From Midlife to Muscle: Understanding Steroid Use Among Older Men

Estimated reading time: 9 minutes

Introduction

Among readers of MESO-Rx, it’s well-known that men over 40 form a significant portion of the anabolic androgenic steroid (AAS) user base. Historically, the primary demographics of the site’s users have skewed younger, with men in their 20s and then those in their 40s. These trends were first spotted in informal surveys conducted among the website’s community as far back as 1999.

However, the landscape of AAS use is changing. In recent years, there has been a notable uptick in the number of men over 40 turning to steroids, often for non-medical reasons — a demographic shift that has not been as extensively studied as younger users. This gap in research underscores a broader pattern of older adults increasingly engaging in substance use that had previously been dominated by younger age groups.

Addressing this overlooked segment, Evelyn Hearne and her team have conducted the first comprehensive review of research on the use of AAS among men over 40. Their study spans international borders, incorporating findings from 44 studies published between 1996 and 2021. This pioneering work not only sheds light on the motivations and health outcomes of these older steroid users but also sets a new course for future inquiries into how demographic shifts affect drug use trends globally.

Themes of AAS Use Among Older Men

The new review titled “‘Sustaining masculinity’: a scoping review of anabolic androgenic steroid use by older males” delves into the complex world of steroid use among older men, identified three central themes that characterize this issue.

Firstly, the review highlights the motivations behind why some older men turn to anabolic androgenic steroids (AAS). These individuals often seek to preserve or enhance muscle mass, physical strength, and a youthful appearance—attributes traditionally associated with masculinity.

Secondly, the research documents a range of self-reported adverse effects linked to AAS use. Among these are diminished sexual function, fertility complications, and broader health issues.

Finally, the review details the health problems diagnosed by medical professionals in this demographic. Cardiovascular issues, liver damage, and other systemic harms have been identified, highlighting awareness of the long-term impacts of steroid use.

By exploring these themes, the review provides a nuanced understanding of the reasons older men may use AAS and the health risks associated with their use, contributing important insights to the ongoing discussion about masculinity and aging.

Characteristics of AAS Use

As the use of anabolic androgenic steroids (AAS) continues to evolve, a notable trend has emerged: more individuals are beginning their use at a later stage in life, with some starting as late as their forties and the oldest documented beginners at the age of 69. This marks a significant shift from previous decades when steroid use was predominantly initiated before the age of 30. Recent studies from regions as diverse as the UK, the USA, and across the globe have noted this rise in the age of initiation, suggesting a demographic transition that necessitates new directions in both research and policy.

The motivations for taking up AAS in later years align closely with those of younger users, centering on desires to enhance aesthetics, improve performance, and engage in bodybuilding. However, for older users, these motivations often extend into maintaining well-being and male status, particularly in terms of sexual function and appearance. This underlines a deeper pursuit of well-being, where emotional satisfaction and a sense of youthfulness play pivotal roles in why older men continue or return to AAS use after periods of cessation.

Interestingly, the patterns of AAS use have also shifted. There’s a growing tendency among these older users to follow prolonged cycles and adopt non-traditional usage patterns like “blasting and cruising,” practices that suggest a psychological dependence. Yet, despite the concerns of dependency, many do not perceive their steroid use as an addiction. Instead, they view it as part of a health regimen that is integral to their lifestyle.

These observations reveal complex layers of behavior and motivation among older AAS users, highlighting a shift in initiation age and the reasons for continued use that are comparable to those of younger generations. The evolving nature of steroid use among the older population underscores the need for tailored approaches to understanding and addressing the unique challenges they face.

Health Harms Reported by AAS Users

Among the range of health complications linked with anabolic androgenic steroid (AAS) use, sexual dysfunction and fertility issues stand out as particularly distressing for many older men.

Sexual Dysfunction and Fertility Issues

Reports commonly cite erectile dysfunction, testicular atrophy, and diminished libido as adverse side effects. These physical symptoms are often accompanied by psychological repercussions, such as depression and low mood, which researchers associate with the low testosterone levels following the cessation of prolonged AAS use.

Moreover, infertility and reduced testicular function remain significant concerns, with some cases noting persistent anabolic steroid induced hypogonadism (ASIH) following the cessation of steroid use. To combat these side effects, some individuals turn to pharmaceuticals such as clomiphene citrate, commonly known as Clomid, and human chorionic gonadotropin (hCG), which can help mitigate the hormonal imbalances caused by steroid use.

Other Hormonal and Physical Effects

Beyond these reproductive and psychological effects, AAS users also report a spectrum of other hormonal and physical adverse outcomes. These include early-stage gynecomastia—an increase in male breast tissue—as well as skin and hair changes like acne and alopecia. Other symptoms can affect day-to-day functioning, with some men experiencing enough fatigue to impair their ability to engage in resistance training—a key activity for most steroid users.

