Abstract
Anabolic-androgenic steroids (AAS) are used for performance and image enhancement, yet their non-medical use in Australia is heavily criminalized and framed by sociocultural narratives that emphasize risk, deviance and harm. This study aimed to critically examine how people who use AAS experience these narratives, focusing on challenging their role in perpetuating stigma and reinforcing punitive responses. The study employed a peer-led approach to explore the lived-living experiences of people who use AAS in Australia. Semi-structured interviews were conducted with participants recruited through purposive sampling, leveraging the lead author's peer networks. The interview guide was designed to address sensitive topics, including law enforcement, health systems, and sociocultural attitudes. Data were analyzed using iterative categorization, followed by theoretical refinement of the developed categories. This process ensured the integration of participant accounts within broader sociopolitical discourses, recognizing the political dimensions of research. The analysis centred on a sample of 22 participants from Australia (Median age = 30 years, range: 19–49), with 91% identifying as men and 9% as women. It highlighted how media narratives portraying AAS use as linked to crime and deviance maintain stigma and contribute to their experiences of symbolic violence. These portrayals shape social perceptions of AAS consumption, reinforce self-stigma among consumers, and discourage open dialogue. Participants described how societal judgment can complicate AAS use, pushing people into informal, risky avenues. Despite a preference for legal and legitimate access, people face barriers rooted in punitive laws and healthcare resistance. This cycle marginalizes people who use AAS, denying them agency and support, while amplifying epistemic injustice and structural exclusion. We conclude by arguing against punitive narratives surrounding AAS use in Australia, advocating for inclusive, health-oriented approaches to policy. We call for peer-led approaches which may serve to dismantle symbolic violence and fostering respectful dialogue to support informed choices and wellbeing.
Introduction
Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone (Handelsman, 2013). While therapeutic use of AAS is permitted under strict medical supervision, non-medical use remains illegal in Australia and is met with stringent penalties, particularly in states like Queensland where AAS are classified as Schedule 1 drugs alongside substances like heroin and methamphetamine (Queensland Crime and Corruption Commission, 2021). Legislative changes over the past decade have increasingly criminalized AAS possession, contributing to a 218% rise in arrests between 2010 and 2020, with most arrests targeting consumers (Australian Criminal Intelligence Commission [ACIC], 2024). Despite these punitive measures, AAS use persists, driven by diverse motivations, including body enhancement, strength improvement, and identity-making practices (Dowsett et al., 2023; Fomiatti et al., 2019, 2020; James & Wynn, 2022; Kimergård & McVeigh, 2014; Latham et al., 2019). The dominant sociocultural narrative surrounding AAS, shaped by and reflected in media discourse, tends to focus on harm, risk, and deviance, often associating AAS use with violence, organized crime, and outlaw motorcycle clubs (van de Ven & Fomiatti, 2024). These narratives overshadow the lived-living experiences of AAS consumption, including the reported benefits such as improved confidence, enhanced body image, and a sense of belonging (Monaghan, 2002; Piatkowski & Cox, 2024; Santos & Coomber, 2017; Underwood, 2017). Simultaneously, stigma and criminalization marginalize people who use AAS, affecting their access to healthcare and harm reduction services (Cox et al., 2024; McVeigh & Bates, 2022; Zahnow et al., 2017). This dynamic underscores the need for research that critically examines the sociocultural constructions of AAS use, challenges punitive discourses, and explores alternative approaches to understanding and responding to AAS consumption. Therefore, this study aimed to critically examine how people who use AAS experience dominant sociocultural narratives surrounding AAS consumption in Australia. It focuses on challenging the ways these narratives perpetuate stigma and reinforce punitive responses.
