Awareness and Risk Behaviors Associated with Tribulus terrestris (Tt), Dietary Supplements, and Anabolic Steroids: Evidence from an Italian Questionnaire-Based Study

<b>Background</b>: <i>Tribulus terrestris</i> (<i>Tt</i>) is a popular herbal supplement marketed to enhance fitness performance, despite inconclusive evidence regarding its efficacy and safety. This study aimed to investigate the prevalence of TT use, awareness, and motivations for its use among recreational athletes in Italy, helping to address the lack of empirical data describing who actually uses <i>Tt</i>, for what purposes, and with what behavioral risks. <b>Methods</b>: A cross-sectional anonymous survey was administered between May and October 2024 across Italian gyms and fitness clubs using Microsoft Forms. A total of 696 individuals initiated the questionnaire; after removal of duplicate, incomplete and ineligible entries, 510 responses were analyzed. Two indicators of <i>Tt</i> consumption were assessed: ever use and current use, with the latter designated as the primary outcome. A multivariable logistic regression evaluated predictors of current <i>Tt</i> use, entering sex, age category (18-24, 25-34, 35-44, ≥45 years), and motivation for supplement consumption. <b>Results</b>: Current <i>Tt</i> use was reported by 7.8% of respondents, while 10.5% declared ever using a <i>Tt</i>-containing product. Motivation was the only independent predictor of <i>Tt</i> consumption (<i>p</i> = 0.012). Individuals reporting performance enhancement as their primary motivation were markedly more likely to currently use <i>Tt</i>, compared with those using supplements for other purposes (adjusted OR ≈ 18.5; <i>p</i> = 0.008). Neither sex (<i>p</i> = 0.918) nor age category (<i>p</i> = 0.519) significantly predicted <i>Tt</i> use. Admission of anabolic steroid use was infrequent but was linked to online purchasing from potentially unregulated sources. <b>Conclusions</b>: <i>Tt</i> consumption in fitness settings is driven predominantly by performance-oriented expectations rather than demographic characteristics. The observed discrepancy between consumer beliefs and scientific evidence suggests a pressing need for educational interventions and regulatory vigilance in sports nutrition. Public health policies should focus on improving label literacy, strengthening consumer protection, and countering misinformation within supplement marketing environments.