Roid Rage

When is a ‘supplement’ or a ‘protein shake’ a bit more than that? Taking androgenic anabolic steroids (AAS) used to be thought of as limited to the realm of elite athletes. However, it is becoming clear that AAS use is a much bigger problem than that now, and one, whether knowingly or not, we will be seeing in routine General Practice. Whether through the normalisation of performance-enhancing drug use for athletic performance in the ‘’Enhanced Games', the rise of ‘bodyrexia’, or other factors, anabolic steroid use has well and truly seeped into the mainstream. 

An excellent BJGP review (BJGP 2024; 74 (741)) has highlighted that this is a common problem that will rarely present with patients independently disclosing AAS use, and may present in a number of ways from erectile dysfunction to subfertility or hypogonadism. We don’t really know what the prevalence of AAS use is, as most of it is undisclosed, but it is estimated that 1-5% of the population take anabolic steroids, and the vast majority of users are men.

One of the real learning points for me when reading around this topic is that the assumption we can simply ‘spot’ a steroid user by their body shape is obsolete. Most anabolic steroid users do not have the ‘typical’ body builders shape with disproportionate upper torso development. Instead we will see them when they present with complications from the steroid use. Common sequelae of AAS use include sexual dysfunction, infertility, hypogonadism as well as aggression, mood swings and irritability - also known as ‘Roid Rage’. I’d never even thought to consider anabolic steroid use as a potential trigger for aggression and irritability, but maybe I should now. 

Many AAS users see their steroid use in a positive health-promoting context, and are often reluctant to disclose use, with the BJGP authors noting there is often ‘resilience in disclosing the relevant information during GP consultations’. There is no diagnostic test for AAS use, we just need to ask the question, in a non-judgemental fashion, as engaging the patient will be key to any positive outcome.

Whilst some blood testing is indicated to assess for complications of anabolic steroid use, regular health checks are not recommended as absence of abnormalities can be used as false reassurance and fuel ongoing AAS use.

Most, but not all, AAS complications will resolve on cessation, but convincing patients to stop their steroid use can be challenging, especially if they see use in a health positive rather than health negative way. Associated substance misuse and mental health difficulties are common, and need to addressed to improve the chances of AAS cessation.

‘Do you take any supplements? Tell me a bit more about them, and why you take them’. Not a question I’ve asked in the context of erectile dysfunction or male infertility, but one we should all think about more now, as it may lead to some interesting and highly relevant information. 

We’re just putting the finishing touches on our updated Men’s Health Course. So for more detail on how to assess and manage men using anabolic steroids, and a host of other Men’s Health problems, come and join us on Friday 18th September for our updated Men’s Health Live Webinar!