Associations between anabolic-androgenic steroid testing, healthcare access and undesirable effects among international consumers

Background Anabolic–androgenic steroid (AAS) consumption is associated with significant physical and psychological health risks, often linked to unregulated supply chains and difficulty accessing informed healthcare. Therefore, this study examines how healthcare access difficulties and independently testing AAS purity and content relate to self-reported undesirable effects among AAS consumers. Methods Data from 854 respondents (95.6% male) reporting past-year AAS consumption in the 2024 Global Drug Survey were analysed. Respondents provided information on healthcare access, AAS testing behaviours, and undesirable physical (e.g., cardiovascular) and psychological (e.g., mood disturbances) effects. Chi-squared tests assessed differences across four groups defined by combinations of difficulty accessing healthcare and AAS testing. Results Respondents not testing their AAS and experiencing difficulty accessing healthcare ( n = 196) reported significantly higher frequencies of several undesirable effects compared to the other three groups ( n = 102–390). Significant differences were observed for decreased sexual function (χ² (3) = 10.19, p = .017, φc = 0.109), decreased fertility (χ² (3) = 11.54, p = .009, φc = 0.116), negative impacts on sexual organs (χ² (3) = 8.08, p = .044, φc = 0.097), anger/aggression (χ² (3) = 13.27, p = .004, φc = 0.125), depression/low mood (χ² (3) = 10.62, p = .014, φc = 0.112), and irritability (χ² (3) = 8.66, p = .034, φc = 0.101). Conclusion Difficulties accessing healthcare and not testing AAS are associated with higher reported AAS-related undesirable effects, though consumer-specific and contextual factors may be central. These findings highlight the need to address systemic and psychosocial barriers to reduce AAS-related harms.