabolic-androgenic steroid users: a pilot study. Psychiatry Res Neuroimaging Sect. 2017;260:1–5.CrossRef
16.
Kaufman M, Janes A, Hudson J, Brennan B, Kanayama G, Kerrigan A, et al. Brain and cognition abnormalities in long-term anabolic-androgenic steroid users. Drug Alcohol Depend. 2015;152:47–56.PubMedPubMedCentralCrossRef
17.
Bjørnebekk A, Walhovd KB, Jørstad ML, Due-Tønnessen P, Hullstein IR, Fjell AM. Structural brain imaging of long-term anabolic-androgenic steroid users and nonusing weightlifters. Biol Psychiatry. 2017 Aug 15;82(4):294–302.PubMedCrossRef
18.
Sagoe D, McVeigh J, Bjørnebekk A, Essilfie M-S, Andreassen C, Pallesen S. Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. Subst Abus Treat Prev Policy. 2015;10(12).
19.
Hope V, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergard A. Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking. Epidemiol Infect. 2015 Jan;143(1):132–40.PubMedCrossRef
20.
Pope JH, Kanayama G, Athey A, Ryan E, Hudson J, Baggish A. The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates. American Journal on Addictions. 2013; p. 371–7.PubMedPubMedCentralCrossRef
21.
Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy. 2011 Aug;31(8):757–66.PubMedCrossRef
22.
Kimergård A. A qualitative study of anabolic steroid use amongst gym users in the United Kingdom: motives, beliefs and experiences. J Subst Use. 2015 Aug;20(4):288–94.CrossRef
23.
Sagoe D, Andreassen CS, Pallesen S. The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. Subst Abus Treat Prev Policy. 2014;9(1):24.CrossRef
24.
Galvani S. Supporting people with alcohol and drug problems: making a difference. Bristol: The Policy Press, University of Bristol; 2012.CrossRef
25.
McCarthy T, Galvani S. Alcohol and other drugs – essential information for social workers. A BASW pocket guide. Luton: University of Bedfordshire; 2010.
26.
Peterson J, Pearce PF, Ferguson LA, Langford CA. Understanding scoping reviews: definition, purpose, and process. J Am Assoc Nurse Pract. 2017;29(1):12–6.PubMed
27.
Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6.PubMedCrossRef
28.
Moher D, Liberati A, Tetzlaff J, Altman DG. Methods of systematic reviews and meta-analysis: preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009 Jan 1;62:1006–12.PubMedCrossRef
29.
30.
31.
Aveyard H. Doing a literature review in health and social care: a practical guide. 3rd ed. Maidenhead: Open University Press; 2014.
32.
Wellman B, Haythornthwaite C, editors. The Internet in everyday life. Malden, MA: Wiley-Blackwell|; 2002. (Information Age series).
33.
34.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097.PubMedPubMedCentralCrossRef
35.
Public Health Resource Unit. The Critical Skills Appraisal Programme: making sense of evidence. [Internet]. Public Health Resource Unit; 2006 [cited 2017 Jun 6]. Available from: https://​casp-uk.​net/​
36.
Maycock B, Howat P. The barriers to illegal anabolic steroid use. Drugs Educ Prev Policy. 2005 Aug;12(4):317–25.CrossRef
37.
Grogan S, Shepherd S, Evans R, Wright S, Hunter G. Experiences of anabolic steroid use: in-depth interviews with men and women body builders. J Health Psychol. 2006 Nov;11(6):845.PubMedCrossRef
38.
Skårberg K, Nyberg F, Engström I. The development of multiple drug use among anabolic-androgenic steroid users: six subjective case reports. Subst Abuse Treat Prev Policy. 2008 Nov 28;3(24):24.PubMedPubMedCentralCrossRef
39.
Kimergård A, McVeigh J. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J 2014 Jul 2;11(1):1–23.PubMedPubMedCentralCrossRef
40.
van Hout M-C, Kean J. An exploratory study of image and performance enhancement drug use in a male British south Asian community. Int J Drug Policy. 2015 Sep 1;26(9):860–7.PubMedCrossRef
41.
Dunn M, Henshaw R, McKay FH. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev. 2016;35(4):377–82.PubMedCrossRef
42.
Griffiths S, Henshaw R, McKay FH, Dunn M. Post-cycle therapy for performance and image enhancing drug users: a qualitative investigation. Perform Enhanc Heal. 2016 Nov 9;5:103–7.CrossRef
43.
Hanley Santos G, Coomber R. The risk environment of anabolic–androgenic steroid users in the UK: Examining motivations, practices and accounts of use. Int J Drug Policy. 2017 Feb 1;40(New Psychoactive Substances and Human Enhancement Drugs):35–43.PubMedCrossRef
