BENEATH THE SURFACE: METHODOLOGICAL CHALLENGES IN ASSESSING THE HEALTH RISKS OF ANABOLIC ANDROGENIC STEROID USE

Abuse of anabolic-androgenic steroids (AAS) has been widely linked to adverse health outcomes. However, establishing direct causality between AAS use and negative effects remains methodologically complex. This article presents a critical review of the literature, emphasizing the main limitations of observational studies, particularly regarding the lack of control for confounding variables. Systematic reviews and population surveys reveal that AAS users display highly heterogeneous usage patterns, often involving supratherapeutic doses, concomitant use of multiple substances (polypharmacy), and reliance on counterfeit products from the underground market. Moreover, AAS abuse rarely occurs in isolation and is frequently associated with the use of licit and illicit drugs. Users also tend to present distinct psychosocial profiles compared to non-users, including histories of trauma, body image disorders, and low self-esteem. These characteristics undermine group comparability and hinder the attribution of specific outcomes to AAS exposure. We conclude that data interpretation should be approached with caution and that future research must adopt more robust methodologies, including better user characterization and advanced strategies to control for confounders.