Approach to the Young Male Patient Who Abuses Androgens: Harm Reduction as a Clinical Strategy

Nonmedical use of androgens is increasingly encountered in clinical practice, particularly among young men engaging in strength training. Many present with androgen-related complaints or complications but receive limited medical support because of clinician unfamiliarity, stigma, or the perceived need for abstinence as a condition for care. This article outlines a framework for engaging with androgen abusers in clinical practice, emphasizing a nonjudgmental diagnostic approach and 2 parallel management strategies. For individuals motivated to discontinue, structured monitoring and psychological support are key to facilitating hormonal recovery and reducing relapse risk. Only in cases where biochemical hypogonadism with symptoms persists after at least 12 months of abstinence should testosterone replacement therapy be considered in line with standard guidelines. For those unwilling or not yet ready to stop, a harm reduction approach is proposed. Drawing on extensive clinical experience, we provide recommendations for minimizing health risks, including dose reduction, compound selection, cycle structuring, and cardiovascular risk management. This dual strategy-supporting cessation where possible while mitigating harm where possible-offers a realistic and ethical response to the growing population of androgen abusers and aims to bridge the current gap between clinical care and user behavior.