Awareness and Risk Behaviors Associated with Tribulus terrestris (Tt), Dietary Supplements, and Anabolic Steroids: Evidence from an Italian Questionnaire-Based Study.

Current Tribulus terrestris use was reported by 7.8% of respondents, while 10.5% declared ever using a Tt-containing product.

• Cross-sectional anonymous survey administered between May and October 2024 across Italian gyms and fitness clubs.
• 696 individuals initiated the questionnaire; after removal of duplicate, incomplete and ineligible entries, 510 responses were analyzed.
• Two indicators of Tt consumption were assessed: ever use and current use, with current use designated as the primary outcome.
• Survey was administered using Microsoft Forms.

Motivation was the only independent predictor of current Tribulus terrestris consumption in multivariable logistic regression.

• Motivation was statistically significant as a predictor (p = 0.012).
• The multivariable logistic regression entered sex, age category (18–24, 25–34, 35–44, ≥45 years), and motivation for supplement consumption as covariates.
• Neither sex (p = 0.918) nor age category (p = 0.519) significantly predicted Tt use.

Individuals reporting performance enhancement as their primary motivation were markedly more likely to currently use Tribulus terrestris compared with those using supplements for other purposes.

• Adjusted odds ratio for current Tt use among those motivated by performance enhancement was approximately 18.5 (p = 0.008).
• This finding held after adjustment for sex and age category in multivariable logistic regression.
• The result suggests performance-oriented expectations as the primary driver of Tt use in fitness settings.

Admission of anabolic steroid use was infrequent but was linked to online purchasing from potentially unregulated sources.

• Anabolic steroid use was reported infrequently among the 510 analyzed respondents.
• Those admitting anabolic steroid use were associated with online purchasing behavior from potentially unregulated sources.
• This pattern was identified within the same cross-sectional survey of recreational athletes in Italian gyms and fitness clubs.

The study identified a discrepancy between consumer beliefs about Tribulus terrestris and the scientific evidence regarding its efficacy and safety.

• Tt is described as a popular herbal supplement marketed to enhance fitness performance despite inconclusive evidence regarding its efficacy and safety.
• The authors characterize this discrepancy as suggesting a pressing need for educational interventions and regulatory vigilance in sports nutrition.
• Public health policy recommendations include improving label literacy, strengthening consumer protection, and countering misinformation within supplement marketing environments.
• The study was designed to address a lack of empirical data describing who actually uses Tt, for what purposes, and with what behavioral risks.