The world's first anabolic-androgenic steroid testing trial: A two-phase pilot combining chemical analysis, results dissemination and community feedback.

Abstract

Background and aims: The clandestine production and distribution of anabolic-androgenic steroids (AAS) poses health risks due to the uncertainty of their contents. This study aimed to test the chemical content of AAS samples and provide aggregate results back to the community, exploring how these results influenced usage decisions and risk management.

Design: A mixed-methods approach was used, combining chemical analysis of AAS samples with qualitative interviews. Participants submitted samples for testing, and the results were later shared with them. Semi-structured interviews explored participants' perceptions of AAS risks and the impact of testing results on their behaviour.

Setting: The study was conducted at CheQpoint drug checking service in Brisbane, Australia.

Participants: Thirty-two samples were submitted for testing between 19 April and 7 June 2024, with 23 samples analysed. A total of 25 active AAS users participated in interviews.

Measurements: Chemical analyses identified substances present and assessed active ingredient concentrations. Qualitative interviews gathered participants' perceptions, and these data were analysed through iterative categorisation, guided by the Health Belief Model.

Findings: Chemical analysis identified that 13% of samples contained substances different from what was expected. Concentrations of active ingredients were close to expected levels [e.g. testosterone propionate at 96.2 mg/mL (range = 91.39-101.01 mg/mL)]. Interviews identified four key theme categories. Participants sought testing primarily for substance verification, expressing concerns about contamination and dosage. Barriers to testing included limited access and fear of disclosure. While testing was seen as a valuable harm reduction tool, gaps in health guidance and follow-up support were identified as areas for improvement.

Conclusions: Thirteen percent of 23 anabolic-androgenic steroid (AAS) samples analysed contained substances different from what was expected. Interviews with active AAS users highlighted the need for reliable information, accessible testing services and tailored health approaches for AAS use.