Anabolic-Androgenic Steroid Use Among Gym-Goers

Anabolic-androgenic steroid (AAS) use for aesthetic and performance-enhancing purposes has become an increasingly recognized problem among recreational and competitive gym-goers worldwide, with prevalence reported to be substantially higher in bodybuilding and fitness-center populations than in the general population. Non-medical AAS use is associated with cardiovascular disease, hepatotoxicity, endocrine disruption, and psychiatric sequelae including depression, aggression, and dependence. Despite this burden, few theory-driven behavioral interventions targeting AAS use in gym settings have been rigorously evaluated.

The Transtheoretical Model (TTM) proposes that behavior change unfolds through a sequence of stages (precontemplation, contemplation, preparation, action, and maintenance), and that interventions matched to an individual's current stage - using stage-specific processes of change, decisional balance, and self-efficacy strategies - are more effective than generic, one-size-fits-all education. TTM-based interventions have demonstrated efficacy in other health behaviors such as smoking cessation, weight management, and physical activity promotion, but their application to AAS use reduction among gym-goers remains limited.

This study will be conducted as a randomized controlled trial at fitness centers/gyms in Mosul city, Iraq. A total of [N, e.g., 120] adult gym-goers who report current or recent non-medical AAS use, or who are identified as being at risk of AAS use, will be enrolled and randomly assigned to one of two groups: a TTM-based intervention group or a control group. The intervention group will receive a structured, multi-session program of individualized counseling matched to participants' baseline stage of change, incorporating motivational interviewing techniques, decisional-balance exercises, and self-efficacy building strategies delivered over [e.g., 8 weeks]. The control group will receive standard printed health education materials on the risks of AAS use.

Data will be collected using validated self-report questionnaires assessing stage of change (e.g., a URICA-type or AAS-adapted staging algorithm), decisional balance (pros and cons of AAS use), self-efficacy to resist AAS use, and self-reported AAS use behavior (frequency, dose, and duration). Assessments will occur at baseline, immediately post-intervention, and at a follow-up time point. The study will compare the effect of the TTM-based intervention versus control on stage progression and AAS use behavior, and will examine the relationship between stage of change, decisional balance, self-efficacy, and actual reduction or cessation of AAS use.

Inclusion criteria

● Adult gym members regularly attending the study fitness center(s)

● Male or female, aged 18 years or older

● Current or past-year non-medical use of anabolic-androgenic steroids, or identified as at risk of initiating use

● Willing to participate and provide informed consent

● Able to attend the assigned intervention sessions and complete study assessments

Exclusion criteria

● Nurses/participants who do not agree to participate in the study

● Use of AAS under current medical supervision/prescription for a diagnosed condition

● Not available during the study intervention or follow-up period

● Unable to attend the assigned intervention sessions

● Do not complete the required study assessments

● Participated in the pilot study