The nonmedical use of performance-enhancing substances, particularly androgens and related drugs, has been a global public health problem for several decades.1,2 A meta-analysis of 271 studies published between 1970 and 2013 estimated lifetime prevalence rates of 6.4% among males and 1.6% among females.1 The use of banned performance-enhancing drugs in elite sports has received much attention but is merely the tip of the iceberg.
Auchus RJ, Brower KJ. The Public Health Consequences of Performance-Enhancing SubstancesWho Bears Responsibility?. JAMA. 2017;318(20):1983–1984. doi:10.1001/jama.2017.17111
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