44.
Tighe B, Dunn M, McKay FH, Piatkowski T. Information sought, information shared: exploring performance and image enhancing drug user-facilitated harm reduction information in online forums. Harm Reduct J. 2017 Jul 21;14(1):1–9.CrossRef
45.
Greenway CW, Price C. A qualitative study of the motivations for anabolic-androgenic steroid use: the role of muscle dysmorphia and self-esteem in long-term users. Perform Enhanc Heal. 2018 Mar 1;6(1):12–20.CrossRef
46.
Davids E, Roman N. A systematic review of the relationship between parenting styles and children’s physical activity. Vol. 20, African Journal for Physical Health Education, Recreation and Dance. 2014. 228–246 p.
47.
Pluye P, Robert E, Cargo M, Bartlett G, O’Cathain A, Griffiths F, et al. Proposal: a mixed methods appraisal tool for systematic mixed studies reviews. Montreal: Department of Family Medicine, McGill University; 2011.
48.
Johnson B, Richert T. A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment. Addict Res Theory. 2016;24(5):406–15.CrossRef
49.
Al-Falasi O, Al-Dahmani K, Al-Eisaei K, Al-Ameri S, Al-Maskari F, Nagelkerke N, et al. Knowledge, attitude and practice of anabolic steroids use among gym users in Al-Ain District, United Arab Emirates. Open Sport Med J. 2009;2(1):75–81.CrossRef
50.
Bojsen-Møller J, Christiansen A. Use of performance- and image-enhancing substances among recreational athletes: a quantitative analysis of inquiries submitted to the Danish anti-doping authorities. Scand J Med Sci Sports. 2010 Dec;20(6):861–7.PubMedCrossRef
51.
Jacka B, Peacock A, Degenhardt L, Bruno R, Clare P, Kemp R, et al. Trends in PIEDs use among male clients of needle-syringe programs in Queensland, Australia; 2007-2015. Int J Drug Policy. 2017 Aug;46:74–8.PubMedCrossRef
52.
Larance B, Degenhardt L, Copeland J, Dillon P. Injecting risk behaviour and related harm among men who use performance- and image-enhancing drugs. Drug Alcohol Rev. 2008 Nov;27(6):679–86.PubMedCrossRef
53.
Hope V, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergård A, et al. Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open. 2013 Sep;3(9):1.CrossRef
54.
van Beek I, Chronister KJK. Performance and image enhancing drug injectors’ access to needle syringe programs: responding to a public policy dilemma. Int J Drug Policy. 2015 Sep 1;26(9):868–74.PubMedCrossRef
55.
Zahnow R, McVeigh J, Ferris J, Winstock A. Adverse effects, health service engagement, and service satisfaction among anabolic androgenic steroid users. Contemp Drug Probl. 2017 Mar;44(1):69–83.CrossRef
56.
57.
Rowe R, Berger I, Yaseen B, Copeland J. Risk and blood-borne virus testing among men who inject image and performance enhancing drugs. Australia. Drug Alcohol Rev: Sydney; 2017 Feb 28.
58.
Cohen J, Collins R, Darkes J, Gwartney D. A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. J Int Soc Sports Nutr. 2007;4(1):12.PubMedPubMedCentralCrossRef
59.
Zahnow R, McVeigh J, Bates G, Hope V, Kean J, Campbell J, et al. Identifying a typology of men who use anabolic androgenic steroids (AAS). Int J Drug Policy. 2018 May 1;55:105–12.PubMedCrossRef
60.
Dunn M, McKay FH, Iversen J. Steroid users and the unique challenge they pose to needle and syringe program workers. Drug Alcohol Rev. 2014;33(1):71–7.PubMedCrossRef
61.
Jesson J, Matheson L, Lacey F. Doing your literature review: traditional and systematic techniques. London: SAGE; 2011.
62.
Galioto R, Crowther JH. The effects of exposure to slender and muscular images on male body dissatisfaction. Body Image. 2013;10(4):566–73.PubMedCrossRef
63.
Sylvia Z, King TK, Morse BJ. Virtual ideals: the effect of video game play on male body image. Comput Human Behav. 2014;37:183–8.CrossRef
64.
De Jesus AY, Ricciardelli LA, Frisén A, Smolak L, Yager Z, Fuller-Tyszkiewicz M, et al. Media internalization and conformity to traditional masculine norms in relation to body image concerns among men. Eat Behav. 2015;18:137–42.PubMedCrossRef
65.
Bardick A, Nixon G, Bernes K. More than meets the eye: weight lifting and steroid use in men. J Soc Work Pract Addict. 2008 Jun;8(2):208–27.CrossRef
66.
Daniel S, Bridges SK. The drive for muscularity in men: media influences and objectification theory. Body Image. 2010;7(1):32–8.PubMedCrossRef
67.
