Adverse Effects of Anabolic Androgenic Steroid Abuse in Athletes and Physically Active Individuals: A Systematic Review and Meta-Analysis

Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone, primarily used for their anabolic effects in increasing muscle mass. However, AAS have been increasingly abused, posing significant health risks due to their severe effects. This study aimed to quantify the adverse effects of AAS abuse across a diverse population of various ages. The effects were categorized across cardiovascular, hepatic, endocrine, musculoskeletal, and psychiatric domains. A comprehensive search was conducted across multiple databases following PRISMA guidelines. Study quality was assessed using a modified QUADAS-2 tool, and meta-analyses were performed. Meta-analysis revealed significant adverse outcomes. AAS use was linked to an increase in systolic blood pressure (BP) by a pooled mean difference (MD) of 12.43 mmHg (95% CI: 9.59 to 15.26) and diastolic BP by 8.09 mmHg (95% CI: 5.62 to 10.57). There was also a significant rise in LDL-C levels, with an MD of 9.12 mg/dL (95% CI: 6.75 to 11.49), indicating heightened cardiovascular risk. Hepatic effects were marked by elevated levels of AST and ALT, with MD of 14.47 U/L (95% CI: 12.41 to 16.52) and 12.16 U/L (95% CI: 3.28 to 21.04), respectively, suggesting significant liver stress or damage. Endocrine disruptions were profound, with a substantial reduction in testosterone levels observed, showing an MD of -141.57 ng/dL (95% CI: -160.42 to -122.72). Raising awareness among athletes and physically active people using AAS is crucial. Future research should focus on elucidating the long-term effects of AAS and developing strategies to mitigate the associated risks.