Review Article

The Prevalence of Anabolic-Androgenic Steroid Misuse in Iranian Athletes: A Systematic Review and Meta-Analysis


Background: Due to widespread abuse of anabolic-androgenic steroids among professional athletes and amateur sportsmen and their health-related problems, determining the prevalence and the pattern of anabolic-androgenic steroid misuse at the national level seems to be vital for designing efficient preventive and educational measures.

Methods: This systematic review and meta-analysis was conducted via comprehensive searches of the electronic databases including PubMed, MedLine, Scopus, Google Scholar and National Persian Databases including SID, Magiran, IranDoc (between 1980 and Dec 2019 in English and Persian languages) and also from citations in the selected papers. Overall, 39 articles met the criteria and were included in qualitative and quantitative synthesis.

Results: The overall prevalence rate of anabolic-androgenic steroid misuse in the Iranian athletic population was 36.2% (95% confidence interval (CI), 29-43) with significant heterogeneity between studies (I2=99.0%, P<0.001). Prevalence rate of anabolic-androgenic steroid misuse among elite, male and younger athletes was higher (P<0.05). Moreover, prevalence rate of anabolic-androgenic steroid misuse among body-building athletes (36.3%) was higher compared to other athletes (30.9%), (P<0.001).

Conclusion: Due to the higher prevalence of anabolic-androgenic steroids misuse in Iran compared to global statistics and the potential for serious adverse effects, preventive strategies and policies should be regarded as a real concern for public health.

