Exploring treatment aspects of men with longterm anabolic-androgenic steroid use: A dual perspective on health service engagement and the safety and feasibility of endocrine therapy for anabolic-androgenic steroid induced hypogonadism
Sammendrag
The use of anabolic-androgenic steroids (AAS) leads to several adverse health effects, including cardiovascular disease and a dysregulation of the hypothalamic-pituitary-gonadal (HPG) axis. The subsequent decrease in endogenous testosterone production following AAS cessation, termed AAS-induced hypogonadism (ASIH), manifests as symptoms that include fatigue, depression, anxiety and sexual dysfunction. Despite experiencing ASIH or other side effects from use, individuals using AAS often exhibit reluctance to seek treatment. Reluctance to seek health services is largely attributed to the absence of treatment guidelines and clinicians' lack of confidence in addressing ASIH. This thesis aims to enhance treatment knowledge for people with AAS use by a two-fold approach: First, by examining the association between health service engagement and AAS-related health issues, and second, by assessing an off-label hormone intervention with clomiphene citrate and optional human chorionic gonadotropin for AAS-dependent men struggling with ASIH, aiming to discontinue long-term AAS use. Findings revealed that those seeking healthcare experienced more AAS-related side effects, although most had never sought treatment despite having established cardiovascular disease. Barriers to seeking treatment or participation in intervention studies included neglecting the severity of side effects, fear of legal consequences, and dissatisfaction with Norwegian public healthcare. The hormone intervention appeared safe, showing a generally positive response in the HPG axis. However, only half of the participants achieved physiological testosterone levels, which did not correlate with withdrawal symptom severity. The study highlights the complex nature of AAS dependence and the varied treatment needs in this population. It may guide future randomized clinical trials, ultimately leading to the development of new treatment guidelines for people with AAS use.Artikkelliste
Paper I: Henriksen HCB, Havnes IA, Jørstad ML & Bjørnebekk A (2023). Health service engagement, side effects and concerns among men with anabolic-androgenic steroid use: a cross-sectional Norwegian study. Subst Abuse Treat Prev Policy 18, 19. doi: 10.1186/s13011-023-00528-z. The article is included in the thesis. Also available at: https://doi.org/10.1186/s13011-023-00528-z |
Paper II: Henriksen HCB, Havnes IA, Jørstad ML, Abdullah R, Thorsby PM, Hauger LE, Edvardsen T, Haugaa KH, Almaas VM & Bjørnebekk A (2024). Treatment-seeking behavior and cardiovascular morbidity among men with anabolic-androgenic steroid use: A cross-sectional study. Scand J Med Sci Sports 34: e14554. doi:10.1111/sms.14554. The article is included in the thesis. Also available at: https://doi.org/10.1111/sms.14554 |
Paper III: Havnes IA, Henriksen HCB, Jørstad ML, Johansen PW, Bjørnebekk A, Neupane SP, Hisdal J, Seljeflot I, Wisløff C, Jørstad ML, McVeigh J & Jørgensen AP (2024). Off-label use of clomiphene citrate to treat anabolic androgenic steroid induced hypogonadism upon cessation among men (CloTASH) – A pilot study protocol. MethodsX 13: 102810. doi: 10.1016/j.mex.2024.102810. The submitted version is included in the thesis. The published version is available at: https://doi.org/10.1016/j.mex.2024.102810 |
Paper IV: Henriksen HCB, Jørgensen AP, Wisløff C & Havnes IA (2023). Challenges recruiting men with a desire to cease anabolic-androgenic steroid use to a pilot involving hormone therapy intervention. Drugs: Education, Prevention and Policy, 1–13. doi: 10.1080/09687637.2023.2244655. The manuscripts is included in the thesis. The published version is available at: https://doi.org/10.1080/09687637.2023.2244655 |
Paper V: Henriksen HCB, Jørgensen AP, Bjørnebekk A, Neupane SP, & Havnes IA (2024). Clomiphene citrate and optional human chorionic gonadotropin for treating male hypogonadism arising from long-term anabolic-androgenic steroid use—A pilot study. Performance Enhancement & Health, 100283. doi: 10.1016/j.peh.2024.100283. The article is included in the thesis. Also available at: https://doi.org/10.1016/j.peh.2024.100283 |