The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men

Anna L. Goldman; Harrison G. Pope, Jr.; Shalender Bhasin


J Clin Endocrinol Metab. 2019;104(4):1069-1074. 

In This Article

The Epidemiology of AAS use

A recent analysis suggests that 2.9 to 4.0 million Americans have used AASs at some time; ~98% of these individuals are men.[4,6,7] Approximately one-third of the members of this group, some 1 million men, are estimated to have experienced AAS dependence, where they have continued to use AASs for many years, often despite adverse medical and psychiatric effects. Although the attention of the public, media, and policymakers has remained focused on AAS use among competitive athletes, more than 80% of AAS users have never used these drugs for any competitive athletic purpose.[4] These nonathlete AAS users remain largely invisible, because they rarely disclose their AAS use to any clinicians that they see and are not subjected to the scrutiny or testing that the athletes face.[4] Thus, despite the high prevalence of AAS use, this epidemic has remained hidden and not received the attention that it deserves either because it has escaped the attention of public health authorities, or not risen to a level of priority for action because of the current preoccupation with the opioid epidemic.

AAS use in the US military also appears to have risen, as soldiers have attempted to become more muscular and to improve recovery as they prepare for tours of combat duty.[13–16] The prevalence of AAS use in the military is unknown; a small 2012 study using in-depth interviews found that nearly one-third of those surveyed admitted to use of these drugs,[13] whereas Web-based surveys by the Department of Defense have reported a lower but increasing prevalence of AAS use during the past decade.[14] Elite military forces (US Army Rangers, Special Forces, and Navy SEALs) show a higher prevalence of dietary supplement use than other military personnel,[15,16] and thus, by extension, may be at even higher risk for AAS use than other soldiers. In response to concerns from the field about AAS use by US service members, the Consortium of Health and Military Performance hosted a symposium in April 2015 where participants recommended connecting with users, education and intervention, improving knowledge and filling research gaps, and establishing an information clearinghouse and clinical repository.[16]