Anabolic Steroids: If MDs Don't Ask, Patients Won't Tell

This Medscape article mentions Dr O'Connor, me and others.


Before he attended medical school, Thomas O'Connor, MD, had a not-very-well-kept secret: As a competitive powerlifter, he had used steroids to build strength.

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Dr Thomas O'Connor
Now an internist and clinical instructor of medicine at the University of Connecticut in Farmington, O'Connor's practice focuses on the needs of men taking testosterone and other anabolic steroids — a group he feels is poorly understood and largely neglected by conventional medical care, perceptions borne out by a 2020 study of steroid users he helped conduct.

"They felt discriminated against, they did not feel comfortable working with their physicians, and they felt that the doctors did not know what they were doing," O'Connor told Medscape Medical News. His patients often express anger and frustration with doctors they had seen previously, he added.


Patients Turning to Home Tests

Not surprisingly, then, many users of illegal anabolic-androgenic steroids (AAS) have adopted a DIY approach to monitoring the side effects of the drugs, turning to direct-to-consumer laboratory tests. Clients can order a panel of labs designed to screen for health conditions commonly associated with use of AAS, such as dyslipidemia, renal and hepatic dysfunction, polycythemia, thrombosis, and insulin resistance. The panels also include tests for levels of different hormones.

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Thomas O'Connor in his powerlifting days.
Sales of direct-to-consumer tests topped $3.6 billion in the United States in 2022 and are predicted to grow. Some of that spending is coming from people, mostly men, using illegally obtained steroids to build muscle. Although published data on the size of the bodybuilder market are unavailable, the internet is a ready source of relatively inexpensive tests aimed at helping individuals monitor their health.

Continue reading (free access through free account-login): Illicit Steroids: If MDs Don't Ask, Patients Won't Tell
 
Quote from the article above:

Alarming Mistrust of MDs

O'Connor's study shed some light on why AAS users might resort to surfing the internet looking for a way to diagnose their own complications from steroid use. The web-based survey of nearly 2400 men who said they took the drugs found that participants considered physicians to be the worst source of information, ranking them below coaches, online bodybuilding forums and sites, other AAS users, and bodybuilding books or magazines. The majority (56%) did not reveal AAS use to their clinicians. Of those who did, 55% reported feeling discriminated against for the admission.

O'Connor said physicians receive scant education on the many different drugs and regimens used by bodybuilders and have no idea how to a manage withdrawal syndrome for people trying to get off steroids. He urged the medical community to develop an educational campaign for clinicians, similar to those from public health officials aimed at combatting the opioid epidemic: "Let's educate med students and the residents," he said. "Let's put [steroid use] on our agenda."


Consumer Testing Evangelist…or Physician Nemesis?

Nelson Vergel, BSChE, MBA, is on a mission to make medical lab testing affordable and accessible to everyone. The chemical engineer founded Discounted Labs 8 years ago, offering commonly ordered tests, such as complete blood counts, liver function tests, and cholesterol levels.

Vergel has advocated for the use of hormones to treat HIV-wasting disease for nearly 40 years, after his own diagnosis of the infection in 1986. After losing 40 pounds, steroids saved his life, he said.

Vergel said he was shocked to learn about the lack of continuing medical education on AAS for physicians and agreed with O'Connor that more training is needed for the medical profession. He also recognized that stigma on the part of clinicians is a huge barrier for many AAS users.

"We have to accept the fact that people are using them instead of demonizing them," Vergel said. "What I was seeing is that there was so much stigma — and patients would not even talk to their doctors about their use."

After reviewing Google analytics for his lab's website and seeing how often "bodybuilder" came up as a search term, he added a
panel of labs a year ago that allows AAS users to monitor themselves for adverse events.

Although he doesn't condone the use of AAS without a medical indication and advises customers to discuss their results with a doctor, "we have to make sure people are reducing their harm or risk," he said. "That's really my goal."

Many healthcare professionals would disagree with that statement. Nagata said he was concerned that management of side effects is too complicated. "There are a lot of nuances in the interpretation of these tests," he said. Arriving at the correct interpretation of the results requires a clinician's thorough review of each patient's health history, family history, and mental health history along with lab results.
 

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