Outpatient clinic for users of anabolic androgenic steroids: an overview

Anabolic androgenic steroids (AAS) are used by approximately 20,000 amateur athletes in the Netherlands. AAS are harmful but data are lacking as to precisely how harmful they are. An outpatient clinic for past and current users of AAS was established in 2011 to acquire more knowledge about the health risks associated with AAS abuse.

All case files of the patients who visited the AAS clinic were reviewed retrospectively.

180 patients visited the AAS clinic between May 2011 and May 2016. Patients were strength athletes (99% male, mean age 34 years, range 19-61) who had started AAS use at a median age of 23 years (range 16-53). 95% used AAS in cycles (median of 4 cycles completed, median duration 10 weeks). Cycles consisted of a median of three different AAS, most commonly testosterone, nandrolone and trenbolone. Growth hormone was used by 34% in addition to AAS. Side effects occurred in 96% of patients, mainly acne (38%), gynaecomastia (34%) and agitation (27%) during cycles; decreased libido (34%) and erectile dysfunction (20%) afterwards. Medications regularly used by patients to self-treat side effects were aromatase inhibitors, clomiphene citrate, human choriogonadotropin, and tamoxifen.

AAS abuse did not lead to critical health issues. However, the incidence of less severe side effects among AAS users appears high. Considering the large number of abusers in the community, AAS abuse poses an important public health problem. A prospective study with a systematic approach is required to provide more reliable data regarding health risks of AAS abuse.