The CASTRO Study: Unsafe Sexual Behaviors and Illicit Drug Use Among Gay and Bisexual Men Who Use Anabolic Steroids

Background And Objectives: The majority of anabolic androgenic steroid (AAS) studies have focused on the general male population. Approximately 15% of gay or bisexual men are seropositive for HIV and many AASs are administered via injection. Thus, AAS use among gay and bisexual men likely poses a greater risk of spreading infectious disease. Gay and bisexual men who use AAS were compared with non-users regarding self-reported seropositivity for HIV and hepatitis B and C, sexual behaviors and injection practices, illicit drug and alcohol use, and psychiatric disorders.

Methods: The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey of 153 gay and bisexual men who exercise. Data collection occurred outside four gyms in the San Francisco Castro District.

Results: The lifetime prevalence of AAS use among gay and bisexual men in the study was 21.6%. AAS users and non-users did not differ in self-reported seropositivity for HIV or hepatitis B and C, but AAS users reported higher rates of male-male condomless anal sex in the past year (84.8 vs 60.8%, p < .01) than non-users. More AAS users used ecstasy and methamphetamines (39.4 vs 16.7%, p < .01 and 18.2 vs 5.0%, p = .01, respectively) than non-users.

Discussion And Conclusions: Gay and bisexual men who used AAS were more likely to engage in unsafe sexual behaviors and use illicit drugs relative to non-users. Multiple factors place AAS users at higher risks for spreading infectious diseases.

Scientific Significant: Our study suggests increased infectious disease risk among gay and bisexual men who use AAS. (Am J Addict 2019;XX:1-10).