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

Steps to Bridge the Gaps in our Knowledge and Health Policy—the Path Forward

Despite the health threats posed by the rapid growth of AAS use among young people, there is a surprising dearth of studies on the long-term health consequences of AASs. Hardly any major national or regional initiatives have addressed this looming public health crisis. Several expert panels have emphasized the urgent need for AAS research, with particular emphasis on prospective longitudinal studies to gather outcome data on the health effects of these drugs. Randomized trials cannot ethically duplicate the large doses of AASs used by nonathlete weightlifters, the multiplicity of drugs used, and the many high-risk behaviors associated with AAS use. Therefore, the highest priority should be assigned to prospective observational studies, which may be the only feasible approach to collecting valid outcome data on the health risks associated with AAS use. In addition, we need further studies regarding the prevalence of AAS use in children, adults, and among men and women in the armed forces; the mechanisms by which AASs and other appearance- and performance-enhancing drugs exert their adverse health effects; and the interactive effects of AASs with sports injuries and other high-risk behaviors. We also need randomized trials to assess therapeutic interventions for treating the adverse effects these drugs. It seems particularly important to assess treatment strategies for the AAS-withdrawal syndrome, because such treatment is often necessary to break the vicious cycle of AAS-withdrawal hypogonadism, relapse, and dependence. Although human chorionic gonadotropin and selective estrogen receptor modulators such as clomiphene citrate have been used to empirically hasten recovery of testicular function, the efficacy and durability of such therapeutic interventions have not been evaluated rigorously. Furthermore, integration of cognitive and behavioral interventions into a holistic treatment plan to address the body image disorder and the psychosocial contributors that render men susceptible to AAS abuse is necessary to prevent relapse. Integrated nationwide efforts to raise public awareness of the serious health consequences of AASs are urgently needed. Finally, it is time to review a whole range of national and international laws governing the manufacturing, distribution, and sales of these compounds on the Internet and through other black-market avenues, to stem this looming threat to public health.