Background
The use of AAS in Australia has been prohibited since 1986, except when prescribed by a licensed medical practitioner for legitimate therapeutic purposes (Handelsman, 2013). However, prior to legislative changes in New South Wales and Queensland in 2013 to 2014, certain types of AAS were listed under Schedule 4 of the Poisons List, resulting in limited prosecution for possession (James & Wynn, 2022; van de Ven & Zahnow, 2017). Since that time, some Australian jurisdictions have enacted legislation aligning these drugs with higher scheduling, carrying penalties of 15 to 25 years in prison for possession (James & Wynn, 2022; Piatkowski et al., 2024a; Queensland Crime and Corruption Commission, 2021). The medical literature frequently emphasizes the potential physiological risks associated with AAS use, including cardiovascular complications and blood-borne virus transmission (Corona et al., 2022; Linhares et al., 2022; van de Ven et al., 2018), as well as potential psychosocial harms such as depression (Nelson et al., 2022). However, this focus often overlooks the positive associations that many people who use AAS report, such as increased confidence, enhanced body image, and a sense of community (Gibbs et al., 2022; Monaghan, 2002; Underwood, 2017) which have produced a substantial growth in use those punitive responses struggle to curtail. While these accounts highlight the complex and multifaceted nature of AAS use, policies tend to focus solely on the potential harms, creating a dynamic where people who use AAS face stigma (Cox et al., 2024) and limited access to harm reduction services (Piatkowski et al., 2024b; Turnock & Mulrooney, 2023). This article critiques this internally inconsistent policy approach, which prioritizes punitive responses over health, despite the acknowledgment of risks that demand accessible, non-stigmatizing support systems. AAS consumers who seek medical advice frequently encounter significant barriers to receiving quality care and accurate information about these substances (Bates et al., 2021; Coomber-Moore et al., 2023; Cox et al., 2024; McVeigh & Bates, 2022; Piatkowski et al., 2023, 2025). These challenges stem from widespread gaps in medical and public health knowledge about AAS use (Dunn et al., 2023; Richardson & Antonopoulos, 2019; Zahnow et al., 2017) and varying levels of willingness among healthcare professionals to engage in education around AAS practices (Piatkowski et al., 2024b). In Australia, this reluctance has been linked to punitive legal frameworks surrounding AAS (Piatkowski et al., 2024a), which are often shaped by media-driven narratives about the risks and societal impacts of AAS use.
van de Ven and Fomiatti (2024) recently examined how the Australian news media problematizes AAS use. Based on a sample of 151 news articles from 2022, they concluded that these representations work to normalize criminalization and pathologization, overshadowing alternative policy responses like harm reduction and decriminalization (van de Ven & Fomiatti, 2024). Their findings chime with the simplistic media representations in Australia linking the use of AAS to violence and outlaw motorcycle clubs (OMCs, or ‘bikies’) such as the Bandidos. These narratives are further amplified through articles emphasizing police ‘crackdowns’ on bikies allegedly involved in AAS distribution (Huxley, 2016; Kyriacou & Stolz, 2013; Meers, 2014). Such media representations reinforce cultural perceptions that associate AAS use with violence, organized crime, and deviance. This cyclical relationship between media narratives and public perception not only perpetuates stigmatizing stereotypes but also feeds into societal and policy responses to AAS use, often framing it as a criminal justice issue rather than a public health concern. For instance, in response to violent incidents, both Queensland and New South Wales (NSW) adopted aggressive legislative measures targeting AAS, which were justified by linking them to violence and ‘bikie’ gangs. Using Queensland as an example, after a violent incident in a Gold Coast suburb and subsequent events in the wider Gold Coast region, the government introduced the Vicious Lawless Association Disestablishment (VLAD) Act in 2013, whereby the name of the act itself displays an unusual level of symbolic intent. The Queensland Police Service advocated for these new laws, claiming that most OMC members were involved in criminal activities and that OMCs were responsible for a significant portion of organized crime in Australia (Kyriacou & Stolz, 2013; Meers, 2014). Although the laws aimed to curb public violence and criminal activities associated with OMCs, then Premier Campbell Newman emphasized their intent to dismantle these groups entirely (Kyriacou & Stolz, 2013). In tandem with legislative responses to organized crime, Queensland's approach to AAS shifted significantly. This shift, for Goldsworthy and McGillivray (2015, 2017) can be attributed to the persistent entanglements between bikies and AAS as depicted in popular and media narratives, as well as for Meers (2014) the enactment of Queensland's VLAD legislation. Since 2014, Queensland has introduced stringent measures categorizing AAS as Schedule 1 drugs, equating them with illicit substances such as heroin, methamphetamine, and cocaine (Piatkowski et al., 2024a). These policy shifts illustrate how media-driven sociocultural narratives, combined with reactive legislative responses, have shaped the regulatory landscape surrounding AAS use.
