Health consequences of androgenic anabolic steroid use.
Level 3 - non-randomized controlled study
Retrospective matched cohort study with an external replication cohort
PubMed 30460728 · doi:10.1111/joim.12850
What was done
In a retrospective matched cohort study in Denmark (2006–2018), 545 male subjects who tested positive for androgenic anabolic steroids (AAS) in fitness centres were matched to 5,450 male controls. A replication cohort included 644 men sanctioned for refusing a doping test matched to 6,440 controls. Mortality, annual hospital contacts, and specific clinical morbidities were evaluated between groups.
What was found
Mortality was significantly elevated in AAS users compared to non-user controls (hazard ratio 3.0, 95% CI 1.3–7.0). The median annual number of hospital contacts was 0.81 in AAS users versus 0.36 in controls (P < 0.0001). Prevalence of acne, gynaecomastia, and erectile dysfunction each exceeded 10% in AAS users and was significantly higher than in controls (P < 0.0001). Results were replicated in the sanction-refusal cohort.
Why it matters
This study provides large-scale, population-matched observational evidence linking recreational anabolic steroid use to substantially increased all-cause mortality, healthcare utilization, and endocrine-related morbidity.
Limits
The study sample was identified through targeted anti-doping testing in fitness centres, which may introduce selection bias. Unmeasured confounders such as specific dosages, drug regimens, duration of use, poly-substance use, and lifestyle factors were not reported in the abstract. The study included only male participants.
Cited by
- context Using anabolic steroids for muscle mass is associated with a 15-fold increased risk of premature heart failure and a 122-fold increased risk of cardiac death.