Adverse physiological and psychological consequences and decision-making processes amongst older anabolic androgenic steroid (AAS) users.

I. Scientific excellence

Emergent use of anabolic androgenic steroids (AAS) and other image and performance enhancement drugs (IPEDs) for aesthetic and functional body enhancement presents a significant global public health challenge, particularly given its recent diffusion from bodybuilding and elite sports into mainstream populations. Increased levels of male body dissatisfaction, particularly in Westernised societies are evident with value placed on muscle development, definition and size by virtue of its association with male status. Previously identified as an issue amongst young men, growing evidence has pointed to a growing number of older users (>50 years) with a desire to maintain youth and vigour through self-directed hormone treatment. In addition to older male users commencing IPED use now, with associated health implications, there is also a population of users who started as young IPED users in the 1980’s, who are now in their 60s (or older), and who have distinct associated health complications. Most common amongst these IPEDs are AAS. Harmful effects of AAS use include liver, cardiac, psychological and dependence problems, with emerging evidence of structural brain changes and cognitive impairment. Other harms centre on the illicit market and adulterated products, and injecting routes of administration and significant prevalence of blood borne viruses. Very little is known about the individual cost-benefit-analysis within the decision making process to use, despite users awareness of health harms, and experiences of related health consequences particularly for those using in later life. This unique study will explore user trajectories, patterns of use and experiences across the life course. It provides opportunity to study a unique cohort of older men who are recent vs. chronic vs. early life (but no longer) IPED users to identify triggers, drivers and health implications.

II. Clear aim and hypothesis

The aim of the research is to identify the key triggers and drivers, that results in men at different age points initiating AAS using, continuing use despite known risks (and in some case experiences) of severe harms including adverse physical and mental health problems.

III. Methodology and innovations

Using a two prong mixed method approach, in-depth interviews with a purposive sample of current and former users will be conducted to provide rich data illustrating decision-making processes along the continuum of use toward problem use. This will provide the basis for an online research tool, which will identify key factors related to the various ‘tipping points’ in the user trajectory of use and decision making with constructed scenarios to determine opportunities for intervention development. These unique data will inform the design of credible public health and behaviour change interventions.

IV. Strategic relevance

This project will provide key insights into the decisions to use and continue to use, within the context of experienced, anticipated and potential harms across the life course. This work is original, innovative and of significant strategic importance in terms of informing the design of credible public health and age related and targeted behaviour change interventions and strategies.

V. Interdisciplinarity and fit with relevant DTA programme

The supervision team is cross-disciplinary - addiction, public health and sport psychology, with additional advice and from an international specialist psychiatrist and underpinned by a mix of experienced and early career researchers.

Applications

Applicants must apply using the online form on the University Alliance website at https://unialliance.ac.uk/dta/cofund/how-to-apply/. Full details of the programme, eligibility details and a list of available research projects can be seen at https://unialliance.ac.uk/dta/cofund/

The final deadline for application is Monday 8 October 2018. There will be another opportunity to apply for DTA3 projects in the spring of 2019. The list of available projects is likely to change for the second intake.