Most don't get palumboism.
The ones who do get it have megadosed aas for decades and used pharma grade hgh in the 24ui region for years.
I can't prove this, but I suspect your steroid receptor sites eventually stop responding to aas. It is common with almost all forms for drug use. If you use a chemical for long enough, eventually your body will no longer respond to it. Hence the atrophy (see the late greg kovacs).
The gut distension is almost certainly due to hgh-mediated organomegaly.