Anabolic-androgenic steroid use disorder: case for recognition as a substance use disorder with specific diagnostic criteria

Approximately one in three people who use anabolic-androgenic steroids (AASs) develop dependence, characterised by both psychiatric and somatic symptoms. Despite this, AAS use disorder (AASUD) is not distinctly recognised in the latest versions of either the ICD or DSM, impeding both clinical care and research progress. It is clear that AASUD shares many features and correlates with substance use disorders (SUDs) that have specific diagnostic criteria in these classification systems, such as stimulants or opioids. We aim to outline the overlap between AASUD and more ‘typical’ SUDs as well as highlight the specific concerns related to AASUD that warrant recognition and distinct diagnostic criteria.