1. Hartgens F, Kuipers H (2004). Effects of androgenic-anabolic steroids in athletes. Sports Med, 34(8):513-54.
2. Sagoe D, Molde H, Andreassen CS, et al (2014). The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol, 24(5):383-98.
3. Halabchi F (2009). Doping in combat sports. In: Combat sports medicine. Eds, Kordi R, Maffuli N, Wroble RR and Wallace WA. 1st ed, Springer. London, pp. 55-72.
4. Halabchi F, Esteghamati A, Razzaghi A, Noori A (2011). How the Iranian free-style wrestlers know and think about doping?–A knowledge and attitude study. WASET, 59:209-14.
5. Seif-Barghi T, Halabchi F, Dvorak J, et al (2015). How the Iranian football coaches and players know about doping? Asian J Sports Med, 6(74):e24392
6. Bates G, Begley E, Tod D, et al (2019). A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids. J Health Psychol, 24(11):1595-1612.
7. Mulcahey MK, Schiller JR, Hulstyn MJ (2010). Anabolic steroid use in adolescents: identification of those at risk and strategies for prevention. Phys Sportsmed, 38(62):105-13.
8. Jalilian F, Allahverdipour H, Moeini B, et al (2011). Effectiveness of anabolic steroid preventative intervention among gym users: Applying theory of planned behavior. Health Promot Perspect, 1(62):32-40.
9. Halabchi F (2007). Doping in athletes. Hakim Res J, 10(62):1-12.
10. Moher D, Liberati A, Tetzlaff J, et al (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097.
11. Munn Z, Moola S, Lisy K, et al (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc, 13(62):147-53.
12. Ebell MH, Siwek J, Weiss BD, et al (2004). Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician, 69(3):548-56.
13. Borenstein M, Hedges L, Higgins J, Rothstein H. (2005) Comprehensive meta analysis. Version 2. Biostat. Englewood NJ.
14. Aghili M, Gholami M (2011). Prevalence of ergogenic substance misuse and awareness toward the side effects of doping agents in male bodybuilders of Tehran 2011: 6th scientific-students congress on physical education and sport sciences; Tehran: Ministry of Science, Research and Technology.
15. Aliabadi S, Hesami S (2014). The Relation between Awareness, Attitude and the Amount of Doping Substances and Illegal Supplements in Body Builders of Sanandaj, Iran. Arab J Business Manag Rev (Oman Chapter),4(62):73.
16. Alidoust Ghahfarrokhi E, Mokhlesi S, Shariati J (2017). An investigation of consumption and awareness of side effects of doping and weight loss drugs in non-professional athletes in Tehran fitness clubs. Sport Physiol Manag Invest, 9(74):113-126.
17. Allahverdipour H, Jalilian F, Shaghaghi A (2012). Vulnerability and the intention to anabolic steroids use among Iranian gym users: An application of the theory of planned behavior. Subst Use Misuse, 47(62):309-17.
18. Angoorani H, Jalali M, Halabchi F (2018). Anabolic-androgenic steroids and prohibited substances misuse among Iranian recreational female bodybuilders and its associated psycho-socio-demographic factors. Addict Health, 10(4):216-222.
19. Angoorani H, Halabchi F (2015). The misuse of anabolic-androgenic steroids among Iranian recreational male body-builders and their related psycho-socio-demographic factors. Iran J Public Health, 44(12):1662-1669.
20. Arazi H, Bazyar F (2014). The prevalence of anabolic steroid misuse and the awareness about its negative effects among bodybuilders in Karaj city. Alborz Univ Med J, 3(62):48-56.
21. Arazi H, Salehi A (2013). Attitude and awareness of male bodybuilders toward adverse effects of anabolic-androgenic steroids in Qazvin, Iran. Iran J Epidemiol, 9(74): 45-53.
22. Arazi H, Hosseini R (2012). The prevalence of anabolic-androgenic steroids abuse, knowledge and attitue of their side effects, and attitude toward them among the bodybuilding athletes in Rasht. J Gui-lan Uni Med Sci, 20(80):34-41.
23. Bahrami S, Yousefi B, Kaviani E, Ariapooran S (2014). The prevalence of energetic drugs use and the role of perfectionism, sensation seeking and physical self-concept in discriminating bodybuilders with positive and negative attitude toward doping. International Journal of Sport Studies, 4:174-180.
24. Bijeh N, Dehbashi M, Saghi M (2015). Studying the amount of prevalence awareness and complications of anabolic steroids among the male athletes in Mashhad city. Journal of Practical Studies at Biosciences in Sport, 2(4):78-89.
25. Eskandarion M, Kheirvari Khezerloo J, et al (2019). Prevalence of anabolic steroids among the male bodybuilding athletes and rate of awareness to side effects in Shahrud. Sci J Forensic Med, 25(1):1-7.
26. Fakhari rad F, Gholami M (2014). The prevalence of the use of ergogenic aids and awareness of their side effects among Iranian body builders. Int J Sport Stud, 4(7):830-5.
27. Fijan A, Eftekhari MH, Dashtabi A (2018). The prevalence of anabolic androgenic steroid misuse and its associated factors among bodybuilders in Shiraz, Iran. Int J Nutr Sci, 3(3):151-156.
28. Ghaderi H, Malekpoor Tehrani A, et al (2019). Using of anabolic steroids and its association with mental health and body image concept in men referring to sports clubs in Iran. Pak J Med Health Sci, 13(2): 559-564.
29. Haerinejad MJ, Ostovar A, Farzaneh MR, et al (2016). The prevalence and characteristics of performance-enhancing drug use among bodybuilding athletes in the south of Iran, Bushehr. Asian J Sports Med, 7(3):e35018.
30. Hazavehei MM, Abdolmaleki MH (1999). The study of using anabolic androgenic steroid among body builders in Hamadan city in 1997. Avicenna J Clin Med, 6(2): 0-0.
31. Hoseini Kakhak A. Investigating prevalence of ergogenic substances (drugs, protein and vitamin supplements) in elite bodybuilders of Tehran and Mashhad. [Master's Thesis], Tarbiat Moallem University, Iran; 2001.
32. Khabiri A. Evaluation of knowledge and prevalence of using supplements and stimulating drugs in elite athletes in the province of East Azarbaijan. [Master’s Thesis], Tabriz University of Medical Sciences, Iran; 2019.
