Men who use androgenic anabolic steroids have an increased mortality risk, a notable increase in hospitalizations, and higher prevalence of certain disorders compared with the general population, according to study results published in the Journal of Internal Medicine.

In this retrospective matched cohort study, researchers followed 545 men who tested positive for androgenic anabolic steroids in Danish fitness centers between January 3, 2006 and March 1, 2018. These fitness centers were among those collaborating with Anti Doping Denmark, a doping control program. Each confirmed androgenic anabolic steroid user was matched by age, gender, and date with 10 control participants from the general population, and statistical analyses were performed using data from national registry systems to compare mortality, hospital contacts, and incidence and cumulative prevalence of 15 prespecified disorders potentially related to androgenic steroid use. In addition, the researchers analyzed the incidence of somatic comorbidity in ICD-10 level 3 using a hypothesis-free approach in the Danish National Registry.

Overall, researchers found the average age at doping sanctions was 26.2 ± 6.3 years, and age at enrollment in the control cohort was comparable. On average, the length of follow-up was 7.4 ± 2.9 years in the androgenic anabolic steroid cohort and 7.3 ± 3.0 years in the control cohort. During the follow-up period, there were 7 deaths in the androgenic anabolic steroid cohort and 23 deaths in the control group, equaling a hazard ratio of 3.0 for steroid users (95% CI, 1.3-7.0). For morbidity, researchers noted a substantial increase in hospitalizations during follow-up among men in the androgenic anabolic steroid cohort, with 5115 hospital contacts among 545 men compared with 27,167 hospital contacts among 5450 men in the control group; in both cohorts, 59% of hospital admissions or contacts resulted from injuries or unspecific health examinations.

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Gynecomastia was strongly linked with the use of androgenic anabolic steroid use, with a 13-fold increase in incidence compared with the general population. Infertility was 2.4 times higher in men using androgenic anabolic steroids compared with the control group (6.6% vs 3.1%, cumulatively and respectively). Testicular dysfunction and testosterone supplementation were also higher in the androgenic anabolic steroid group. For acne medications, users of androgenic anabolic steroids showed an incidence of 10.8/1000 person-years compared with 4.7/1000 person-years in the general population. Cardiomyopathy and atrial fibrillation were 3 times higher among androgenic anabolic steroid users compared with control subjects, and the risk for thromboembolic disorders (thrombophlebitis and pulmonary embolism) was also increased in this group compared with the control group (hazard ratio, 5.0; 95% CI, 1.7-14.6). Further, in the hypothesis-free analysis, researchers confirmed increased mortality and adverse effects associated with androgenic anabolic steroid use.

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“Androgenic anabolic steroid users have an increased risk [for] dying and significantly more hospital admissions than their nonuser peers,” the researchers concluded. “Based on the high prevalence of [androgenic anabolic steroid] abuse, these side effects are a public health concern.”

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Horwitz H, Anderson JT, Dalhoff KP. Health consequences of androgenic anabolic steroid use [published online November 20, 2018]. J Intern Med. doi:10.1111/joim.12850