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.