Feasibility of implementing current best clinical practice for people who are using anabolic androgenic steroids within a Swiss primary care practice: a quality assurance study.

Abstract

Background: The non-medical use of anabolic androgenic steroids for the improvement of aesthetic and sports performance purposes has become a global substance use disorder, particularly among men in recreational sports. Health outcomes among people who are using anabolic androgenic steroids may be detrimental, yet healthcare services for these users are scarce. Therefore, the aim of this project was to conduct a quality assurance study to evaluate the feasibility of providing current best clinical practice for anabolic androgenic steroids users based on the published literature within a primary care practice in Zurich (Switzerland).

Methods: A primary healthcare practice for current or past anabolic androgenic steroids use was established at the Arud Centre for Addiction Medicine in Zurich providing specialised medical care for this population. The reporting and methodology to evaluate feasibility of this quality assurance study follow a checklist for pilot studies. The primary feasibility outcomes for this study were satisfaction with the services received (customer satisfaction score), as well as loyalty towards the services (net promoter score). These customer metrics have been used successfully in the medical field to measure patient experiences, as well as infer future word-of-mouth advertisement (i.e. return and refer). Furthermore, the objective was to describe patient characteristics and substance use behaviours in a Swiss context. Patients could access these services in Zurich from 1 June 2023 onwards. The recruitment strategy was word-of-mouth advertising among anabolic androgenic steroids users and paper advertisement (i.e. flyers) about the healthcare service. Eligibility criteria were based on legal restrictions regarding doping laws and professional ethical principles of medicine. In an initial visit at the practice, a focused patient history was assessed, and patients received a physical, psychometric, instrumental as well as laboratory examination. Datasets are summarised using descriptive statistics.

Results: Overall, 34 eligible patients were seen over the period from June until December 2023. Excellent results regarding loyalty towards the service (net promoter score: 100; integer) as well as patient satisfaction with the received services (customer satisfaction score: 100%) were achieved. Patients were commonly young professional males (mean: 38.5 years, standard deviation: 8 years), with educational level beyond compulsory schooling. The main motivation for using anabolic androgenic steroids was aesthetic purposes. Acquisition of these substances occurred mostly through non-medical sources. Patterns of anabolic androgenic steroids use were complex with extensive polypharmacy and concomitant illicit substance use. Most patients suffered from side effects with multiple physical as well as mental health complications. Many abnormal findings were found regarding the physical as well as laboratory and instrumental examination, although mostly mild and transient, some possibly severe regarding health outcomes.

Conclusion: With this first quality assurance study, we demonstrate that integration of current best clinical practice for anabolic androgenic steroids users in recreational sports appears to be feasible with high acceptance in a Swiss primary care practice. Furthermore, those patients may engage in high-risk behaviours and a high prevalence of comorbid medical conditions was demonstrated. Anabolic androgenic steroids users likely benefit from integrated medical care provided and coordinated in a primary health care setting. On the basis of the initial study results, these services were continued at a larger scale to further assess as well as mitigate health risks among this user population. Importantly, current doping legislation was demonstrated to be a major limitation to provision of adequate medical care for this user population, thus changes in legislation are crucial to avert this growing public health threat.