Medicines for Anabolic steroid misuse

What it is

Anabolic steroid misuse is the use of anabolic-androgenic steroids — synthetic drugs related to the male hormone testosterone — usually to build muscle, improve physique, or enhance athletic or physical performance, rather than for a legitimate medical reason. (Steroids are sometimes used medically under supervision for certain conditions; this is different from misuse.) Anabolic steroids are misused by some people who want to increase muscle size and strength or improve their appearance, and their non-medical use is associated with a range of potential harms to physical and mental health, which is an important point, as these harms are often underestimated. They are usually taken in doses much higher than would ever be used medically, sometimes in combination, and often obtained without medical supervision, which increases the risks. The potential harmful effects of anabolic steroid misuse are wide-ranging and can include: effects on the heart and circulation (such as high blood pressure, changes in cholesterol, and an increased risk of heart problems); liver problems; effects on hormones and fertility (such as reduced sperm production, shrinking of the testicles, and, in men, breast development — and in women, effects such as deepening of the voice, facial hair, and menstrual changes, some of which may be long-lasting); skin problems (such as acne); mood and mental health effects (such as mood swings, aggression, irritability, and, in some, depression, particularly when stopping); dependence (some people become dependent on them); and, if injected and equipment is shared, the risks of blood-borne infections. Some effects may improve on stopping, while others can be long-lasting. Because anabolic steroid misuse can cause significant harm, and because stopping can itself cause difficulties (such as low mood or hormonal effects), it is important that people who use them, or who want to stop, can access non-judgemental information, health checks, and support. The key messages are that anabolic steroid misuse can cause serious physical and mental health harms, that some effects may be long-lasting, and that support to reduce or stop, and to look after health, is available.

How it is treated

The approach to anabolic steroid misuse focuses on providing non-judgemental information and support, monitoring and protecting health, and helping people who wish to reduce or stop, while managing any harms. Because people who misuse anabolic steroids may be reluctant to seek help, a non-judgemental, supportive approach is important, and services such as GPs, sexual health or drug services, and specialist services can provide advice, health checks, and support. Key aspects include: health monitoring and assessment — checking for and managing the potential effects on the heart and circulation (such as blood pressure and cholesterol), the liver, hormones and fertility, mental health, and other areas, and providing relevant tests and advice; harm reduction — for those who inject, advice on safer practices and not sharing equipment (to reduce the risk of blood-borne infections), and access to relevant services (some drug services provide needle and syringe programmes and advice); and support to reduce or stop, for those who wish to — this may include information about what to expect, support for the effects of stopping (which can include low mood, fatigue, and hormonal effects, as the body’s own hormone production can be suppressed and takes time to recover), and psychological and other support, including for any dependence. Managing specific problems — such as treating high blood pressure, addressing mental health effects (such as depression, which needs support and treatment), or managing effects on fertility or other areas — is part of care, sometimes with specialist input. Because some effects may improve on stopping while others can be long-lasting, and because stopping can itself be difficult, support through the process helps. It is also worth being aware of the mental health aspects, including that concerns about body image can drive steroid use, and support for these can help. The reassuring messages are that support is available and non-judgemental, that health can be monitored and harms managed, that people who wish to stop can be supported (including through the effects of stopping), and that seeking help protects health — so anyone using anabolic steroids, or wanting to stop, is encouraged to seek advice and support.