{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T10:59:27Z","timestamp":1785236367632,"version":"3.55.0"},"reference-count":74,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Image and performance\u2010enhancing drugs (IPEDs) include agents such as androgens, growth hormone, and erythropoietin, which are used to enhance appearance and physical performance. Androgens, also known as anabolic\u2010androgenic steroids (AAS), are the most used IPEDs worldwide. While historically associated with elite athletes, androgen abuse is now widely prevalent among recreational athletes, with a lifetime prevalence of 6.4% in men. Androgens, testosterone and its derivatives, promote muscle growth, lipolysis and haematopoiesis and, thus, physical strength, endurance, and muscularity. However their abuse is associated with significant adverse effects across multiple organ systems. Androgen abuse is associated with cardiovascular complications, hepatic dysfunction, psychiatric disorders, and endocrine disruption, notably suppression of the hypothalamic\u2010pituitary\u2010gonadal axis, leading to androgen\u2010induced hypogonadism. Symptoms of androgen\u2010induced hypogonadism, such as fatigue, low mood, and sexual dysfunction, are common following cessation and may persist for months to years even when there has been biochemical recovery. Psychiatric disorders include mood disorders, anxiety and suicidality, highlighting the complexity of androgen withdrawal management. Current clinical approaches prioritise complete cessation, supported by non\u2010judgmental, multidisciplinary care. Management strategies include \u2018watch\u2010and\u2010wait\u2019 for hormonal recovery, although this can be prolonged and is not always associated with restoration of well\u2010being. Pharmacological interventions include selective oestrogen receptor modulators, hCG, aromatase inhibitors or prescribed testosterone therapy. These therapies remain unlicensed and lack robust evidence, with treatment outcomes that are uncertain and highly variable. Psychological support and harm\u2010reduction services, play a key role in engagement. In the absence of standardised guidelines and the increasing burden of androgen\u2010related harm, further research is essential to optimise evidence\u2010based care for affected individuals.<\/jats:p>","DOI":"10.1111\/cen.70181","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T10:07:44Z","timestamp":1785233264000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Current Approaches to Support Patients to Withdraw From Image and Performance Enhancing Drugs"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7069-7497","authenticated-orcid":false,"given":"Elizabeth","family":"Hyams","sequence":"first","affiliation":[{"name":"Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1121-9211","authenticated-orcid":false,"given":"Bonnie","family":"Grant","sequence":"additional","affiliation":[{"name":"Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4842-8095","authenticated-orcid":false,"given":"Richard","family":"Quinton","sequence":"additional","affiliation":[{"name":"Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2578-8223","authenticated-orcid":false,"given":"Channa N.","family":"Jayasena","sequence":"additional","affiliation":[{"name":"Section of Investigative Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Image and Performance Enhancing Drugs: 2016 National Survey Results","author":"Begley E.","year":"2017"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1032"},{"key":"e_1_2_12_4_1","volume-title":"Image and performance enhancing drugs: 2016 National Survey Results","author":"Begley E.","year":"2017"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2013-1058"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-093526"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2014.01.009"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06751-3"},{"key":"e_1_2_12_9_1","first-page":"2000","volume-title":"Endotext [Internet]","author":"Handelsman D. J."},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.steroids.2008.10.016"},{"key":"e_1_2_12_11_1","first-page":"7497346","volume-title":"Journal of Sports Medicine (Hindawi Publ Corp)","author":"Ding J. B.","year":"2021"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2014.02.002"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad164"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.15187"},{"issue":"1","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.drugalcdep.2010.01.011","article-title":"Treatment of Anabolic\u2010Androgenic Steroid Dependence: Emerging Evidence and its Implications","volume":"109","author":"Kanayama G.","year":"2010","journal-title":"Drug and Alcohol Dependence"},{"issue":"1","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","DOI":"10.1530\/RAF-22-0097","article-title":"Survey of Endocrinologists Managing Recovery From Anabolic Androgenic Steroid Induced Hypogonadism","volume":"4","author":"Grant B.","year":"2023","journal-title":"Reproduction and Fertility"},{"issue":"1","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13011-023-00528-z","article-title":"Health Service Engagement, Side Effects and Concerns Among Men With Anabolic\u2010Androgenic Steroid Use: A Cross\u2010Sectional Norwegian Study","volume":"18","author":"Henriksen H. C. B.","year":"2023","journal-title":"Substance Abuse Treatment, Prevention, and Policy"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13843"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-023-00573-8"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.peh.2024.100283"},{"issue":"12","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","DOI":"10.1530\/EC-23-0358","article-title":"Physical, Psychological and Biochemical Recovery From Anabolic Steroid\u2010Induced Hypogonadism: A Scoping Review","volume":"12","author":"Solanki P.","year":"2023","journal-title":"Endocrine Connections"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12850"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz324"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa366"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.124.071117"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2021.732318"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2008.00271.x"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.26636"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-24-0283"},{"issue":"1","key":"e_1_2_12_30_1","article-title":"Perturbation