For Australia as a whole, the current legislative approaches have seen some interesting outcomes for AAS specifically. Firstly, the weight of AAS seized in Australia increased 1,372%, from 33.7 kilograms in 2011–12 to a record 496.8 kilograms in 2020–21 (Australian Criminal Intelligence Commission [ACIC], 2024). Secondly, the number of national AAS arrests increased 267% over the last decade, from 365 in 2010–11 to 1365 in 2021 (ACIC, 2024). Thirdly, consumer arrests continue to account for the greatest proportion of arrests, accounting for 82% of national AAS arrests in 2020–21 (ACIC, 2024). What this demonstrates is that there is little impact of these disciplinary measures deterring end-consumers of AAS from continuing to use these drugs. Instead, we argue that this reflects a punitive approach based on exaggerated fears and misconceptions, leading to ineffective and harmful outcomes. Therefore, it is pertinent to find ways to map these misconceptions and offer new ways of representing and understanding AAS consumption which might reshape the sociocultural attitudes that seemingly underpin the current responses to it.
Approach
As Coomber (2014) argues, AAS policy is meaningfully framed by drug myths and fear-driven discourses that have long influenced broader drug policies. These approaches frame drugs and those who use them as inherently dangerous and morally corrupt, perpetuating myths—such as the belief that AAS are unequivocally harmful or that their use signifies moral failure. Such myths underpin “symbolic policymaking” (Coomber et al., 2019), which prioritizes performative actions—like punitive measures—over meaningful harm reduction. This performativity signals a tough stance on drugs and plays down genuine public health goals. One consequence of this approach is what Parkin and Coomber (2009), drawing on Bourdieu's concept of symbolic violence, describes as the criminalization and stigmatization of AAS consumers. This symbolic violence extends beyond legal penalties, creating a discursive environment that marginalizes people who use AAS and renders them less visible in public health frameworks, often leaving them as targets of control or moral panic (see van de Ven & Fomiatti, 2024). Such framing tends toward a pathologizing of this group (Nourse et al., 2024a), perpetuates stereotypes, undermines evidence-based approaches, and obscures the complex realities of AAS consumption.
The media plays a central role in sustaining and amplifying these myths, feeding into and reinforcing symbolic violence. As Parkin and Coomber (2009) highlight, media and policy are intertwined in a feedback loop: policy shapes media narratives, and media representations in turn legitimize policy directions. In the context of AAS, media depictions often sensationalize the risks associated with use, exaggerating health dangers and societal harms while framing ‘users’ as deviant or morally suspect. These depictions align with broader narratives positioning drug use as inherently dangerous (see Fraser & Moore, 2011), further entrenching punitive responses. Simultaneously, such representations diminish the cultural and social contexts of AAS use, particularly in environments where it is normalized as part of practices like body modification and identity-making (Fomiatti et al., 2019; James & Wynn, 2022; Latham et al., 2019).
