Commentary on Piatkowski et al.: Anabolic-androgenic steroid testing sites are necessary to identify specific anabolic-androgenic steroid types that are commonly faked putting users at risk

The majority of anabolic-androgenic steroid (AAS) are obtained on the illicit black market, where quality and specificity of desired AASs are known to be substandard [1]. Evidence presented in the study by Piatkowski and colleagues [2] support the fact that AAS users are concerned for the chemical purity and specificity, when obtaining AAS from illicit sources. Therefore, identifying safe, accurate quality AAS compounds for the user should be a societal priority, in line with harm-reduction strategies. Having a network of high quality AAS testing sites throughout the world would substantially support this goal. The AAS user must not only navigate drug purity issues because AAS compounds are commonly contaminated with dangerous impurities but also with safety issues caused by other counterfeit AAS that are not intended to be used. The nuances among AAS agents in terms of clinical utility are not as subtle as one might assume. For example, in the class of nor-19–derived AAS, there are two classic agents that need to be distinguished from one another: nandrolone decanoate is typically more sought after for bulking as compared with nandrolone phenylpropionate, which has become more commonly added to a testosterone regimen for subtle performance attributes. These two AAS are commonly available in the illicit market and their consumption can risk serious side effects, including hypertension, androgen induced erythrocytosis, venous thrombosis, pulmonary embolism, heart attacks and strokes. Healthcare providers, regulators, government officials and the general public need to better recognize the motivations of different groups to take these drugs.

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