“Big-blast, little-blast”: Risk neutralization strategies for sustaining masculinity by older men who use anabolic androgenic steroids (OMAAS)

UK research in the past decade has indicated the emergence of a cohort older men who use anabolic androgenic steroids (OMAAS), with studies suggesting OMAAS are motivated to use for aesthetics, performance enhancement, to combat the effects of ageing, and for perceived testosterone replacement therapy associated with wellbeing. Currently, there is a lack of information on the experiences and perspectives of harm reduction workers who support OMAAS at needle and syringe programmes in the UK. Semi-structured in-depth interviews ( N = 13) with harm reduction workers were conducted to explore their experiences of engagement with OMAAS and how they view their healthcare and support needs. The analysis generated four key themes with subthemes: 1) AAS Use Patterns of Older Men Accessing Healthcare Services; 2) Motivations for AAS Use; 3) Adverse Health Effects; 4) and Healthcare Responses to OMAAS. Two higher levels of abstraction centred on ‘ risk neutralization’ and ‘masculinity’ were identified above the theme level and were described by all harm reduction workers in distinct ways throughout the findings. They focused on scapegoating, self-confidence, and risk comparison as strategies to uphold masculine values and identity through AAS use. The findings are useful in informing AAS specific training for harm reduction workers, medical and healthcare professionals, and age-appropriate healthcare and treatment pathways specific to the needs of OMAAS who engage in risk neutralization techniques to conform to traditional masculine norms. There is a need for accessible, adequate, non-judgemental AAS-specific treatment and care pathways for OMAAS. Needle and syringe programmes should be developed to implement and evaluate interventions such as blood testing, cardiac monitoring, substance testing, and rapid access and referral pathways for medical support. Medical professionals and harm reduction workers at needle and syringe programmes are urged to address issues with OMAAS’ perceptions of masculinity to help prevent and encourage safer use. • Medical professionals and harm reduction workers at NSPs are urged to address issues with OMAAS’ perceptions of masculinity to help prevent and encourage safer use of AAS by older men. • There is a need for accessible, adequate, non-judgemental AAS-specific treatment and care pathways for older men who use AAS in UK healthcare. • Needle and syringe programmes and harm reduction services in the UK should implement blood testing, cardiac monitoring, substance testing, and rapid access and referral pathways for medical support.