Contrary to the caricature, when users of non-prescribed steroids walk into Beng Eu's clinic, their shoulders aren't stuck in the doorframe.
Rather, world-first research led by the Melbourne GP and released this week suggests anabolic-androgenic steroids users appear much like the rest of the population.
"It's not your huge bodybuilder necessarily that is using anabolic steroids," Dr Eu says.
Their body mass index is about 28, resembling that of the average Australian and users of prescribed testosterone.
But under the surface, health risks emerge.
Compared to the average population, the non-prescribed users examined after walking into six GP clinics across the country had increased risks of blood clots, abnormal liver function and high cholesterol.
The rate of hypertension even exceeded that of people on prescribed testosterone, which is already well above average, the study showed.
Dr Eu says the results show why a harm minimisation approach to non-prescribed steroids use is needed.
He said steroid users seldom disclose it to anyone, because they fear judgment from others, including doctors.
"Some doctors are a bit judgmental about it and others feel they don't know what to do the information anyway," he said.
"So many of them (AAS users) are so keen to get help. They don't want to have liver failure or have a heart attack, they want to do it safely. Generally, it's like illicit substances, people use this for a period of time and then stop."
The paucity of quality public information on performance and image-enhancing drugs is an issue raised last month by a NSW coroner investigating the death of personal trainer Jesse Drabsch.
The 31-year-old collapsed in a 24-hour gym's bathroom in 2017 after injecting himself with non-prescribed insulin.
Coroner Harriet Grahame found there was limited reliable evidence about the prevalence of PIEDs and expressed surprise at the lack of specific educational and treatment strategies and support for users.
She advised industry players and health authorities work with Dr Eu and others researching PIEDs use to form harm minimisation strategies.
Once the conversation starts with AAS users, Dr Eu's study suggests plenty are willing to modify their behaviour.
According to surveys filled out by users' treating doctors, about half of users appeared ready to monitor and/or treat adverse effects of AAS use.
About 36 per cent appeared to want to modify their use, while about 9 per cent were turned off AAS, the results said.
"Harm minimisation is really important," Dr Eu said.
"If we're worried about these people and the harm steroids actually cause to health, it's better to monitor them so you can advise them."
The research, which authors say is the first epidemiological study on non-prescribed PIEDs users presenting for healthcare, was conducted between 2019 and 2021.
It was presented this week at the Australasian Professional Society on Alcohol & other Drugs (APSAD) conference