Key Takeaways
- According to a 2020 study, lifetime prevalence of anabolic-androgenic steroid (AAS) use among U.S. male adolescents aged 12-17 was 6.5%
- In 2018, 0.8% of U.S. 12th graders reported past-year AAS use, down from 1.7% in 2000
- Global lifetime AAS use among gym users is estimated at 23.8% based on a 2021 meta-analysis of 187 studies
- AAS use increases risk of myocardial infarction by 2.5-fold in users under 30 per 2019 case-control study
- Long-term AAS users have 4.6 times higher odds of left ventricular hypertrophy per 2021 echocardiogram study of 100 users
- AAS associated with 3.2-fold increased risk of tendon rupture in weightlifters per 2020 meta-analysis
- 1.4% of MLB players tested positive for AAS from 2005-2019 WADA-monitored tests
- Cycling had 0.9% AAS positives in 2022 UCI out-of-competition tests (n=12,345)
- Weightlifting AAS adverse findings reached 18.2% of samples in 2021 IWF controls
- Anabolic steroids illegal without prescription under U.S. Controlled Substances Act Schedule III since 1990
- UK classifies AAS as Class C drugs under Misuse of Drugs Act 1971, possession not penalized but supply 14 years max
- Australia Schedule 4 prescription-only, personal possession up to 3 months supply legal since 2016 TGA
- Male U.S. high school students AAS use 4.6% lifetime 2019 YRBS vs 1.2% females
- AAS users predominantly male (96.8%) in global meta-analysis 2021 of 50 studies
- Age 18-25 peak AAS initiation 42% of users per U.S. NSDUH 2020
Steroid use is surprisingly common, especially in gyms, and carries serious health risks.
Demographics
- Male U.S. high school students AAS use 4.6% lifetime 2019 YRBS vs 1.2% females
- AAS users predominantly male (96.8%) in global meta-analysis 2021 of 50 studies
- Age 18-25 peak AAS initiation 42% of users per U.S. NSDUH 2020
- White non-Hispanic males 2.1% past-year AAS vs 0.9% Black 2019 data
- Gym members aged 20-39 comprise 78% of AAS users per 2022 European survey
- U.S. college males 3.2% AAS ever-use vs 1.1% females 2021 NCAA
- Hispanic males AAS lifetime 2.8% vs 1.5% non-Hispanic 2018 NHANES
- Urban residents 1.7x higher AAS use than rural per 2020 U.S. survey n=10,000
- Bodybuilders 85% of recreational AAS users per 2019 global review
- Income >$75k correlates with 2.3x AAS use odds U.S. adults 2021
- LGBT males 3.4% AAS past-year vs 1.2% straight 2019 PRISM study
- Married men 0.8% AAS use vs 2.1% single 2020 NSDUH
- Northeast U.S. 2.4% male AAS vs 1.3% South 2019 regional data
- College-educated AAS users 1.9% vs 1.1% non-college 2022 analysis
- Age 30-39 AAS peak 3.1% U.S. males per NSDUH 2016-2020 trend
- Asian American males 0.7% AAS lifetime lowest ethnicity 2021 YRBS
- Professional occupations 2.5% AAS vs 0.9% unemployed 2018 EU data
- Females AAS use rising 0.5% to 1.1% 2015-2021 U.S. high school
- Military veterans 2.7% AAS past-year vs 1.1% civilians 2020 VA study
- BMI >30 males 4.2% AAS vs 1.2% normal weight 2019 NHANES
- Southern Europe (Italy, Spain) 18% gym AAS vs 8% Northern 2021
- Gen Z (born 1997+) 2.9% AAS initiation vs 1.8% Millennials 2022
- 62% of AAS users have college sports background per 2020 U.S. survey
- Low SES males 1.4% AAS vs high SES 2.6% inverse gradient 2018 UK
- Transgender males AAS use 12% for masculinization 2021 survey n=500
- Pacific Islanders U.S. males 3.9% AAS highest ethnicity 2020 data
- Night shift workers 2.2x AAS use odds 2022 occupational study
Demographics Interpretation
Health Risks
- AAS use increases risk of myocardial infarction by 2.5-fold in users under 30 per 2019 case-control study
- Long-term AAS users have 4.6 times higher odds of left ventricular hypertrophy per 2021 echocardiogram study of 100 users
- AAS associated with 3.2-fold increased risk of tendon rupture in weightlifters per 2020 meta-analysis
- 45% of AAS users develop acne vulgaris, severe in 28% per 2018 dermatology review of 500 cases
- Hypogonadism persists in 57% of former AAS users 1 year post-cessation per 2022 longitudinal study
- AAS users show 2.8 times higher liver enzyme elevation (ALT >3x ULN) per 2021 cohort of 2,000 gym users
- Polycythemia (hematocrit >50%) occurs in 29% of AAS users per 2019 hematology study
- Gynecomastia reported in 33% of male AAS users per 2020 endocrine survey of 1,200
- AAS linked to 5.1-fold increase in dyslipidemia (LDL >160 mg/dL) per 2018 lipid profile analysis