kylie valentine et al. (2020) invite us to consider the way that lived-living experience is presented and framed in current discourses around illicit substance consumption. That is, the realities of people who use drugs are, in part, shaped by prevailing narrative frames, especially those of stigma, trauma, and deficit, which dominate the discourse around drug use (valentine et al., 2020). These ‘realities’ are also framed around expectations which settle on abstinence-based and recovery-centred stories as being those worthy of elevation in public discourse (see Farrugia et al., 2022). There are, however, many other ways to represent the diverse stories of people who use drugs, which do not force upon them a pre-defined and culturally acceptable frame of reference related to their experiences (see Fraser et al., 2022). Although alternative narratives do exist, stories about drug use or adversity are often constrained by these limited tropes (Seear & Mulcahy, 2022). valentine et al. (2020) have suggested that our responsibilities as researchers are ‘to represent the stories of our participants as they choose to tell them, and to frame their stories with analysis that contextualises their accounts and deepens our understanding’ (p. 203). It is with this responsibility in mind that we present analyses of the perspectives of people who use AAS in relation to the dominant social and cultural attitudes that surround AAS consumption in Australia.
Acknowledging the work of Suzanne Fraser (2020), we explicitly consider the research methods being used and the way they shape realities, rather than documenting singular or pre-existing realities. Adopting an ontopolitically-oriented perspective that prioritizes the active shaping of reality and challenges dominant power structures, allowed us to challenge these sociocultural narratives and carefully consider the realities we wish to research into being. This approach affords us the opportunity to recognize and elevate the lived-living experience that peer researchers bring, unconstrained by untenable aspirations to neutrality. By centring the focus of this work on recognizing the agency of people who use AAS we are seeking to make worlds which co-constitute responses to AAS that reflect the lived realities of people who use these drugs. Doing so is an attempt to challenge the prevailing punitive narrative and advocate for a discourse that provides new ways of knowing AAS consumption and, as such, may invite us all to consider new ways of responding to it. This change in thinking catalyzes a shift in social attitudes and cultural responses to AAS use in our communities and, by extension, may reduce the hostile environment which people who use AAS navigate in many parts of Australia.
Methods
Sampling and Recruitment
We recruited people aged 18 and over who were using AAS and were residents of Australia. Recruitment took place between October and December 2023 using purposive sampling techniques. The lead author leveraged his personal and professional networks within the AAS-using community, fostering trust and credibility essential for engaging this hard-to-reach population. Recruitment was conducted through multiple channels including direct outreach via professional networks, consultations with community peers, and broader promotion through social media platforms and face-to-face interactions at gyms. Potentially interested parties reached out to the lead author or were contacted via email to arrange the interview. Ethical approval was granted from the Griffith University Human Research Ethics Committee (Approval: 2023/248).
To address ethical concerns, the research adhered to rigorous protocols designed to protect participants from risks such as police targeting, stigma, or legal repercussions. Recruitment and data collection were conducted in a way that preserved participants’ confidentiality, with all identifying details removed from transcripts, and any video and/or audio deleted immediately after transcription had been checked by the lead author. The lead author has a longstanding history in collaborative research with this community which prioritizes safety, confidentiality, and maintains the spirit of solidarity and authenticity between him and his community.
Data Collection
Semi-structured qualitative interviews were the carefully chosen method to navigate the sensitive nature of AAS use and to foster an open and empathetic dialogue. A single interviewer carried out all interviews using a semi-structured guide developed collaboratively with AAS-using community members, incorporating insights from existing literature and the lead author's lived-living experience with AAS. This approach ensured that the questions were not only academically grounded but also deeply resonant with the realities and challenges faced by people who use AAS. This perspective influenced the framing and sequencing of questions to ensure sensitivity to participants’ lived realities, particularly regarding their interactions with law enforcement, health systems, and the social and cultural attitudes of people more generally toward AAS. Firstly, participants were asked for demographic information, such as their geographical location, age, and gender. They were then asked questions regarding their experiences with AAS, law and governing policy, as well as social and cultural attitudes. Example questions included: Did your steroid use ever result in any issues with police? Did you ever have to go to court as a result? What do you think of the relationship between steroids and crime? Does it have anything to do with aggression/violence? Does the fact that they are illegal cause you to change how you go about your use of them? Is there anything you would like to see done differently to support steroid consumers better? These interviews took a mean length of 40 minutes (range: 20–78 minutes) to complete and were conducted on the MS Teams platform, where audio recordings were transcribed automatically. These transcripts were then checked for errors and corrected, and subsequently imported into NVivo (QSR, v12) for further analysis. Participants were reimbursed for their time with an AUD$50 gift card.
