GP guide to anabolic steroid use: recognising non-prescribed AAS and practising harm reduction

Terminology — non-prescribed anabolic-androgenic steroids

In the community people say “anabolic steroids.” In scientific literature the preferred term is anabolic-androgenic steroids (AAS) — to keep the androgenic effects visible — and non-prescribed, to distinguish community use from medically prescribed testosterone.

Chemists modify the testosterone molecule to shift activity toward more anabolic (or androgenic) effects. Common agents mentioned included testosterone itself, plus community names such as trenbolone (“tren”), boldenone, nandrolone, and stanozolol (no longer available medically in Australia). The list is illustrative, not exhaustive.

The talk’s aim for GPs: recognise the issue, feel comfortable talking about it, and have enough knowledge to address associated harms using a harm-reduction approach — not to invent new prescribing protocols for non-prescribed AAS.

Performance and image-enhancing drugs (PIEDs)

AAS traditionally make up roughly 80–90% of PIEDs people use, though peptide use is shifting that balance (a separate Healthed talk covered peptides). Related practices include:

• Post-cycle therapy (PCT) — drugs taken to try to overcome or prevent AAS side effects; often taken prophylactically despite limited evidence that this works as intended.
• Injection — usually intramuscular; some use subcutaneous (unpredictable without trial data). Multi-dose vials (10–20 doses) are common; frequent “microdosing” (e.g. testosterone enanthate every second day instead of every 2–3 weeks medically) raises infection risk.
• Oral AAS — all oral anabolic steroids are hepatotoxic, regardless of marketing claims that a “new” agent is safer.
• Stacking — multiple AAS plus, increasingly, peptides.
• Cycles — classic “three months on, three months off”; blast and cruise (high doses then supposed physiological testosterone — often still high); and continuous use without breaks.

Why people use AAS

• Performance in social (not elite drug-tested) sport — e.g. keeping up with younger gym peers in one’s 50s.
• Training recovery (muscle / ligament) and muscle gain for image or bodybuilding.
• Social media–driven muscular aesthetic.
• Non–drug-tested strength sports (e.g. some powerlifting).
• Anti-ageing / wellness / energy — overlapping with grey-area clinic prescribing.

They continue because, for many users, the substances work for their goals — which is why “just stop” alone is a weak clinical opener.

Why GPs should care — school and population estimates

The Australian Secondary Schools Alcohol and Drug survey (large samples of 12–17-year-olds, ~10–20,000 per wave) asks about performance-enhancing drugs defined as anabolic steroids. Across recent waves (~2014, 2017, 2022/23) about 2.3% reported ever use and about 1% past-month use — consistently under-discussed because the percentage looks small, yet that maps to an estimate of over 37,000 secondary students. Earlier reports suggested girls were as likely as boys; recent public extracts may not split sex.

The speaker’s rough population estimate: on the order of ~300,000 Australians using AAS — a large group GPs should be seeing, yet often do not disclose to.

Stigma, criminalisation, and how to ask

Barriers to disclosure include self-stigma, peer stigma (“cheating”), perceived GP ignorance or “stop or leave” responses, family secrecy, and — in Queensland and NSW — criminalisation of possession, which heightens fear even though disclosure is not a reportable event for GPs in this framing.

Who uses them — not only “bodybuilders”

• Mostly male, not exclusively — women present too (including requests for heavy agents such as trenbolone).
• Age span from secondary-school ages through to 70+; motives shift with life stage.
• PUSH study (2023) — observational study across nine Australian GP clinics of people using AAS: average BMI was 28, matching Australian male BMI. Do not wait for an obvious bodybuilder phenotype; many look like average gym-goers, and larger physiques may be hidden by clothing.

Cardiovascular harms GPs can act on

Potential harms can be reduced with monitoring and advice. Cardiovascular themes from the talk and PUSH:

Online culture teaches dosing and cycles; GPs can instead teach side effects and monitoring — which itself can shift risk perception.

Hormonal suppression, fertility, and liver

Endogenous testosterone

AAS suppress endogenous testosterone; recovery can be long-lasting or permanent — highly variable (some recover after 15–20 years of use; others struggle after ~12 months). Baseline testosterone is often unknown.

Fertility counselling

Fertility may be affected long-term. For younger patients who may want children later, discuss risk and consider sperm storage — many have never thought of it. Complex recovery / hormonal regulation: speaker prefers endocrinology referral and shared care rather than GPs prescribing hormone regulators or testosterone alone without support.

Liver

All oral AAS are hepatotoxic; some injectables can be too. Oral agents often drive marked LFT rises that improve with cessation — an objective “harm you can see” that sometimes motivates stopping. Ultrasound and broader work-up still matter (alcohol remains a major LFT driver in Australia).

Mental health — beyond “roid rage”

“Roid rage” is less common than popular culture suggests, and causality may mix AAS, lifestyle, and other substances. More useful framing:

• Pre-existing depression, body dysmorphia, eating disorders.
• On-cycle anxiety, depression, agitation, mania-spectrum symptoms (more relevant than classic rage).
• Recovery — low energy from hypogonadism, insomnia, craving, depression.

PUSH analysis (co-author): people with anxiety/depression were less likely to change behaviour; those told of an adverse outcome were more likely to change — objective harm feedback matters. Offer mental-health support across contemplation, active use, and recovery; psychology may be needed over time. Evidence base in this niche remains thin.

Anabolic steroid use in women

Additional masculinising effects: loss of breast tissue, voice deepening (often noticeable), menstrual disturbance, infertility concerns. Women may request potent agents; fertility and AAS goals can conflict — specialist endocrinology input was used in one case described.

GP engagement changes outcomes (PUSH questionnaires)

Among GPs surveyed about enrolled PUSH patients:

• 77% reported benefit from engaging
• 65% better monitoring / treatment
• 47% reduction in use
• 12% cessation from GP engagement alone

Monitoring and discussing downsides — counterweight to online “how to dose” content — can modify behaviour even without prescribing AAS.

Key points and practice tips

1. Significant prevalence — including teenagers — often not volunteered; ask.
2. GPs can encourage disclosure, discuss and monitor harms across CV, liver, hormones, fertility, and mental health.
3. Harm reduction can still change behaviour (PUSH).

Clinic tips from the stage

• Ask about supplements in anyone going to the gym — they need not look like bodybuilders.
• Set monitoring follow-ups (e.g. ~6 months) for agreed measures.
• Discuss short- and long-term side effects explicitly.
• Standard tests: LFTs, U&Es, etc. Hormone panels while on-cycle are often unhelpful (levels expected sky-high); more relevant in recovery.
• Explore mental health beyond stereotypes of rage.

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