of the Hematopoietic Profile by Anabolic Androgenic Steroids","volume":"2014","author":"Mullen J. E.","year":"2014","journal-title":"Journal of Hormones"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-015-9320-5"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13048"},{"issue":"1","key":"e_1_2_12_33_1","first-page":"A5688","article-title":"Beefing Up! Fulminant Liver Failure Secondary to Anabolic Steroid Use","volume":"209","author":"Santosh N.","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2022.101691"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.23287"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2017.03.008"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yhbeh.2009.09.006"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.12850"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2009.02734.x"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.4103\/aja2024104"},{"issue":"11","key":"e_1_2_12_41_1","doi-asserted-by":"crossref","first-page":"2638","DOI":"10.1177\/0363546515602010","article-title":"Ruptured Tendons in Anabolic\u2010Androgenic Steroid Users: A Cross\u2010Sectional Cohort Study","volume":"43","author":"Kanayama G.","year":"2015","journal-title":"American Journal of Sports Medicine"},{"key":"e_1_2_12_42_1","article-title":"Nice, Needle and Syringe Programmes Public Health Guideline Reference Number","volume":"52","author":"National Institute for Health and Care Excellence","year":"2014","journal-title":"PH"},{"key":"e_1_2_12_43_1","volume-title":"Swedish Clinical Guidelines On: The Abuse of Anabolic Androgenic Steroids and Other Hormonal Drugs","author":"Arver S.","year":"2013"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-015-0006-5"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.5534\/wjmh.190002"},{"issue":"1","key":"e_1_2_12_46_1","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1186\/s12889-022-13734-4","article-title":"Fake Anabolic Androgenic Steroids on the Black Market \u2013 a Systematic Review and Meta\u2010Analysis on Qualitative and Quantitative Analytical Results Found Within the Literature","volume":"22","author":"Magnolini R.","year":"2022","journal-title":"BMC Public Health"},{"key":"e_1_2_12_47_1","unstructured":"(NICE). N.I.f.H.a.C.E. Polycythaemia\/Erythrocytosis: Diagnosis. Clinical Knowledge Summaries. London: NICE Last Revised in September 2024."},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-01882"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad164"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68614-5"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/and.14576"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12890"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12641"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xfre.2025.03.001"},{"issue":"1","key":"e_1_2_12_55_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12954-019-0343-1","article-title":"Treatments for People Who Use Anabolic Androgenic Steroids: A Scoping Review","volume":"16","author":"Bates G.","year":"2019","journal-title":"Harm Reduction Journal"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1177\/0091450921998701"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7517-11-19"},{"issue":"1","key":"e_1_2_12_58_1","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1186\/s12889-019-7288-x","article-title":"Support for People Who Use Anabolic Androgenic Steroids: A Systematic Scoping Review Into What They Want and What They Access","volume":"19","author":"Harvey O.","year":"2019","journal-title":"BMC Public Health"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.16643"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102876"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1080\/14659891.2016.1179806"},{"issue":"1","key":"e_1_2_12_62_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1159\/000012362","article-title":"Psychiatric and Medical Effects of Anabolic\u2010Androgenic Steroid Use in Women","volume":"69","author":"Gruber A. J.","year":"1999","journal-title":"Psychotherapy and Psychosomatics"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0080"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e3181fb5370"},{"issue":"5","key":"e_1_2_12_65_1","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/0002-9378(91)90374-Z","article-title":"Endocrine Effects in Female Weight Lifters Who Self\u2010Administer Testosterone and Anabolic Steroids","volume":"165","author":"Malarkey W. B.","year":"1991","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjp.2008.99"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1177\/19417381231197389"},{"issue":"1","key":"e_1_2_12_68_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s40798-024-00697-6","article-title":"Metabolic Consequences of Anabolic Steroids, Insulin, and Growth Hormone Abuse in Recreational Bodybuilders: Implications for the World Anti\u2010Doping Agency Passport","volume":"10","author":"Di Girolamo F. G.","year":"2024","journal-title":"Sports Medicine \u2010 Open"},{"key":"e_1_2_12_69_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241252435"},{"key":"e_1_2_12_70_1","first-page":"1634799","volume-title":"Front Endocrinol (Lausanne)","author":"Bond P.","year":"2025"},{"key":"e_1_2_12_71_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvad027"},{"key":"e_1_2_12_72_1","doi-asserted-by":"publisher","DOI":"10.1002\/dta.3923"},{"key":"e_1_2_12_73_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac223"},{"issue":"5","key":"e_1_2_12_74_1","article-title":"Clenbuterol Abuse in Bodybuilding and Athletics: Unsupervised Use, Psychological Motivations, and Health Consequences","volume":"17","author":"Kataveni S.","year":"2025","journal-title":"Cureus"},{"key":"e_1_2_12_75_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.13585"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.70181","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cen.70181","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.70181","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T10:07:49Z","timestamp":1785233269000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.70181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":74,"alternative-id":["10.1111\/cen.70181"],"URL":"https:\/\/doi.org\/10.1111\/cen.70181","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"2025-11-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cen.70181"}}