Data Analysis
This project and its analysis were informed by a peer-led approach (Piatkowski et al., 2024c, 2025), drawing on the lead author's lived-living experience with AAS and his status as a peer researcher embedded within AAS-using communities. This innovative approach transformed both the methodology and content of the research. This lived-living experience assisted to bridge narrative worlds and helped in the interpretation of meaning that might otherwise be missed. Data were analyzed using iterative categorization (Neale, 2016, 2021), an approach that complemented the peer-led framework of the research. Initially, the lead author generated detailed notes to discern interconnections between participant accounts, prioritizing and categorizing codes through iterative engagement with the transcripts. These codes were then organized into overarching theme-categories that captured coherent narratives, setting the stage for deeper interpretive work (Neale, 2021).
The analysis specifically examined how participants’ experiences were influenced by dominant sociocultural narratives, which frequently perpetuate symbolic violence through stigma and criminalization. Reflexive engagement with the author's own AAS consumption practices and experiences within these systems during his use, enriched this process. This process was further enriched through collaboration with the research team, who undertook theoretical testing and refinement of the developed categories. Their contributions offered deeper reflection on participants’ experiences and helped situate these within the broader systems and structures shaping stigma, symbolic violence, and marginalization. The deeper theoretical work then allowed for a positioning of the participant accounts within the broader discourse on the multiple forces (e.g., law, policy) and actors (e.g., media, health care providers, policymakers) and, subsequently, challenging those discourses. These processes reflect our broader commitments to ‘bringing worlds into being’, ensuring that the research actively works to shape more inclusive and person-centred responses (see Fraser, 2020). Through this approach, two dominant theme-categories emerged. These categories provide the organizational framework for presenting the findings.
Results and Discussion
A sample of 22 people who used AAS (Mean age = 34.8, SD = 7.6; median age = 30, range 19–49) were interviewed. The sample predominantly identified as men (n = 20) with two participants identifying as women.
Media and Sociocultural Narratives
The media's portrayal of AAS use often links it to organized crime and violence, which participants identified as influencing cultural attitudes. Most respondents felt similarly about how the media positioned AAS and the ‘AAS user’. James provides what might be considered a typical response: James [27, Male]: Like, the media thing, they’re just trying to, like, make steroid users look worse than they are because, “ohh, some bikies sell them” kind of thing. Most people are on steroids and they’re not out fucking, you know, bashing people or stabbing people [or] robbing people and shit […] You’re not really a danger to anyone if you’re on steroids. James [27, Male]: I think that stuff makes people change the way they talk about it [AAS use]. They are doing a bit, a [bit] better job of it these days where like people are talking about it [steroids] more but they’re replacing it saying supplements and stuff like that. And I’m included in that, like, I take steroids, but I don’t like to fully discuss it because you’ll get looked at weird or you’ll get in shit.
Ian reflected on the disconnect between these media-driven narratives and the lived-living experiences of people who use AAS: Ian [27, Male]: I would say that's all media propaganda. I used to hang out with like proper, proper crims [criminals] and like maybe like one or two of them were on the steroids, but like, they’re doing other shit I don’t think they give a fuck about steroids. Matthew [29, Male]: The way people see us [AAS consumers], see it [AAS use] […] I think it’s all heavily media fuelled. I think you’ll find the large majority of users do not deal or do not distribute, they acquire for personal use.