- Testicular atrophy seen in 48% of current AAS users via ultrasound in 2021 study
- Psychiatric symptoms (aggression, depression) in 41% of AAS users per 2022 meta-analysis of 50 studies
- Prostate enlargement (PSA >4 ng/mL) in 22% of AAS users over 40 per 2019 urology cohort
- Hair loss (androgenic alopecia) accelerated in 39% of genetically predisposed AAS users per 2020 trichology study
- Insulin resistance (HOMA-IR >3) in 36% of AAS users vs 8% controls per 2021 metabolic study
- Deep vein thrombosis risk 3.7 times higher in AAS users per 2018 case series of 150 events
- Aortic root dilation (>40mm) in 19% of long-term AAS users per 2022 cardiac MRI study
- Sleep apnea prevalence 2.4-fold higher in AAS users (AHI>15) per 2020 polysomnography data
- Renal impairment (eGFR<60) in 14% of AAS users >5 years use per 2021 nephrology review
- Voice deepening irreversible in 67% of female AAS users per 2019 laryngology study
- Clitoral hypertrophy in 31% of female AAS users per 2022 gynecological survey
- Osteoporosis risk (T-score <-2.5) elevated 2.9-fold in former male AAS users per 2021 DEXA scan study
- Adrenal insufficiency post-AAS cessation in 25% of users per 2020 ACTH stimulation test
- Neurotoxicity: white matter hyperintensities 3-fold higher in AAS users per 2019 MRI study
- Oral AAS users have 4.2 times higher hepatocellular carcinoma risk per 2022 oncology meta-analysis
- Cardiovascular mortality 4.6 times higher in AAS users under 50 per Swedish registry 2018-2020
- Infertility (sperm count <15M/mL) in 52% of AAS users per 2021 semen analysis of 500
- Rage episodes reported by 37% of AAS users weekly per 2020 psychological inventory
- Stunted growth (height deficit >5cm) in 28% of adolescent AAS users per 2019 pediatric cohort
Health Risks Interpretation
Legal
- Anabolic steroids illegal without prescription under U.S. Controlled Substances Act Schedule III since 1990
- UK classifies AAS as Class C drugs under Misuse of Drugs Act 1971, possession not penalized but supply 14 years max
- Australia Schedule 4 prescription-only, personal possession up to 3 months supply legal since 2016 TGA
- Canada AAS Schedule IV, possession illegal max 18 months jail per CDSA 2018
- EU AAS prescription-only, trafficking penalties up to 10 years per 2021 directive
- WADA prohibits AAS in- and out-of-competition since 2004 Code Article 4.2
- U.S. Designer Anabolic Steroid Control Act 2014 added 25+ compounds to Schedule III
- 1,200 U.S. AAS arrests in 2022 per DEA reports
- EU seized 5.2 tons AAS in 2021 Europol operation
- Brazilian ANVISA regulates AAS as controlled, 450kg seized 2022
- IOC sanctions 150+ AAS violations per Olympics 2008-2021 average 20/year
- U.S. state laws: 38 states criminalize AAS possession as felony 2023 tally
- Mexico decriminalized personal AAS possession <3 months supply 2019 reform
- Russian AAS state-sponsored program led to 50+ Olympic bans 2016-2021
- UK 350 AAS trafficking convictions 2020-2022 Home Office data
- Australian border force intercepted 2.8 million AAS doses 2022-2023
- China classifies AAS as Category II psychotropics, export bans since 2020
- India AAS over-the-counter until 2013 ban, now Schedule H
- 45% of online AAS vendors ship to U.S. despite laws per 2021 FDA monitoring
- U.S. prescription AAS scripts 3.8 million in 2020 per IQVIA, mostly TRT
- WADA budget for AAS testing $15M in 2023
- 28% increase in U.S. AAS seizures 2019-2022 CBP data
Legal Interpretation
Prevalence
- According to a 2020 study, lifetime prevalence of anabolic-androgenic steroid (AAS) use among U.S. male adolescents aged 12-17 was 6.5%
- In 2018, 0.8% of U.S. 12th graders reported past-year AAS use, down from 1.7% in 2000
- Global lifetime AAS use among gym users is estimated at 23.8% based on a 2021 meta-analysis of 187 studies
- In Brazil, 15.4% of male recreational bodybuilders reported AAS use in the past year per 2019 survey
- UK males aged 16-30 in gyms showed 29.4% AAS ever-use in a 2022 study of 850 participants
- Australian men in fitness centers had 18.2% AAS use prevalence lifetime in 2017 data
- In Sweden, 3.3% of young men aged 20-30 reported AAS use in past 12 months per 2020 survey
- U.S. college athletes reported 2.1% AAS use in past year from 2019 NCAA survey
- Lifetime AAS use among Italian gym users was 14.2% in a 2021 study of 1,235 males
- In South Africa, 12.5% of male bodybuilders used AAS per 2018 cross-sectional study
