A rise in the use of performance and image enhancing drugs by older men trying to fight the effects of ageing has prompted the release of a practical and potentially life-saving guide for GPs.
Lead author Dr Katinka van de Ven, a Senior Lecturer at the University of New England’s Centre for Rural Criminology, says young men (aged 20-24) and those over 40 are most likely to use non-prescribed anabolic-androgenic steroids, the most common performance and image enhancing drug (PIED), and to present at a GP clinic.
She hopes the evidence-based guide will help GPs to identify those using steroids and to promote effective and non-judgemental treatment.
“Population studies show that the prevalence of steroid use for non-medical reasons is relatively low but steadily increasing,” says Dr van de Ven.
“Australian Needle Syringe Program national data revealed a significant increase in PIED use from 1% in 1995 to 10% in 2019 as the ‘last drug injected’ in NSW. The 2017 Australian Secondary Students’ Alcohol and Drug Survey also reported that 2% of secondary school students had used steroids or other enhancement drugs in their lifetime.”
One or a combination of injectable or oral steroids are commonly combined to enhance a person’s appearance and improve their physical strength and endurance. But steroid use can also increase a person’s risk of cardiovascular disease, cognitive deficiencies, infertility, and psychological issues associated with body image disorders. Black market products, of varying strength and purity, pose additional threats, including injection-related infections.
“There are still a lot of unknowns for this drug-using group but we have relied upon the best available evidence to dispel some of the myths. You certainly cannot necessarily always tell from a person’s body that they are using steroids,” said Dr van de Ven.
“The media would have us believe that it is only young body-builder types who are interested in using these drugs, in order to achieve a muscular body. But we are also seeing a growing number of older men using steroids for anti-ageing purposes, to boost their energy levels and sex drive. Occupational users also use PIEDs for strength-related reasons.
“Whatever the reason, this is a group that is often afraid to disclose their steroid use. Some people fear being reported to the police and others fear being rejected by their GP.”
Developed in close collaboration with GPs, other health professionals and people who use non-prescribed steroids, the PIED guide is a valuable national and international resource.
Dr van de Ven says she hopes that one recommendation in particular – that GP practices add a question on substance use to their standard patient information forms, along with routine questions on alcohol and other drug use – will encourage people who use these substances to disclose more, in the interests of their health.
While steroid use is a criminal offence, GPs are not obliged to report it unless the use is putting the patient’s life at risk.
“Having a more complete picture enables the GP to consider everything that might impact a person’s health and to warn patients about the long-term consequences of steroid use,” she says.
Previous research Dr van de Ven conducted on the quality of steroids manufactured and distributed in Australia found that only 16% of the 43 black market products she tested contained what the label purported.
“Quality can vary widely and those using these products cannot be sure of what they are getting,” she said.
The main aim of the guide, funded by the Sydney North Health Network, is to create awareness among GPs, to improve their knowledge on these substances, and to arm them with valuable information on harm reduction, assessment and management.
“GPs were reporting that they had very little understanding of this patient group, their specific needs and how to engage with them,” Dr van de Ven says.
“People using non-prescribed steroids often chose not to disclose their use, which puts them at risk.
“Steroid use is not a uniform problem and appears greater in certain urban areas but we believe targeted education will enable this drug-using group to get the medical support they need. We also hope to remove some of the stigma that surrounds steroid use, largely due to the history of doping in professional sports.”
The guide is available at https://www.snhn.net/steroid-harm-minimisation
