Challenges recruiting men with a desire to cease anabolic-androgenic steroid use to a pilot involving hormone therapy intervention

IntroductionLong-term use of anabolic-androgenic steroids (AAS) might lead to distressing withdrawal symptoms following cessation. This paper aims to share challenges in recruiting patients to a pilot intervention study with parallel substance use disorder (SUD) treatment and to explore barriers to participation among AAS forum members.MethodsEligible AAS-dependent men were recruited to receive hormone therapy for 16 weeks, and exclusion reasons were registered. Audience engagement from social media advertisements was measured. Information about the study was posted in an AAS online forum, and discussion among forum members was thematically analyzed.ResultsTwelve of 81 potential participants were included, whereas ten completed the intervention. Participants were excluded due to residency outside the study area, illicit substance use or severe medical conditions. Challenges in recruitment were linked to the COVID-19 pandemic, funding and advertisements on social media. AAS forum members suggested modifications to the intervention, were skeptical to the SUD-patient requirement, feared prosecution or other negative outcomes and/or preferred to seek online advice on self-initiated testosterone replacement therapy or post cycle therapy.ConclusionAAS-related online recommendations among peers, criminalized AAS use setting and obligatory SUD treatment might have affected recruitment. Based on lessons learned, recommendations for future similar studies are presented.