Treating steroid users in general practice – A harm minimisation approach

Amanda Lyons

11/07/2018 2:22:52 PM

Illicit steroid use may be more widespread among patients than GPs realise, and Dr Beng Eu believes harm minimisation is the best approach for practitioners to take.

Dr Beng Eu believes it is better for steroid users to have access to independent medical advice if they are going to use the drugs.
Dr Beng Eu believes it is better for steroid users to have access to independent medical advice if they are going to use the drugs.

Social expectations of the male body have been changing over time – we need look no further for evidence than the increasing size and chiselled abs of superheroes who surround us everywhere, on TV, in the movies, on posters and even in toy shops.
These social shifts have led to an increase in the numbers of men feeling self-conscious about their bodies – and a concomitant rise in the illicit use of anabolic steroids in order to gain what is perceived as the perfect male physique.
‘There is a lot of pressure in the media about men being big and muscular, so that really feeds into that image consciousness,’ Dr Beng Eu, a GP with a special interest in treating patients who use steroids, told newsGP.
However, Dr Eu has found that many of the steroid users he treats do not necessarily conform to the popular ‘roid-rage’ body-builder stereotype.
‘Almost all the people referred to me who use steroids are not people you would pick as using steroids; they’re not that large, they just look fit and muscular,’ he said.
He has also found that people who use steroids can have a range of reasons for doing so.
‘It’s not always about body-building or power sports,’ Dr Eu said. ‘Sometimes it’s about men in their 40s wanting to have the same energy as in their 30s. Sometimes it’s just about getting better gains out of their workout. Some people, if their work involves security type of work, such as being a bouncer, feel better if they carry a bit more weight.
‘So there are lots of other reasons that don’t fit into the obvious categories of body-building or sports.’
One thing that Dr Eu has found many of these patients have in common, however, is the way they are affected by the stigma that comes with their steroid use.
‘The studies show that almost all the people who use anabolic steroids do it off their own bat and don’t access any healthcare because they think doctors are very negative against their steroid use,’ he said.
While Dr Eu would never prescribe or encourage a patient to use steroids, he advocates that GPs take a harm minimisation approach to patients who are already using them.
‘Harm minimisation, for me, is about informing patients about potential harm of their steroid use,’ he said. ‘Talk to them about how they use and make sure that if they are going to, they use it in a safer way.
‘It’s also about health monitoring, blood tests, blood pressure tests, all those sorts of things, to see if the steroids have a negative impact; at least then we can talk about those side effects and discuss whether it is the steroids causing them.’
Potential side-effects of steroids cover a range of impacts, from mild to extremely serious.
‘Right from the start, there can be a risk if they don’t know where the steroids are coming from; they can be contaminated with heavy metals or bacterial contamination, so you can get infections or poisoning from that,’ Dr Eu explained.
‘If people are injecting, they need to make sure they’ve got clean needles and equipment, otherwise they can risk infections.
‘The steroids themselves can cause depression, especially if you’re coming off them, or infertility. There are also milder changes like testicular shrinkage and acne.
‘[Steroid users] can also get a really high haemoglobin level because it stimulates the production of haemoglobin to a level that can be dangerous and cause heart attacks. You can get high cholesterol, high blood pressure.
‘So there’s lots of potential side-effects, and it’s important to try and identify the people who will get them.’
Mental health issues to be aware of among steroid users include not just those that may be caused by the drugs themselves, but the fact that some patients may have been motivated by body dysmorphia to use the drugs in the first place.
‘A lot of people who want to look larger have no real perception of their size, they will always see themselves as being small regardless of how much muscle they carry,’ Dr Eu said. ‘So that’s certainly one of the things we should be on the lookout for if patients are referred to us for steroid use.’
Dr Eu believes that independent advice from GPs can prevent patients who use steroids from being out on their own without professional healthcare.
‘The only way people usually access medical information about [steroids] is online, through forums where they’re talking about how to access the steroids, what to use, how to use them,’ he said. ‘So there’s no health message about potential harms coming across.
‘The other place people get information from is from those who sell steroids, and they have a vested interest and are probably going to give advice according to what they have in supply.’
Dr Eu is currently working with colleagues to create education for other GPs about how to approach and treat patients who use steroids. He has no doubt such education is important, as he believes steroid use is more widespread than people may think – even among his own patient population.
‘Though I’m identified as someone who looks after steroid users, there are a lot of my regular patients who, unless something specific comes up, don’t admit to it,’ he said.
‘People are still generally very embarrassed. So I’m sure that lots of GPs see people who are using anabolic steroids, but not admitting to it.’

