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To the Editor: We report the findings of a study of 100 current
anabolic-androgenic steroid (AAS) users in New South Wales which
aimed to explore the patterns and correlates of AAS use (motivations
for use, ways of identifying harms, and knowledge, attitudes and
behaviours concerning harm reduction strategies, as well as
appropriate public health strategies). We recruited the sample
through media and gymnasia advertising and conducted interviews in
1996-1997. Thirty-eight subjects were from inner-city areas, 50
from suburban metropolitan areas and 12 from non-metropolitan
areas.
Our AAS users were different from other Australian samples of
injecting drug users.1 They were more likely to be
men (94), homosexual (27), in a stable relationship (37 were married
or in a de-facto relationship; of the 85 non-married subjects, 55 were
in a relationship that had lasted a mean of 22.5 months), well educated
(68 post-secondary school), and employed (86). Their median age was
27 years (range, 18-50) and they had been using AASs for a
median of four years (range, 1 month - 21 years). General
practitioners (GPs) were the reported source of AASs for 42 subjects
and, for 21, their usual supply source. Fifty-four were being
monitored (32 by a GP, 2 by a medical student, and the rest by a friend,
trainer or partner). The most common source of education on injection
technique was a GP (30).
In common with other illicit drug users, AAS users experienced
negative health and psychological effects; those most commonly
self-reported included fluid retention (64), painful injection
sites (57), acne (54), and hypertension (18). Men reported
testicular atrophy (52/94) and gynaecomastia (32/94), and all of the
women reported clitoral hypertrophy and voice changes (which are
irreversible2), and four of the six women
reported menstrual irregularities. Nearly half of the sample (42)
reported more aggressive behaviour when using AASs. Thirteen met
DSM-IV3 criteria for dependence on
AASs, including symptoms of tolerance and withdrawal, and a further
24 met criteria for AAS abuse.
Subjects reported that health concerns were the most likely
deterrent to AAS use.
Several potentially harmful activities engaged in included
self-taught injection procedures, injecting specific muscle
groups for localised growth (calves, biceps), concurrent use of
several AASs ("stacking"), use of high doses and/or long cycles, and
use of other drugs such as clenbuterol, diuretics, thyroxine,
insulin, and human growth hormone.
AAS users actively seek out information relevant to their AAS use.
Friends (63), non-medical handbooks (60) and fitness magazines (53)
are the most common sources, making the quality of the information
highly questionable. Almost three-quarters (73) of the sample
claimed that their preferred AAS information source would be their
family medical practitioner (provided she or he were well informed
and approachable), giving scope for improving the harm reduction
information available to this eager group by educating medical
practitioners. Medical education could highlight the legal and
ethical obligations of medical practitioners as well as provide harm
reduction information to pass on to their patients.
Jan Copeland
Lecturer Richard Peters
Research Assistant Paul Dillon
Information Officer
National
Drug and Alcohol Research Centre,
University of New South Wales,
Sydney, NSW 2052
- Darke S, Ross J, Hall W. Overdose among heroin users in Sydney,
Australia. 1. Prevalence and correlates of non-fatal overdose.
Addict 1994; 91: 405-411.
-
Bierly JR. Use of anabolic steroids by athletes: do the risks
outweigh the benefits? Postgrad Med 1987; 82: 67-74.
-
American Psychiatric Association. Diagnostic and statistical
manual of mental disorders, 4th edition. Washington, DC: American
Psychiatric Association, 1994.
©MJA 1999
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