‘Sustaining masculinity’:a scoping review of anabolic androgenic steroid use by older males

In the past, research, policy and media have reported the use of anabolic androgenic steroids (AAS) primarily among younger males. However, recent studies have indicated the presence of an older cohort of men who use AAS in comparison to previous years. We carried out a scoping review of the extant literature to map and describe what is known about the use of AAS by older men (>40 years). A systematic search collected and analysed empirical research and grey literature relevant to the research question. Following application of inclusion and exclusion criteria, 44 studies were included which were subsequently charted and thematically analysed. The records included originated from the UK, USA, Canada, Australia, Slovenia, Norway, Spain, Turkey, Switzerland, Japan, and five global studies and were published between 1996 and 2021. Age ranged overall from 14 to 78 years old, however our review only discussed findings pertaining to those older than 40. Three main themes with subthemes were generated as follows: 1) Characteristics of AAS Use; Self-reported Adverse Effects from AAS Use; and Harms Diagnosed by Medical Professional. The review highlights the significant risks to hypothalamic-pituitary testicular function, cardiovascular health, and other organ systems as a result of the ageing man who is motivated to sustain masculine characteristics such as muscularity, youthfulness, sexual function, and perceived desirability and attractiveness. Future research is required to further understand the motivations of older men who use AAS. Furthermore, there is a need for age-specific research and recommendations to inform future policy and practice pertaining so that age-appropriate healthcare and policy decisions can be made in the future

Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming

Pre-exposure prophylaxis (PrEP) is an evidence-based new biomedical HIV prevention intervention, which involves the pre-emptive use of daily (or event-based) antiretroviral drugs, to reduce risk of HIV acquisition if exposed. PrEP has recently been positioned as an integral prevention tool to reduce HIV acquisition risk among men who have sex with men (MSM) at country-level and within global prevention strategies. Given this global scale up of PrEP, we conducted a scoping review of extant international literature documenting service related perspectives, models and lessons learnt in PrEP programming for MSM. A systematic search of literature was conducted, and restricted to English language records in the timeframe 2008 to February 2019. Eligibility criteria centered on whether studies broadly described PrEP programming and service delivery for MSM as well as health communication. Following exclusion of ineligible records and removal of duplicates, 84 records were charted and thematically analysed according to scoping review methods. Four themes emerged from the thematic analysis of data; 'PrEP service aspects, settings and staff'; 'PrEP prescriber experiences, therapeutic alliance and care planning'; 'PrEP adherence within formal service structures'; and 'Multi-disciplinary and innovative PrEP care pathways'. The review highlights the complexities in providing optimal PrEP services for MSM by mapping and illustrating the importance of understanding the informal and formal routes to PrEP use among this HIV risk population; the barriers to uptake; the requirement for the presence of a positive therapeutic alliance between patient and prescriber in supporting patient initiation and adherence to PrEP regimes; and the need for availability in different culturally and ethnically sensitive models of PrEP service delivery according to low to high risk groups within the MSM communities

‘Sustaining masculinity’: a scoping review of anabolic androgenic steroid use by older males

In the past, research, policy and media have reported the use of anabolic androgenic steroids (AAS) primarily among younger males. However, recent studies have indicated the presence of an older cohort of men who use AAS in comparison to previous years. We carried out a scoping review of the extant literature to map and describe what is known about the use of AAS by older men (>40 years). A systematic search collected and analysed empirical research and grey literature relevant to the research question. Following application of inclusion and exclusion criteria, 44 studies were included which were subsequently charted and thematically analysed. The records included originated from the UK, USA, Canada, Australia, Slovenia, Norway, Spain, Turkey, Switzerland, Japan, and five global studies and were published between 1996 and 2021. Age ranged overall from 14 to 78 years old, however our review only discussed findings pertaining to those older than 40. Three main themes with subthemes were generated as follows: 1) Characteristics of AAS Use; Self-reported Adverse Effects from AAS Use; and Harms Diagnosed by Medical Professional. The review highlights the significant risks to hypothalamic-pituitary testicular function, cardiovascular health, and other organ systems as a result of the ageing man who is motivated to sustain masculine characteristics such as muscularity, youthfulness, sexual function, and perceived desirability and attractiveness. Future research is required to further understand the motivations of older men who use AAS. Furthermore, there is a need for age-specific research and recommendations to inform future policy and practice pertaining so that age-appropriate healthcare and policy decisions can be made in the future

The anabolic androgenic steroid treatment gap: a national study of substance use disorder treatment

Background Anabolic-androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use amongst people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD-treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results Lifetime AAS use was reported by 156 (28.3%) SUD-patients, thereof 35.6 % of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS using men. AAS users reported more severe substance use than non-AAS users. More than half (58%)of all patients had not been asked about AAS use, and 42.4% of those who were asked, experienced that treatment providers lacked expertise about AAS. Conclusion Lifetime AAS use in this sample of SUD patients is common practice and comprise an underrecognized problem in SUD treatment. Given the deleterious implications to the individual and society that concomitant use of AAS may cause, it would be essential to raise the awareness about AAS use amongst SUD patients, and the level of competence among health professionals

Internet sourcing and unsafe use of controlled drugs (opioids, sedatives and GABA drugs) in the UK: an in depth case study of consumer dynamics during COVID-19