33. Madani AH, Aghamolaei T, Davoodi SH, et al (2017). Prevalence of Anabolic Steroids abuse and awareness of its effects in male athletes in Southern Iran. J Prevent Med, 4(1):27-33.
34. Mahdavi M, Shooshtarizadeh ASF, Sadri B, et al (2012). Study of prevalence of consumption and consumer awareness of doping substances and supplements side effects among male bodybuilders in Karaj. Res Pharm Sci, 7(5):S65.
35. Malek M, Ghanaei M, Ghorbani R (2005). Survey of the frequency percentage of doping drugs among the male body building athletes and rate of knowledge to side effects. Koomesh, 6(2): 123-30.
36. Minasian V, Sarlak M (2010). Prevalence, attitude and knowledge of side effects of ergogenic substances in elite athletes of national teams and professional clubs of Tehran province. Sport Manag Stud, 4(25):119-30.
37. Nakhaee MR, Pakravan F, Nakhaee N (2013). Prevalence of use of anabolic steroids by bodybuilders using three methods in a city of Iran. Addict Health, 5(3-4):77-82.
38. Nojoomi M, Behravan V (2005). Study of Anabolic Steroids and the Awareness of their Complications in Bodybuilding Athletes in Karaj (2003).RJMS, 11(44):1057-1063.
39. Pasharavesh L, Ramandi M, Khoshboo S, et al (2008). Prevalence of Doping Agents' Abuse and Male Bodybuilders' Knowledge about their Side Effects in Kermanshah Gymnasiums (2004). Journal of Kermanshah University of Medical Sciences (Behbood), 11(4):418-427.
40. Rahimi MA, Siabani H, Siabani S, et al (2008). Effect of education on performance-enhancing drug abuse by bodybuilders. Journal of Kermanshah University of Medical, 12(1): e80106.
41. Rashid Lamir A, Dehbashi M, Taghizadeh V (2014). Study the prevalence of legal and illegal supplements between athlete’s men in Bodybuilders and powerlifting field. Shomal J Manag & Physiol Sport, 2(1):1-11. [Persian]
42. Razavi Z, Moeini B, Shafiei Y, Bazmamoun H (2014). Prevalence of anabolic steroid use and associated factors among bodybuilders in Hamadan, western province of Iran. J Res Health Sci, 14(2):163-6.
43. Rezaei SMA (2017). Study the prevalence of anabolic steroids consumption among bodybuilding athletes in Yasuj, Iran. Int J Nutr Sci, 2(2):103-108.
44. Saeidinejat S, Hooshmand E, Zahra H, et al (2017). Evaluating the pattern of anabolic androgenic steroid use and its relation with mental health of male members of bodybuilding clubs of Iran in 2015. Asian J Sports Med, 9(1):e60164.
45. Sepehri G, Mousavi Fard M, Sepehri E (2009). Frequency of anabolic steroids abuse in bodybuilder athletes in Kerman city. Addict Health, 1(1):25-9.
46. Shahsavani A (2014). Prevalence of doping drug use and awareness of their adverse effects among bodybuilding athletes in Zahedan. Adv Environ Biol, 8(17):1306-9.
47. Sharifirad GR, AhmadzadehSani F, Mohebi S, et al (2011). Identification of factors related to the use of doping drugs and its side effects on body building athletes in Gonabad based on health belief model. The First International & 4th National Congress on Health Education & Promotion, 16-19 May 2011,Tabriz-Iran. Health Prom Persp.
48. Shojaee Mahallati A. Frequency of Nutrition Supplements and energy enhancing drugs in bodybuilding athletes in Tehran. [M.D. Thesis], Islamic Azad University of Tehran, Iran; 1999.
49. Sobhanian S, Rajabian D, Sadeghi F, Parsayee Manesh E (2013). Frequency of the use of anabolic drugs in bodybuilding athletes in Jahrom city. J Jahrom Univ Med Sci, 11(3):30-4.
50. Taghavi SMR. Determining the awareness and usage degree of doping among body-builders in Zahedan in 2002. [M.D. Thesis] Sistan and Baluchestan University of Medical Sciences, Iran; 2003.
51. Zakeri A (2012). The frequency of infertility following anabolic steroid in bodybuild-ers in Tehran in 2010. Iran J Obstet Gynecol Infertil, 15(2): 29-34.
52. Mottram DR, Chester N (2018). Drugs in sport. 7th ed. Routledge Taylor & Francis, Oxfordshire, pp.:34-67.
53. Sagoe D, Torsheim Tr, Molde H, et al (2015). Anabolic-androgenic steroid use in the Nordic countries: A meta-analysis and meta-regression analysis. Nordic Stud Alcohol Drug, 32(1):7-20.
54. Al Bishi KA, Afify A (2017). Prevalence and awareness of Anabolic Androgenic Steroids (AAS) among gymnasts in the western province of Riyadh, Saudi Arabia. Electron Physician,9(12):6050-6057.
55. Afolayan J (2012). Knowledge and use of performance enhancing drugs among Nigeria elite athletes. OSR Journal of Applied Chemistry, 1(5):31-38.
56. Bagge AL, Rosén T, Fahlke C, et al (2017). Somatic effects of AAS abuse: a 30-years follow-up study of male former power sports athletes. J Sci Med Sport, 20(9):814-818.
57. Abrahin OSC, de Sousa EC, Santos AM (2014). Prevalence of the use of anabolic-androgenic steroids in Brazil: a systematic review. Subst Use Misuse, 49(9):1156-62.
58. Harmer PA (2010). Anabolic-androgenic steroid use among young male and female athletes: is the game to blame? Br J Sports Med, 44(62):26-31.
59. Bird SR, Goebel C, Burke LM, et al (2016). Doping in sport and exercise: anabolic, ergogenic, health and clinical issues. Ann Clin Biochem, 53(Pt 2):196-221.
60. Pope Jr HG, Kanayama G, Athey A, et al (2014). The lifetime prevalence of anabolic‐androgenic steroid use and dependence in Americans: Current best estimates. Am J Addict, 23(4):371-7.
61. World Anti-Doping Agency (2019). 2019 Anti-doping testing figures. Montreal, Canada.
IssueVol 50 No 6 (2021) QRcode
SectionReview Article(s)
Anabolic-androgenic steroid; Athletes Public health Doping Prevalence

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How to Cite
Selk- Ghaffari M, Shab-Bidar S, Halabchi F. The Prevalence of Anabolic-Androgenic Steroid Misuse in Iranian Athletes: A Systematic Review and Meta-Analysis. Iran J Public Health. 50(6):1120-1134.