Analysis of thousands of forum posts shows Australians rely on peers for guidance, underscoring an urgent need for clinical support.
Australians who use anabolic-androgenic steroids are increasingly turning to online forums – rather than seeking clinical care – for advice on how to safely discontinue use, according to new research from Griffith University.
The study, published in Drug and Alcohol Review, examined more than 5000 posts across steroid-related forums to investigate how users approach cessation and the practice of post-cycle therapy (PCT), a self-directed and often controversial process aimed at restoring the body’s natural hormone production after stopping steroid use.
Lead author Dr Tim Piatkowski from Griffith’s School of Applied Psychology, said that while PCT was often promoted among users as a means of managing withdrawal symptoms, preserving sexual health and maintaining muscle gains, the guidance shared online was inconsistent and frequently contradictory.
“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,” he said.
“Most often 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 research found that stigma around AAS use, regulatory restrictions and conflicting voices within forums contributed to barriers that prevent people from seeking evidence-based care.
While some forum participants advocated strongly for PCT, others promote abstinence or expressed skepticism, creating a confusing environment for individuals attempting to navigate discontinuation.
Compounding this was a gap in clinical knowledge, with some health professionals unprepared to support patients through cessation, further driving reliance on non-clinical sources of information.
“The data underscores the urgent need for evidence-based, non-stigmatising clinical support for steroid consumers in Australia,” Dr 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.”
The researchers noted that AAS use was rising in Australia, with new initiates to AAS use (injecting for less than three years) increasing from 18% in 2019 to 26% in 2023.
The potential consequences of poorly managed steroid discontinuation are significant, they said.
“Acute symptoms, occurring within the first few days of cessation, include headaches, tremors, palpitations and nausea,” they wrote.
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“As the acute phase subsides, chronic symptoms emerge, most notably a transient hypogonadism. Hypogonadism is particularly distressing due to its symptoms of erectile dysfunction, fatigue, persistent low libido and mood disorders.
“The severity of these symptoms can act as a significant barrier to AAS cessation, as individuals may be reluctant to discontinue use due to the physiological and psychological difficulties associated with hormonal disruption.
“As a result, some men may go on to develop a dangerous AAS dependence syndrome.”
PCT is a commonly used but informal and unvalidated approach to endocrine management and harm reduction among AAS users.
It is intended to ease withdrawal symptoms and hasten recovery of the hypothalamic–pituitary–gonadal axis following cessation of steroid use. Protocols vary widely but typically involve self-administering a combination of pharmaceutical agents over two to 12 weeks, most often human chorionic gonadotropin (hCG), selective oestrogen receptor modulators (SERMs) and aromatase inhibitors.
The hCG acts by directly stimulating testicular testosterone production, while SERMs and aromatase inhibitors reduce oestrogenic feedback, thereby enhancing gonadotropin-releasing hormone (GnRH) and pituitary gonadotropin output.
PCT is frequently adopted in an attempt to preserve muscle mass accrued during AAS cycles. Despite this, significant doubts remain regarding both the legitimacy and clinical efficacy of PCT, compounded by concerns about the authenticity of products accessed outside medical settings.
Although several recent studies have examined PCT practices, important knowledge gaps persist regarding who engages in PCT, the ways in which information circulates, and which groups may benefit. Evidence remains sparse on its safety, tolerability, dosing, duration and efficacy, with no high-quality prospective studies to guide best practice, the authors noted.
“The absence of standardised medical protocols and clinical guidance for AAS cessation and recovery is compounded by a broader structural issue: the lack of knowledge and education among healthcare professionals regarding AAS use,” they wrote.
“Research consistently shows that healthcare providers are underprepared to meet AAS consumers’ needs, creating barriers to accessing appropriate care. Consumers often feel displaced or misunderstood when seeking support for cessation or recovery.”
The most discussed AAS-related symptoms in forum discussions were hypogonadism and general symptoms of fatigue, low energy, mood disturbances and perceived declines in overall health. Participants frequently sought guidance on managing these effects, often linking them to concerns about post-cycle recovery and long-term hormonal regulation, the researchers reported.
While forums provided an important space for harm reduction discussions, the inconsistency of available information underscored the urgent need for evidence-based cessation strategies. However, the researchers said addressing these challenges required more than individual education. They said structural barriers, particularly those imposed by Australian drug policy, must also be acknowledged.
“The continued criminalisation of AAS possession and use in Australia exacerbates harm by discouraging people from seeking healthcare support, reinforcing both physiological and psychological barriers to cessation,” they said.
“Fear of legal consequences further limits engagement with harm reduction services, making it essential to prioritise public health approaches over punitive responses. A shift toward education-driven harm reduction strategies is crucial for promoting long-term health awareness and risk mitigation.”
