Elevated PSA levels, testosterone deficiency and severe mood disruptions are red flags for steroid abuse, new GP guidance warns.

And not all patients will have evident features such as muscular or ‘toned’ physiques, with men over 40 more likely to use non-prescribed anabolic-androgenic steroids and other performance and image enhancing drugs (PIEDs) for anti-ageing purposes.

The guide to harm minimisation from steroids and PIEDs, funded by the Sydney North Health Network, provides clinicians with evidence-based guidance on identifying and managing patients contemplating, using or wanting to stop using these substances.

PIEDs include weight-loss drugs, sexual enhancers such as sildenafil, cognitive enhancers like methylphenidate, and mood and behaviour enhancers including beta-blockers.