Many anabolic steroid users are turning to online forums – not doctors – for help coming off the drugs, a new study shows. With misinformation and inconsistent advice rife, experts warn that this could fuel preventable health risks.
A recent systematic review found that anabolic-androgenic steroid (AAS) use among gym-goers typically falls in the 15% to 25% range, though some studies report much higher rates, particularly among bodybuilders. Most steroid users know that stopping can be physically and psychologically challenging. However, it’s presently an unregulated process, so many turn to online forums for advice.
In a new study led by Griffith University, researchers sought to understand how AAS users talk about post-cycle therapy (PCT), which consists of using various medications to bring testosterone levels back to normal and better manage withdrawal symptoms after stopping steroids.
“While many consumers use PCT as an important tool for managing withdrawal symptoms, protecting sexual health, and maintaining muscle gains, the advice being shared is inconsistent and often conflicting,” said Tim Piatkowski, PhD, a lecturer in Griffith’s School of Applied Psychology and the study’s corresponding author. “People are seeking support, but instead of turning to health services where stigma and a lack of expertise are barriers, they are relying on their peers in online forums for guidance.
“Most of the advice reflects subjective perspectives of people with lived experience of AAS-use, with some people appearing to be more focused on short-term health improvements rather than long-term health promotion or longevity. This makes them vulnerable to misinformation and unnecessary health risks.”
The researchers, who were also from the University of Queensland, Imperial College London, and the University of Zurich, collected 5,059 posts from 150 discussion threads across three Australian steroid forums. After looking for discussions mentioning PCT or related terms, they analyzed the posts using the Health Belief Model, which considers how people perceive their health risks, the seriousness of those risks, benefits and barriers to action, and what motivates them to act.
The study identified several factors that were barriers to stopping use, engaging in PCT, or seeking medical help. Social pressure and community norms played a role. Some forum members discouraged PCT, promoted continued steroid use, or mocked those who stopped. Further, many users feared the symptoms that accompanied the withdrawal period, such as low mood, loss of libido, and fatigue, and were anxious about how they’d feel off-cycle. Users often reported that doctors were dismissive or uninformed about AAS use, which discouraged them from seeking help. And, as unregulated medications, PCT drugs are often intercepted by customs or police, creating legal fears.
Despite mixed attitudes, many users recognized that PCT can prevent or reduce withdrawal symptoms, help preserve muscle gains achieved during steroid cycles, and restore natural testosterone production more quickly, potentially preventing long-term issues like infertility. The researchers found that forums often served as educational spaces, with users sharing their recovery logs, blood test results, and experiences with specific PCT drugs.
Another factor that played into users’ behavior was a fear of the side effects they might experience if they skipped PCT. These included hormonal imbalances leading to testicular shrinkage, infertility, and erectile dysfunction; the risk of permanent damage that required lifelong testosterone replacement therapy; and the loss of gains. That last factor – rapid muscle loss – was a major motivator for people deciding whether to seek guidance about PCT. However, some users, especially younger users, dismissed these risks, believing their bodies would recover naturally.
The researchers noted significant debate and misinformation in the forums. Some users shared potentially harmful advice about dosage or combinations of PCT drugs, and others described their bad experiences with certain substances; for example, loss of bone density or hormonal crashes from misuse.
There are a few limitations to the study. Only people active on forums were studied, and they may not represent all AAS users. Most data came from Australian forums; however, patterns may also apply elsewhere. The study didn’t attempt to verify the accuracy of user claims about PCT effectiveness or side effects, relying solely on self-reported data from online forums.
Nonetheless, it sheds light on a significant public health gap. Most non-medical steroid users rely on peer advice because healthcare professionals are often unprepared or unwilling to engage with AAS issues. The fear of legal consequences discourages users from seeking medical help, pushing them towards risk self-treatment.
“The data underscores the urgent need for evidence-based, non-stigmatizing clinical support for steroid consumers in Australia,” Piatkowski said. “It also highlights a gap in clinical knowledge with some health professionals often unprepared to guide patients through safe cessation, leaving forms to fill the void. We desperately need to close the gap so AAS-users have access to evidence-based support.”
With tens of thousands of people worldwide using AAS, understanding how they attempt to come off these drugs, and where they’re getting their information, is vital for reducing health risks and shaping harm-reduction policies.
The study was published in the journal Drug and Alcohol Review.
Source: Griffith University
