The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research

The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research / Dominic Sagoe, Cecilie Schou Andreassen, Ståle Pallesen. - (Substance Abuse Treatment, Prevention, and Policy 9 (2014) 27 (2 July); p. 1-14)

  • DOI: 10.1186/1747-597X-9-27



To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use.


We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines.


A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation.


Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.

Original document


2 July 2014
Andreassen, Cecilie Schou
Pallesen, Ståle
Sagoe, Dominic
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Universitetet i Bergen - University of Bergen
Doping classes
S1. Anabolic Agents
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Substance use research
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Monitoring Report
Scientific article
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Date generated
15 October 2020
Date of last modification
2 December 2021
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