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

Abstract

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.