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People who use anabolic steroids should receive similar treatment to drug addicts, a group of Australian doctors say, with concerns those who become hooked on the muscle-building injections are being left without support.

Melbourne GP Dr Beng Eu is one of three doctors presenting on the subject at an international medicine conference this month. He said the approach from state health departments was too limited, focusing on providing harm-minimisation strategies to users who actively seek it out, such as information about needle safety.

A group of doctors say anabolic steroid users require better health support.

“We need to realise that for some people steroid use can become a bit of an addiction: it is hard to come off because of its addictive qualities, psychologically but also physically,” he said.

“These people are used to a level of testosterone in their system, and if you remove it, they feel tired, lethargic, depressed; their hormones will be very, very low and some will take six months to recover.”

Eu has been working with psychologist Dr Marcus Squirrell and endocrinologist Dr Kevin Lee to provide a novel addiction medicine-informed treatment for anabolic steroid users in Melbourne. The group will present their experiences trialling the approach at the International Medicine in Addiction Conference, being held in Melbourne later this month.

Anabolic steroids are an injectable testosterone derivative, prescribed by doctors to treat medical conditions such as hormonal imbalance or weight loss following illness or injury.

However, they are illegally used by people seeking to increase muscle mass, with a significant market among fitness-focused men despite jail terms for unauthorised importation, possession and use.

In 2019, the Therapeutic Goods Administration issued a public warning about their increasing prevalence in Australia, as the use of testosterone and related substances can cause shrunken testes, liver failure, heart attack and stroke. The regulator also warned there were unknown risks associated with these types of drugs because of a lack of scientific evidence.

There is little recent data tracking the use of anabolic steroids. Health practitioners and academics working in the space agreed the pandemic had little impact on availability, despite syringe needle program data showing a slight drop in the use of performance-enhancing drugs in 2021.

Data from the National Drug Strategy Household Survey showed a growth in the small number of Australians who have ever used anabolic steroids, up from 0.3 per cent in 2007 to 0.6 per cent in 2016.

Anecdotally, Eu said use in Australia had become increasingly mainstream over the past decade, with more outside the bodybuilding community influenced by social media and gym culture pressures to have larger muscles.

The average user is a professional male in his mid to late 30s, although experts say teenage boys as young as 14 are taking the drugs.

Steroid users required comprehensive psychological support, Squirrell said, noting their withdrawals could include symptoms similar to other illicit drugs and body dysmorphia.

Despite this, there is little healthcare available for anabolic steroid users in Australia beyond state health department needle safety initiatives. National addiction service Turning Point does not have a program for performance and image-enhancing drug users.

‘It is hard to come off because of its addictive qualities, psychologically but also physically.’

University of New England researcher Dr Katinka van de Ven, who specialises in the use and supply of steroids and other performance-enhancing drugs, said an addiction-based approach was relatively novel, both in Australia and abroad.

“In the UK there is a really strong focus on harm reduction; there are more health services for people who use anabolic steroids. But that all focuses on needle syringe harm,” she said.

“The problem is there is very little evidence as to what treatments would work best when it comes to this group.”

University of Queensland senior lecturer Mair Underwood, an anthropologist who has researched steroid use among bodybuilders, said it was possible that some people use steroids in a careful and systematic way, and could stop at any time.

However, she had also spoken to men who do not feel able to stop using despite their experience of significant social, mental and physical harm.

“I have spoken to men whose use is informed by mental psychopathology (i.e. muscle dysmorphia) so that their use can’t be characterised as completely voluntary,” she said.

Underwood and van de Ven both said steroid use needed more treatment regardless of whether it was regarded as an issue of addiction.

“Programs across the country provide clean equipment and some advice, but they feel ill-equipped to serve this group as they are used to serving very different types of drug users,” Underwood said.

Research by European drug experts suggests anabolic steroids may be less harmful than alcohol, tobacco and cannabis, let alone illicit drugs such as heroin, cocaine and amphetamine.

Underwood said drug laws do not reflect this relatively low level of harm: “What I think is going on is that the morality of sport and issues of cheating are colouring our views about how the law should approach these drugs.”

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