A Holistic Multi-Disciplinary Healthcare Pathway for Older Men who use Anabolic Androgenic Steroids

Research suggests that the majority of people who use anabolic androgenic steroids (PWU AAS) are young males, non-athlete recreational exercisers within the general population whose motivations to use are to increase strength, muscle mass, aesthetic enhancement, and wellbeing. Research over the past decade has increased our knowledge of the long-term harms of AAS. Of concern is the long-term morbidity and mortality resulting from damage to the liver, cardiovascular health, secondary hypogonadism, and cognitive decline associated with dependency. Needle and syringe program data in the UK has indicated an increase in the numbers of men aged 40 or older who use AAS accessing  services. Furthermore UK survey data report that age of initiation to AAS use is now higher than previously with reports of men in the 40-54 year age-group initiating use. These men may be at age-related increased risk for cardiovascular health problems, low testosterone, and, if combined with a history of AAS use, may be at an even higher risk for cardiovascular problems and hypogonadism. This research aimed to address this significant gap in research to provide insight into older men who use AAS (OMAAS) thus addressing a major gap in public health research and developing the literature base. 

A mixed-methodology comprising a scoping review, interviews with healthcare professionals, interviews with OMAAS, and a cross-sectional survey of OMAAS were conducted. The research aimed to explore OMAAS’ motivations, patterns and trends of use, experienced harms, healthcare experiences, and any difference between new and long-term users.

The findings have underscored the urgent need for improved healthcare services for OMAAS such as availability of AAS-specific healthcare provision at harm reduction services (NSPs, drug services), rapid access and referral pathways for medical services, and a multi-disciplinary healthcare response to OMAAS who wish to: reduce/minimise harm whilst continuing to use; get support for cessation attempts, withdrawal, and prolonged abstinence; and accessible medical care to address harms from long-term use.

A holistic multi-disciplinary healthcare pathway to support the needs of OMAAS in the UK has been developed. The model is based on the findings of this doctoral research from the perspectives of healthcare professionals and OMAAS. Scenario 1 outlines current healthcare responses as experienced by OMAAS and scenario 2 outlines the ideal healthcare pathway based on the HCPs recommendations for their own professional needs and the needs of OMAAS, and the experience and perceived needs of the OMAAS themselves. The model supports harm reduction for The multi-disciplinary team to support OMAAS includes general practitioners, harm reduction services, endocrinologists, and mental health and psychosocial services.

The research contributed to knowledge and addressed gaps in research pertaining to the use of AAS by older men in the UK from a public heath perspective.