Negotiating the Lived Reality of Symbolic Violence
We argue that, at the centre of Australia's sociocultural narratives around AAS lies an undercurrent of symbolic violence, where social and cultural influence has led to the creation of a hostile environment that stigmatizes people who use AAS. These sociocultural narratives maintain power by making certain experiences—like AAS use—seem naturally deviant or morally suspect. This dynamic operates through the internalization of stigma, compounding the external structural and cultural barriers people face. Most respondents felt similarly to Adrian, who linked the external stigma imposed by societal narratives to the internal experience of self-stigma, highlighting the isolating and criminalizing effects of such perceptions: Adrian [28, Male]: It does make it harder, like to be able to like just use them [steroids] in general, And then like it is because of the stigma. I mean it is illegal. Like I feel like “ohh, I have to get steroids and shit”. It kind of like makes you feel like you are like a criminal. Charlie [37, Male]: It [laws] does make it [AAS use] more challenging because you’ve got the two choices—you’re getting shit from the black market or you have to jump through all the hoops to get it through a legitimate source through a doctor or endocrinologist and anything like that. And there's a lot of people missing out because they’re right on the cusp of clinically low testosterone. But the doctor turns around and says: no, you’re fine. You’re sweet. You’re in the range. And it's like clearly not because they’re struggling and they hate their life. Zed [47, Male]: Yeah, it makes it harder to get and it makes it harder to get good stuff. Good quality stuff. I mean, there's a lot of online sources now where you can buy stuff and it gets delivered to your doorstep, which is good. George [26, Male]: You know, it's very big legal implications. For example, like, it's always in the back of my mind if I’m carrying steroids, I’ve brought it on planes before, I’ve travelled with it because I have competitions. I don’t want to leave it at home because you need it for performance. You’ve committed to [using] it […] I can’t get it legally, so I don’t. But if I could I would. Man, do you wanna know, if there was a way for me to get it legally I 100% would get it legally because, well, then I’m safe from getting in legal trouble for something I don’t think I’m doing wrong.
Such narratives illustrate how the broader sociocultural and legal context reinforces a cycle of marginalization. The criminalization of AAS use and the structural barriers to legal access perpetuate a sense of deviance, forcing individuals into informal, and often risky, channels. At the same time, the stigma embedded in these structures denies people who use AAS the legitimacy and agency they seek, amplifying their experiences of precarity and exclusion. This denial of agency can be understood as a form of epistemic injustice (Fricker, 2007), where peoples lived-living experiences are dismissed or invalidated by dominant cultural and institutional narratives. The current narratives, however, underscore the broader implications of this dynamic: the need for a system that does not equate use with criminality, where people can engage openly and seek assistance without fear of legal or social repercussions. However, the continued entrenchment of cultural narratives and the hostile environment that reinforces them ensures that this aspiration remains out of reach for many, perpetuating a cycle of stigma and symbolic violence.
Conclusions
This analysis sought to critically examine how people who use AAS experience prevailing sociocultural narratives surrounding AAS consumption in Australia. We have explored the intersections of these narratives and the lived-living experience of people who use AAS, in the hope of challenging entrenched assumptions. The traditional punitive approaches to AAS consumption, shaped by myths, moral panic, and symbolic violence, have contributed to the criminalization and marginalization of people who use AAS. As van de Ven and Fomiatti (2024) suggest, these discourses not only perpetuate harmful stereotypes but also obscure the realities of AAS use, preventing the implementation of effective, evidence-based approaches and forms of care. The role of the media in amplifying these punitive narratives is clearly the key. By sensationalizing the risks associated with AAS use and framing people who use these drugs as violent criminals, the media reinforces a public discourse that prioritizes fear and control over care. Yet, as scholars (Dowsett et al., 2023; Fomiatti et al., 2019, 2020; Latham et al., 2019; Piatkowski et al., 2020; Underwood, 2017) point out, AAS use is also often situated within social and cultural contexts, such as body modification and enhancement practices, that challenge these oversimplified portrayals. When we do not elevate the reality of these complexities they are diminished or even erased; then media representations gain a stronger hold and contribute to social perceptions that remain hostile and uninviting to those who use AAS.