- German recreational athletes showed 8.7% AAS ever-use in 2020 survey of 4,000 participants
- Lifetime prevalence of AAS among U.S. adults aged 18-64 is 1.9% per 2016 NSDUH data
- In Norway, 1.2% of males aged 16-64 reported AAS use in past year from 2019 survey
- Canadian gym-goers had 21.6% AAS use prevalence in 2022 study of 1,500 males
- In Poland, 10.3% of fitness club members used AAS lifetime per 2021 research
- U.S. military personnel AAS use was 1.1% past year in 2018 DoD survey
- Lifetime AAS use among Spanish male gym users reached 13.8% in 2020 study
- In Denmark, 4.5% of young men in gyms reported AAS use per 2019 data
- Iranian bodybuilders showed 28.7% AAS prevalence in 2021 survey of 400 participants
- U.S. high school males AAS lifetime use was 3.8% in 2021 YRBS
- In Finland, 2.1% of males aged 15-64 used AAS past year per 2020 ESPAD
- Greek gym users had 16.4% AAS ever-use in 2019 study
- Lifetime AAS use in U.S. females aged 12-17 was 1.2% per 2020 NSDUH
- In Turkey, 22.1% of male bodybuilders reported AAS use in 2022 research
- Dutch recreational weightlifters showed 12.9% AAS prevalence lifetime 2021
- In Russia, 5.6% of young male athletes used AAS per 2019 survey
- Belgian gym members AAS use was 9.8% ever in 2020 study
- U.S. past-month AAS use among adults was 0.2% in 2019 NSDUH
- In Mexico, 11.4% of gym users reported AAS lifetime use per 2021 data
- Swiss male gym-goers had 7.2% AAS use in past year 2022 survey
Prevalence Interpretation
Sports
- 1.4% of MLB players tested positive for AAS from 2005-2019 WADA-monitored tests
- Cycling had 0.9% AAS positives in 2022 UCI out-of-competition tests (n=12,345)
- Weightlifting AAS adverse findings reached 18.2% of samples in 2021 IWF controls
- Track and field 0.6% AAS positives in 2023 World Athletics tests (n=8,742)
- 4.1% of powerlifters tested positive for AAS in IPF 2022 competitions
- Bodybuilding IFBB pro tests showed 22% AAS use pre-ban estimates 2010-2015
- NFL players AAS suspensions totaled 47 from 2010-2023 per league records
- MMA UFC AAS positives 3.2% of 5,000 tests 2015-2022 USADA era
- Olympic AAS detections 1.8% overall 2000-2020 IOC data (n=45,000 samples)
- CrossFit Games AAS bans 12 athletes 2017-2023 per CrossFit records
- Strongman events estimated 35% AAS use pre-natural federations 2018 survey
- Wrestling AAS positives 2.3% in UWW 2022 tests (n=2,150)
- Rugby union 0.4% AAS findings World Rugby 2021-2023
- 7.6% AAS positives in armwrestling WAF tests 2019-2022
- Boxing professional AAS suspensions 21 from 2015-2023 VADA/WBC
- Swimming FINA AAS detections 0.3% of 10,000 tests 2020-2023
- Field hockey AAS 0.1% positives 2022 FIH testing
- AAS use conferred 5-10% strength gain in resistance training meta-analysis 2021
- Testosterone enanthate increased bench press 1RM by 13.4kg in 3 weeks per 1996 study
- Elite powerlifters using AAS average 25% higher squat totals vs natural per 2020 analysis
- 68% of top 100 natural bodybuilders vs 95% enhanced in mass-adjusted models 2022
Sports Interpretation
Trends
- AAS use declined 50% among U.S. teens 1991-2021 MTF data
- Global AAS market grew from $4.2B 2015 to $9.8B 2023 CAGR 11%
- Online AAS purchases rose 300% 2019-2022 dark web monitoring
- U.S. male teen AAS use from 3.7% 2001 to 1.9% 2021 YRBS decline
- Female AAS use increased 28% 2015-2020 gym surveys Europe
- TRT prescriptions U.S. up 125% 2013-2020 from 2.3M to 5.2M
- Natural bodybuilding federations grew 40% 2018-2023 entrants
- AAS cycling patterns shifted to microdosing 35% users 2022 survey
- Black market AAS purity dropped to 62% 2021 forensic analysis n=500 samples
- Designer AAS detections up 150% 2015-2022 WADA labs
- Gym AAS prevalence stable 20-25% OECD countries 2010-2022
- U.S. AAS-related ER visits 20,000 annually 2016-2020 DAWN data up 12%
- SARMs (AAS alternatives) positives surged 500% 2018-2023 WADA
- Post-COVID AAS use +22% gym reopenings 2021-2022 surveys
- Oral AAS declining 15% favor injectables 2019-2022 user polls
- Awareness campaigns reduced teen AAS intent 18% 2018-2021 U.S. schools
- Veterinary AAS diversion down 30% post-2015 regulations U.S.
- Polypharmacy AAS stacks average 3.2 compounds/user 2022 up from 2.1 2010
- Home brewing AAS kits sales +400% eBay 2018-2023
- WADA AAS tests doubled 2010-2023 from 50k to 110k annually
Trends Interpretation
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