BACKGROUND: Anabolic androgenic steroids (AAS) are administered via injectable and oral route of administration (ROA). Each ROA carries a distinct set of challenges and risks; however, scarce qualitative research has focused on why people who use AAS select one ROA over another.

AIM: This study aims to explore the perceptions and preferences underpinning the decision behind ROA.

METHOD: Ten semi-structured interviews were conducted with people from the UK who use AAS.

FINDINGS: The findings demonstrate that participants had four primary initiation patterns: exclusive use of orals, exclusive use of injectables, and a transition from orals to include injectables or injectables to orals. Factors underpinning drug ROA included: stigma; risk; fear; convenience; efficacy; knowledge of drugs and their desired effects; health; motivations for use; and experience, including number of cycles completed. Each of these factors contributed to differences within the choice underpinning drug ROA.

RECOMMENDATION: With needle and syringe programs being the primary public health intervention for AAS consumers in the UK, oral-only consumers likely experience a lack of critical support services. We suggest future harm reduction strategies consider ways to engage oral-only AAS consumers, especially considering their comparatively lower prioritization of health concerns.