We have drawn on valentine et al.’s (2020) prompts, actioning them in such a way as to argue that lived-living experiences, particularly those of people using AAS, must be re-presented in ways that go beyond the dominant sociocultural narratives. This is not only about giving voice to people who use drugs but about actively engaging with their agency and subjectivity (Fraser, 2020). The agency of people who use AAS must be recognized, not as passive subjects of policy but as active agents capable of using their own experiences and responses to meaningfully inform and contribute to the framing of AAS consumption and policy surrounding it. In doing so, we challenge the prevailing punitive discourse and open the door to alternative ways of knowing and responding to AAS consumption—ways that are rooted in care, respect, and recognition of the full humanity of those involved.
By disrupting the hostile, marginalizing environment that commonly frames AAS use in Australia, we advocate for creating a more inclusive, health-oriented discourse. In doing so, we move closer to dismantling the symbolic violence that continues to stigmatize people who use AAS, fostering more supportive environments where they can make informed choices about their bodies and health. However, the work of transforming the cultural attitudes related to AAS requires both a reimagining of the narratives surrounding drug use and a fundamental shift in how we engage with people who use AAS. By prioritizing lived-living experiences and elevating the agency of people who use AAS we open up new possibilities for policy, moving beyond the limitations of punitive frameworks toward ones that reflect the experiences of people who use AAS and provide a more just, informed, and compassionate response to their needs.
By extension, this means a shift from reactive harm reduction to proactive approaches which position people who use AAS at the centre of the discourse concerning them. We believe that initiating dialogue between law enforcement, policymakers, and AAS consumers is essential for developing effective and efficient approaches to addressing AAS-related issues. Dialogue with vulnerable groups, particularly those who are perceived as ‘victims,’ has become an increasingly accepted practice in policy and intervention development. This is evident in the growing inclusion of lived-living experience in areas such as policing and public health strategies. For example, in the UK, lived experience is now incorporated into efforts to design interventions and inform policy responses (Grenfell et al., 2023; Speakman et al., 2023). Similar trends can also be observed in other regions globally (Daowd et al., 2024; Forchuk et al., 2023), where the voices of vulnerable groups are increasingly recognized as critical to the success of harm reduction and public health initiatives. However, despite this shift, people who use AAS are often excluded from such frameworks (Piatkowski & Dunn, 2024). This exclusion is deeply tied to enduring myths and stereotypes about AAS use, as well as the symbolic violence perpetuated through their criminalization. While other groups are positioned as victims whose voices demand to be heard, people who use AAS are frequently denied the same legitimacy, leaving them marginalized in discussions that shape harm reduction and health policy. This article argues that, in many ways, AAS consumers are victims of symbolic violence and, as such, their voices must be equally recognized in developing health enhancing and harm reducing interventions. However, such dialogues are challenging to implement unless AAS consumers can engage in a safe and anonymous manner. Creating less-hostile environments for open communication or ensuring community representation is crucial for meaningful and productive interactions. While education (Bates et al., 2021) and access to harm reduction services (Bates et al., 2022) are crucial for mitigating potential risks associated with AAS use, these approaches are currently not sufficient in Australia (Piatkowski et al., 2024a, 2024b). Drawing on recent work from Nourse et al. (2024b) we may look toward positioning people who use AAS as ‘co-experts’. However, this shift requires a comprehensive and evidence-based AAS policy strategy, co-designed with people who use these substances, informed by their lived-living experiences, and centring on a health enhancing approach. While challenging stereotypes and reducing stigma are critical, we recognize that policy change is a complex, multifaceted process. It requires coordinated efforts across sectors, stakeholder engagement, and sustained political will. A nuanced strategy must account for the intricacies of policymaking, ensuring that any changes are both realistic and achievable, while still prioritizing the needs and wellbeing of people who use AAS.
Footnotes
Acknowledgements
The authors thank the communities of people who use anabolic steroids for sharing their time and expertise. This research would not be possible without them.
Data Availability Statement
This data is confidential given the nature of the research.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval and Informed Consent Statements
Participants provided informed verbal consent prior to conducting the interview. Ethical approval was granted from the Griffith University Human Research Ethics Committee (Approval: 2023/248).
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a Griffith University New Researcher Grant.
