The global lifetime prevalence rate of anabolic-androgenic steroid (AAS) use is 3.3%.[3]Sagoe D, Molde H, Andreassen CS, et al. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol. 2014 May;24(5):383-98.
http://www.ncbi.nlm.nih.gov/pubmed/24582699?tool=bestpractice.com
The lifetime prevalence rate of AAS use in general populations varies, but is found to be higher in the US, parts of Europe (e.g., Scandinavia), and the Middle East, and lower in parts of Asia (e.g., China, Korea, and Japan) and Africa.[4]Havnes IA, Jørstad ML, Wisløff C. Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires. Subst Abuse Treat Prev Policy. 2019 May 16;14(1):20.
https://www.doi.org/10.1186/s13011-019-0206-5
http://www.ncbi.nlm.nih.gov/pubmed/31096999?tool=bestpractice.com
AASs are the most abused category of banned drugs in Olympic athletes.[5]Fitch KD. Androgenic-anabolic steroids and the Olympic Games. Asian J Androl. 2008 May;10(3):384-90.
http://www.ncbi.nlm.nih.gov/pubmed/18385900?tool=bestpractice.com
Determining the prevalence of use of AAS by standard questionnaires is unreliable, especially in elite athletes, as there is a high likelihood of false answers.[1]Anawalt BD. Diagnosis and management of anabolic androgenic steroid use. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2490-500.
https://www.doi.org/10.1210/jc.2018-01882
http://www.ncbi.nlm.nih.gov/pubmed/30753550?tool=bestpractice.com
The use of randomized response techniques results in higher and more accurate estimations of socially undesirable behaviors, and studies using this technique indicate that 20% to 60% of elite athletes report past-year use of some type of performance-enhancing drug, although further information on the specific type of drug is not available.[1]Anawalt BD. Diagnosis and management of anabolic androgenic steroid use. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2490-500.
https://www.doi.org/10.1210/jc.2018-01882
http://www.ncbi.nlm.nih.gov/pubmed/30753550?tool=bestpractice.com
Use is prevalent among bodybuilders, weightlifters, and elite power lifters with rates between 33% to 80%.[6]Thirumalai A, Anawalt BD. Androgenic steroids use and abuse: past, present, and future. Urol Clin North Am. 2022 Nov;49(4):645-63.
http://www.ncbi.nlm.nih.gov/pubmed/36309421?tool=bestpractice.com
It is estimated that over 20% of US college athletes have used AASs.[7]Buckman JF, Farris SG, Yusko DA. A national study of substance use behaviors among NCAA male athletes who use banned performance enhancing substances. Drug Alcohol Depend. 2013 Jul 1;131(1-2):50-5.
http://www.ncbi.nlm.nih.gov/pubmed/23688842?tool=bestpractice.com
Use is primarily a problem among male athletes.[1]Anawalt BD. Diagnosis and management of anabolic androgenic steroid use. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2490-500.
https://www.doi.org/10.1210/jc.2018-01882
http://www.ncbi.nlm.nih.gov/pubmed/30753550?tool=bestpractice.com
National Institute on Drug Abuse 2022 data show that for three grades in US secondary schools (8th, 10th, and 12th, combined [ages 13, 15, and 17 years, respectively]), the lifetime prevalence of use of steroids was 1.3%, and both annual and past 30-day prevalence levels were <1.0%.[8]National Institute on Drug Abuse. Monitoring the future national survey results on drug use, 1975-2022: secondary school students. 2023 [internet publication].
https://monitoringthefuture.org/wp-content/uploads/2022/12/mtf2022.pdf
The overall prevalence of AAS use seems to be declining among adolescents after a peak in the early 2000s.[6]Thirumalai A, Anawalt BD. Androgenic steroids use and abuse: past, present, and future. Urol Clin North Am. 2022 Nov;49(4):645-63.
http://www.ncbi.nlm.nih.gov/pubmed/36309421?tool=bestpractice.com