An 11-year observational study showed a roughly threefold higher risk for death in steroid users than in nonusers.

Androgenic anabolic steroids (AASs) are associated with cardiovascular-related and psychiatric morbidity and mortality, but the magnitude of these risks has been difficult to assess from small studies. In this observational Danish study, researchers identified 1189 young men (mean age, 27 years) who had received two-year doping sanctions for AAS use as part of a national antidoping program. Long-term mortality was compared in AAS users and in 60,000 age-matched controls.

During a mean follow up of 11 years, 2.8% of AAS users and 1% of controls died, for a hazard ratio (HR) of 2.8 – a significant difference. In AAS users, HRs were 3.6 for unnatural deaths (i.e. accidents, violent crimes or suicide) and 2.2 for natural deaths (e.g. cancer, cardiovascular-related deaths).

Comment: The excess death rate in this young adult population is striking. Although causality cannot be proven from this unadjusted naturalistic study, it might help clinicians counsel patients about long-term risks associated with AAS use. Risk for death due to accidents and suicides is particularly notable, given known behavioural dysfunction with AAS use.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Windfeld-Mathiasen J, et al. Mortality among users of anabolic steroids. JAMA 2024 Mar 14; e-pub (https://doi.org/10.1001/jama.2024.3180).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.