New guide to help GPs manage patients who use steroids

Doug Hendrie

15/02/2021 3:36:50 PM

Users of steroids don’t often reveal that fact to their GP – but it’s vital they feel comfortable to do so, according to an expert.

Thin man lifting weights
‘The majority of [steroid] users aren’t that large. They just look like fit gym-goers, and that’s why they’re often missed,’ according to expert Dr Beng Eu.

‘Surveys have shown lots of GPs don’t feel comfortable managing these patients. They aren’t really sure what to do when they are presented with them. We want to make GPs more comfortable.’
Dr Beng Eu is talking about people who use performance and image enhancing drugs (PIEDs), with the use of non-prescribed anabolic-androgenic steroids most common, followed by hormones.
Dr Eu has been involved in producing a new guide for GPs on issues that may arise in patients who use these drugs.
These patients tend not to reveal their use, meaning GPs may be uncertain of how to approach these issues when they arise.
The guide is aimed at giving GPs confidence in identifying, assessing and managing them these patients, as well as knowing which investigations to perform. Harm reduction framing enables GPs to work with patients who are not yet ready to stop using steroids or other PIEDs.
‘There are things GPs can do to engage patients, minimising harm and actively manage their health, starting an ongoing conversation they can come back for,’ Dr Eu told newsGP.
The guide lists red flags of which to be aware, such as post-use hypoandrogenism [testosterone deficiency], as well as comorbidities like cardiovascular disease and hypertension.
People under the age of 21 have a higher risk of ‘irreversible complications even with short term use’, the guide states. Steroid use by young people ‘should be strongly discouraged’ due to the high risk of potentially lifelong complications such as stunting of growth, early physical maturation or joint and bone pain.

Dr Beng Eu wants to make it easier for GPs to help users of steroids and other performance and image enhancing drugs.

For Dr Eu, the issue is personal. He regularly sees these patients in his practice.
‘I’ve looked after these patients for a long time, but this population is often hidden from our view,’ he said.
‘Steroids come with lots of stigma and people generally won’t disclose their use, including to their GP, until we actively talk about it. But we are all worried about potential side effects of steroid use.
‘People often use steroids for a fixed period, but it could be one month or 10 years. So we have to keep them safe in the period they might be using it.’
Dr Eu said inner-city GPs might be more likely to see people who use anabolic steroids or even human growth hormones, but that the issue was not exclusive to urban areas.
He has found a non-judgmental approach framed around monitoring health to be effective.
‘People will have heard of side effects, so there are opportunities to engage there,’ Dr Eu said.
‘Don’t expect a huge bodybuilder to walk into the room and ask about their steroid use. The majority of users aren’t that large. They just look like fit gym-goers, and that’s why they’re often missed.
‘It’s often young guys who want the gains they haven’t got from their workouts, or they may be in their 40s and they want to regain the strength they feel they don’t have anymore.’
Dr Eu has a patient in his 50s who regularly comes in for monitoring of any emerging side effects from steroid use.
‘His PSA levels were high and I eventually diagnosed prostate cancer – that wouldn’t have been picked up without active monitoring,’ he said. ‘Steroids are high risk for prostate cancer, as they can stimulate [tumour] growth.’
For younger people who use PIEDs, higher haemoglobin counts can also signal the risk of dangerous heart conditions.
‘You won’t know unless you’re monitoring and testing,’ Dr Eu said.
The upside is that feeding information about emerging risks back to patients can lead them to modify their use.
Up to 150,000 Australians use steroids regularly or occasionally, according to Dr Eu. Seizures of anabolic steroids and other PIEDs at the border have increased 72% between 2009 and 2019, according to a 2020 report by the Australian Criminal Intelligence Commission.
PIED expert and University of New England senior lecturer Dr Katinka van de Ven oversaw the guide’s production, which was funded by the Sydney North Health Network.
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