body-image harm-minimisation illicit-drugs Steroids

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Dr Lance Holland-Keen   13/07/2018 7:17:32 AM

100% agree.

Dr Peter J Strickland. FRACGP   13/07/2018 10:38:09 AM

The major problem in general practice is not illicit anabolic steroid use, but rather being able to treat males with a known testosterone deficiency both clinically and biochemically without having to send the patients to specialists to confirm the findings. There is absolute bias here in the PBS availability of testosterone for males compared to treating oestrogen and progesterone deficiency for females, and really a form of discrimination against GPs and their male patients.

Iain Anderson   17/07/2018 10:53:21 AM

What are the best resources for us to help anabolic steroid users?

Beng Eu   30/07/2018 2:10:36 PM

Thanks for your query, Iain.
I use this - file:///C:/Users/paul.hayes/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/
9TFKBO1S/NDARC.%20PIEDS.pdf - as a source document. It has useful knowledge to guide doctors.
There are not specific resources for GPs, but we are working on some education and
eventually some simple tools for GPs to use. Hopefully, we might have a draft document by the
end of this year if not sooner.
Thank you.

Dr Matthew A Stark. FRACGP FSEM MRCP   7/08/2018 6:45:13 AM

Peter I think that is a very valid point which should be taken further

Gymrat   21/10/2018 10:45:35 AM

I have spoken with people who use steroids and resemble the patients the author describes. A common fear is that any admission of use to a doctor becomes part of the patient's medical records. That this will become accessible to insurance companies and come back to eventually haunt the patient is part of that fear. Absent a patient admission, there can be certain markers in blood work that will tell the story anyway. There may be a good deal more resistance to an honest doctor-patient relationship than even the well-intended author realizes.

JD   14/02/2019 12:30:28 AM

How would you recommend a user of AAS go about finding a doctor? I'm so sick of getting judged from my wellness doctor that I'm still using them. I love bodybuilding and wont stop using AAS until I'm done, so whys it so difficult to at least get someone to help me do them as safe as possible?

Replying to JD   14/10/2020 1:42:07 AM

Agreed with JD. Let me know if you get an answer   18/03/2021 4:00:09 AM

I satisfied with your post.   27/03/2021 7:50:36 PM

Thanks for sharing practical information.

Steve   5/07/2021 1:01:30 PM

I took anabolic steroids for decades and never sought medical advice. I don’t regret it at all, it was always a great feeling, but I know that it has most definitely caused me medical issues, and high blood pressure. I no longer take them but would have preferred to see a Dr who didn’t judge me and instead, help me. I started to use them because I have an infliction called Pectus carinatum. My right side chest bone protrudes so I used them to build muscle on my pecs and upper body to disguise the infliction that depressed me every single day. The AAS gave me a way out from the torment of Pectus carinatum and helped me feel more secure and positive about my physique and appearance. I never did it to be huge in muscularity, just enough to avoid the stares and explanations. It gave me some level of normality. If I could have got help or an operation, I would have stopped taking AAS years ago. But, it wasnt to be, so I carried on.

Calvin   10/10/2021 11:36:51 AM

Been to 3 different doctors in Townsville, none of which wanted to work with me on my steroid use. All pretty much said they could do nothing unless I stopped. I’m going to keep on looking but it’s embarrassing and makes you not want to seek medical help.
I know I’m doing it to myself but I still want to have my bloods checked, stay as health as I can in general and have a doctor that I can go to for anything without being stressed or embarrassed.