Approach to the Young Male Patient Who Abuses Androgens: Harm Reduction as a Clinical Strategy.

Nonmedical androgen use is increasingly encountered in clinical practice, particularly among young men engaging in strength training.

• Many users present with androgen-related complaints or complications.
• Clinician unfamiliarity, stigma, or the perceived need for abstinence as a condition for care limits medical support for this population.
• The paper identifies a growing gap between clinical care and user behavior.

A nonjudgmental diagnostic approach is recommended as the foundation for engaging with androgen-abusing patients in clinical practice.

• The framework emphasizes avoiding stigma and not requiring abstinence as a precondition for care.
• Two parallel management strategies are outlined depending on patient motivation to discontinue use.
• The approach draws on extensive clinical experience rather than randomized trial data.

For individuals motivated to discontinue androgen use, structured monitoring and psychological support are key components of management.

• The goal of this strategy is facilitating hormonal recovery and reducing relapse risk.
• Testosterone replacement therapy (TRT) should only be considered if biochemical hypogonadism with symptoms persists after at least 12 months of abstinence.
• TRT in this context should be administered in line with standard clinical guidelines.

For patients unwilling or not yet ready to stop androgen use, a harm reduction approach is proposed to minimize health risks.

• Harm reduction recommendations include dose reduction, compound selection, cycle structuring, and cardiovascular risk management.
• This approach is presented as a realistic and ethical response rather than requiring abstinence.
• Cardiovascular risk management is specifically highlighted as a component of harm reduction.

The dual strategy of supporting cessation where possible and mitigating harm where possible is framed as an ethical and practical clinical framework.

• The framework is intended to bridge the current gap between clinical care and user behavior.
• The approach acknowledges that some patients are not ready or willing to stop androgen use.
• The article outlines these strategies as complementary rather than mutually exclusive.