Taylor LD, Fortaleza J. media Violence and Male Body Image. Psychol Men Masc. 2016;(January).
68.
Bates G, Tod D, Leavey C, McVeigh J. An evidence-based socioecological framework to understand men’s use of anabolic androgenic steroids and inform interventions in this area. Drugs Educ Prev Policy. 2018 Jul;25:1–9.CrossRef
69.
70.
Guss CE, Williams DN, Reisner SL, Austin SB, Katz-Wise SL. Disordered weight management behaviors and non-prescription steroid use in Massachusetts transgender youth. J Adolesc Health. 2016;58(2):S102–3.CrossRef
71.
Onakomaiya M, Henderson L. Mad men, women and steroid cocktails: a review of the impact of sex and other factors on anabolic androgenic steroids effects on affective behaviors. Psychopharmacology. 2016;233:549–69.PubMedPubMedCentralCrossRef
72.
73.
Murray S, Griffiths S, Hazery L, Shen T, Wooldridge T, Mond J. Go big or go home: a thematic content analysis of pro-muscularity websites. Body Image. 2016 Mar;16:17–20.PubMedCrossRef
74.
Antonopoulos G, Hall A. ‘Gain with no pain’: anabolic-androgenic steroids trafficking in the UK. Eur J Criminol. 2016 Nov;13(6):696–713.CrossRef
75.
Andreasson J, Johansson T. Online doping. The new self-help culture of ethnopharmacology. Sport Soc. 2016 Sep;19:7–957.CrossRef
76.
Brennan R, Wells J, van Hout M-C. The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review. Health Soc Care Community. 2017 Sep;25(5):1459–531.PubMedCrossRef
77.
Petersson A, Bengtsson J, Voltaire-Carlsson A, Thiblin I. Substance abusers’ motives for using anabolic androgenic steroids. Drug Alcohol Depend. 2010;111(1–2):170–2.PubMedCrossRef
78.
Simmonds L, Coomber R. Injecting drug users: a stigmatised and stigmatising population. Int J Drug Policy. 2009 Mar;20(2):121–30.PubMedCrossRef
79.
Cole J, Smith R, Halford J, Wagstaff G. A preliminary investigation into the relationship between anabolic-androgenic steroid use and the symptoms of reverse anorexia in both current and ex-users. Psychopharmacology. 2003 Apr;166(4):424–9.PubMedCrossRef
80.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM 5. 5th ed. Washington, D.C.: APA; 2013.CrossRef
81.
Joubert H, Melluish S. Considering anabolic androgenic steroid use in relation to non-substance related diagnostic categories with special emphasis on eating disorders: a systematic review. J Subst Use. 2016 Apr;21(2):210.
82.
Ebbeck V, Lou WP, Concepcion RY, Cardinal BJ, Hammermeister J. Muscle dysmorphia symptoms and their relationships to self-concept and negative affect among college recreational exercisers. J Appl Sport Psychol. 2009;21(3):262–75.CrossRef
83.
Christiansen A, Vinther A, Liokaftos D. Outline of a typology of men’s use of anabolic androgenic steroids in fitness and strength training environments. Drugs Educ Prev policy. 2016;24:3(April):1–11.
84.
Rohman L. The relationship between anabolic androgenic steroids and muscle dysmorphia: a review. Eat Disord. 2009;17(3):187–99.PubMedCrossRef
85.
Mitchell L, Murray SB, Hoon M, Hackett D, Prvan T, O’Connor H. Correlates of muscle dysmorphia symptomatology in natural bodybuilders: distinguishing factors in the pursuit of hyper-muscularity. Body Image. 2017;22:1–5.PubMedCrossRef
86.
Leone J, Sedory E, Gray K. Recognition and treatment of muscle dysmorphia and related body image disorders. J Athl Train. 2005 Oct;40(4):352–9.PubMedPubMedCentral
Metadata
Title
Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access
Authors
Orlanda Harvey
Steve Keen
Margarete Parrish
Edwin van Teijlingen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7288-x

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

Examining income-related inequality in health literacy and health-information seeking among urban population in China

Research article

The psychosocial adaptation of patients with skin disease: a scoping review

Research article

A multi-component intervention to sit less and move more in a contact centre setting: a feasibility study

Research article

Overcrowding and health in two impoverished suburbs of Johannesburg, South Africa

Research article

Analyzing the value of an educational program for psoriasis patients: a prospective controlled pilot study

Research article

Physical activity around the clock: objectively measured activity patterns in young children of the GECKO Drenthe cohort