(88) Harm Reduction among Cisgender Gay and Bisexual Men using Anabolic Androgenic Steroids

Background & Introduction: Anabolic androgenic steroids (AAS) are synthetic versions of testosterone and are among the most commonly used performance enhancing drugs in the United States. Gay, bisexual, and queer (GBQ) men disproportionately use non-prescribed AAS for recreational purposes, and are thus at an increased risk of AAS-related complications including coronary artery disease, stroke, and infection. This study investigated the negative effects experienced by individuals using AAS, and harm reduction methods utilized by the GBQ community to reduce those risks.

Methods: We conducted a mixed methods study using self-administered questionnaires and semi-structured interviews among self-identifying adult GBQ men with a history of AAS use for a minimum of 8 consecutive weeks. Participants were recruited through convenience and snowball sampling from LGBTQ clinical centers in NYC as well as online platforms, and completed a demographics questionnaire and screening for muscle dysmorphia prior to an interview using concept elicitation questioning. Interviews were transcribed and coded for content using reflexive thematic analysis.

Results: Thematic saturation was reached after twelve interviews, with most participants identifying as White non-Hispanic, highly educated, and having used AAS for a mean of 7.5 years. Seven men (58%) met criteria for muscle dysmorphia on screening. All participants (12 of 12) reported actual harms that had occurred to them while using steroids, with the most commonly mentioned being hypertension, injection site cellulitis, tendon rupture, tendonitis, polycythemia, hyperlipidemia, acne, secondary hypogonadism, and emotional instability. Multiple harm reduction techniques were reported, including routine patient-directed lab work, donating blood, learning sterile injection techniques, hiring coaches, utilizing post-cycle therapy, and using additional non-prescribed medications to offset side effects.

Conclusion & Discussion: Despite many GBQ men experiencing harms from using anabolic androgenic steroids, community members have often developed harm reduction techniques in lieu of abstinence. Though many of these techniques embrace clinical reasoning and may be more broadly applicable, additional research is needed to understand the impact of each intervention on the overall health of individuals using AAS.

References: Harvey O, Parrish M, van Teijlingen E, Trenoweth S. Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs. Drugs Educ Prev Policy. 2020;27(5):377-386. doi:10.1080/09687637.2019.1705763

Bonnecaze AK, O’Connor T, Burns CA. Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review. J Gen Intern Med. Published online May 4, 2021. doi:10.1007/s11606-021-06751-3

Anawalt BD. Diagnosis and Management of Anabolic Androgenic Steroid Use. J Clin Endocrinol Metab. 2019;104(7):2490-2500. doi:10.1210/jc.2018-01882