Injection-Related Complications

Additionally, the method of steroid administration itself poses risks; injections can lead to complications such as pain, swelling, and in more severe cases, the need for surgical intervention. Notably, older steroid users report a higher incidence of these injection-related complications than their younger counterparts, pointing to the increased vulnerabilities of aging AAS consumers.

This theme highlights the complex web of adverse effects tied to steroid use among older men, underscoring the impact on their sexual and reproductive health, overall physical well-being, and the particular risks associated with injectable forms of these substances.

Health Harms from AAS Reported by Medical Professionals

Medical professionals have cataloged a series of health issues stemming from the use of anabolic androgenic steroids (AAS), with older users appearing particularly susceptible to a variety of conditions.

Cardiovascular Complications

Prominent among the health risks are cardiovascular problems, including left ventricular systolic dysfunction, hypertrophy, hypertension, myocardial infarction, and diverse forms of heart failure. These conditions, which are typically observed in sedentary or obese individuals, are increasingly being diagnosed in those who have used AAS over many years. Notably, while some cardiovascular dysfunctions, especially systolic ones, may show signs of reversibility after discontinuing steroid use, diastolic dysfunctions are often less responsive to such changes.

Liver Damage

Another critical area of concern is liver injury, associated with the use of oral steroids, which are metabolized differently and can thus cause greater hepatotoxicity. Symptoms reported include nausea, anorexia, and jaundice, with many cases noting an improvement or reversal of liver conditions once steroid use ceases. However, the effective diagnosis and treatment of these liver issues are often complicated by a reluctance among users to disclose their use of AAS to healthcare providers.

Additional Health Risks

The deleterious effects of steroids extend beyond the heart and liver. Medical records indicate that AAS use is linked to acute kidney injury, renal infarction, type 2 diabetes, cholesterol imbalances, and acute conditions such as pancreatitis and respiratory distress. Furthermore, the diagnosis of conditions like rhabdomyolysis and erythrocytosis underlines the impact of steroids on multiple bodily systems, highlighting the diverse health risks associated with these substances.

Healthcare Engagement and Treatment Needs

Older men who use anabolic androgenic steroids (AAS) often find themselves hesitant to seek medical advice, deterred by stigma and a deep-seated mistrust of healthcare providers. This reluctance complicates the path to effective treatment and can obscure the full extent of the health issues involved.

The multifaceted nature of steroid-related health problems necessitates a personalized and comprehensive approach to healthcare, particularly because older users are likely to have a longer history with these substances and potentially more entrenched health complications.

This dynamic underscores the pressing need for specialized, multidisciplinary healthcare strategies designed to address the complex medical needs of older steroid users effectively. The challenges in fostering open communication and ensuring adequate medical care are significant, but they are crucial steps in mitigating the severe health risks associated with prolonged AAS use.

Summary

Hearne’s review marks a pioneering attempt to synthesize the existing research on the use of anabolic androgenic steroids (AAS) by men over the age of 40.

The findings of the review point to a significant and growing trend: more men in their sixties and beyond are beginning to use AAS, a notable shift from past data which suggested that AAS use was primarily initiated before the age of 30. Traditionally associated with young adults in their twenties, the demographic landscape of AAS users is evolving, showing a broader and more varied range of users.

Older men are increasingly drawn to steroids, driven by goals to improve physical appearance and performance—a motivation shared with younger users but coupled with a focused intent on maintaining health and a youthful physique as they age.

This review illuminates the need for more specialized research focused on this older group of AAS users to fully understand their specific motivations and health outcomes. It also stresses the importance of a multi-disciplinary healthcare strategy that includes endocrinologists, psychologists, and addiction specialists to meet the complex needs of this demographic effectively.

By highlighting this shift in AAS usage patterns among older men, the review lays the groundwork for future studies that could lead to more informed healthcare policies and ultimately enhance the quality of life and well-being of older men who use AAS.

Readers of MESO-Rx over the age of 40 will discover extensive resources on our website about minimizing the risks associated with anabolic steroids. Nonetheless, it is essential to consult certified healthcare providers for medical guidance. While these professionals might not specialize in every aspect of performance-enhancing drugs, they possess crucial expertise in addressing and treating AAS-related cardiological issues, including hypertension and other heart-related conditions.

The key point is that the medical field is constantly striving to enhance its engagement with the bodybuilding community regarding issues related to anabolic androgenic steroids (AAS). We urge you to make use of these ongoing efforts.

References

Hearne, E., Atkinson, A., Boardley, I., McVeigh, J., & Van Hout, M. C. (2024). ‘Sustaining masculinity’: A scoping review of anabolic androgenic steroid use by older males. Drugs: Education, Prevention and Policy, 31(1), 27–53. https://doi.org/10.1080/09687637.2022.2132135