USERS VS. NON-USERS OF ANABOLIC STEROIDS: IS THE DIFFERENCE ONLY STEROID USE?

Lucas Caseri Câmara*

Research on anabolic–androgenic steroids (AAS) often categorizes individuals simply as users or non-users, assuming that exposure itself is the only meaningful difference between the groups. Such a dichotomy overlooks important baseline and behavioral factors that shape health outcomes and risks generating misleading interpretations. People who engage in AAS use frequently present distinct psychosocial and medical histories, including psychiatric conditions, body-image concerns, and social vulnerabilities, which may influence both the decision to initiate use and the probability of developing adverse outcomes. In addition, AAS use almost never occurs in isolation: polypharmacy with hormones, stimulants, and ancillary drugs, as well as concomitant consumption of alcohol, tobacco, and illicit substances, introduces further complexity by modifying risks in ways that cannot be separated from the effects of steroids alone. When these heterogeneous profiles are collapsed into a binary classification, observational studies risk inflating or misplacing harm as directly attributable to AAS. This article highlights why the distinction between users and non-users cannot be considered scientifically rigorous without attention to these confounding factors and argues for the need of more robust methodologies, including multivariable analyses and prospective cohort designs, to achieve more accurate and clinically meaningful conclusions.