The Internet offers increased availability and accessibility of medicinal pharmaceuticals including those containing opioids, sedatives and gamma-aminobutyric acid (GABA) drugs through both legal and illegal routes. Sourcing concerns have been further heightened due to the current severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic which reduced face-to-face access for non-COVID-19 related health conditions and to drug treatment services. This study is the second of a two stage study comprising interviews with three key stakeholders who were policy makers, health care professionals or police, and three individuals who sourced medicinal products online (ISOs). An in-depth case study approach was adopted. Thematic analysis of in-depth case narratives revealed the following key themes; Motivations, initiation, and making the move online; Process of sourcing online; Supply issues and COVID-19; Perception of control; Quality of medications; and Public health recommendations. Motivations for purchasing online are complex and methods to divert and control the supply of medicinal pharmaceuticals are equally complex and difficult to navigate. Novel routes to access now include Telegram, a cross-platform messaging service with enhance encryption and privacy. Whilst stakeholders and ISOs had similar views on the prevalence and ease of access to medication, there were also some substantial differences primarily in terms of perceptions of risk. This study highlights the need for enhanced pharmacovigilance of non-regulated online vendors and the imperatives of continued health messaging around the potential self-directed use of these controlled drugs and the dangers of using websites purporting to be regulated pharmacies

Anabolic androgenic steroid use population size estimation : a first stage study utilising a Delphi exercise

Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public health concern. Robust estimates of the numbers using AAS are needed to inform responses, however, in the UK these are lacking. Due to the comparative rarity and associated stigma, general population surveys are problematic and data availability limits the use of indirect approaches. To address this, the Delphi method was used to refine the key parameters needed for indirect estimation from attendances at needle and syringe programmes (NSP) for AAS use. An expert panel (n = 63) was surveyed three times (n = 40, 39, and 37) to refine the parameters needed to generate a likely range from data on NSP attendances. A broad agreement was reached on: regional variations in use; the proportion of men using AAS who only use them orally; the proportion of men who inject AAS using NSP; and the proportion of the AAS population who are women. We conclude that previous general population survey-based estimates of recent AAS use appear implausible, with the likely range indicated by NSP data being up to 10-times higher. AAS use in the UK is more common than previously indicated, but further work is needed to refine population size estimation and characteristics

2,4-Dinitrophenol, the inferno drug: a netnographic study of user experiences in the quest for leanness.

Background: Despite not being licensed for human consumption, the Internet has triggered renewed, widespread interest and availability of 2,4-Dinitrophenol (DNP). DNP, a cellular metabolic poison, causes thermogenesis resulting in fat burning and weight loss. Whilst extensively available for purchase online, research on user experiences of DNP is limited. Methods: A netnographic approach was used to describe user experiences of DNP via online public websites. Public websites discussing DNP were identified and a purposeful sample selected. Discussion threads were downloaded and a textual qualitative analysis conducted. Four themes containing 71 categories were generated. Results: There exists a plethora of communal folk pharmacological advice and recommendations for DNP manufacture and use, together with associated harms and outcomes. The efficacy and untoward effects of DNP were described and discussed alongside the notion that DNP should only be used by experienced bodybuilders. Dosage and regimes for optimal use were also described. Conclusion: This unique study provides a rich examination of the knowledge, attitudes, and motivations of DNP users, illustrating the significant role of online public websites in sharing information. Further understanding of DNP users and the online communities in which they reside is warranted to facilitate engagement and formulate appropriate and effective policy responses

Effectiveness of interventions for informal caregivers of people with end-stage chronic illness:a systematic review

Background People living with advanced, non-malignant chronic conditions often have extensive and complex care needs. Informal or family caregivers often provide the care and support needed by those with advanced chronic conditions at home. These informal caregivers experience many challenges associated with their caring role, which can impact their own wellbeing. Whilst there is growing evidence around the impact on carers, guidance on support for informal caregivers of patients with advanced, non-malignant, chronic conditions is lacking, with little evidence available on effective psychosocial carer interventions. This systematic review explored existing interventions for caregivers of those with advanced, non-malignant, chronic illness, in order to assess the effectiveness of these interventions in improving psychosocial outcomes. Methods Electronic databases, Medline, CINAHL, EMBASE, and PsycINFO, were searched up to the end of March 2023. Studies meeting the inclusion criteria, focusing on interventions to improve psychosocial outcomes, such as depression, anxiety, quality of life, and caregiver burden, in this cohort of caregivers were included. Data were extracted regarding study setting, design, methods, intervention components, and outcomes. Risk of bias and quality assessment were conducted. Results A total of 5281 articles were screened, ultimately identifying 12 studies for inclusion, reported in 13 publications. A narrative synthesis revealed mixed results. Psychosocial interventions resulted in more significant improvements in psychosocial outcomes than psychoeducational or support interventions, with interventions for carer-patient dyads also reflecting more positive outcomes for caregivers. Evidence-based interventions, guided by an appropriate theoretical model, were reportedly more effective in improving caregiver outcomes. Differences in outcomes were related to intervention development, design, delivery, and outcome assessment. Conclusions This review, to our knowledge, is the first to explore the effectiveness of interventions in improving psychosocial outcomes for caregivers of those with advanced, non-malignant, chronic conditions. The review highlights the need for more robust, sufficiently powered, high-quality trials of evidence-based interventions for caregivers of people with advanced chronic illness. Optimal intervention duration and frequency of sessions are unclear and need further exploration