Prevalence and usage-related characteristics of non-clinical anabolic-androgenic steroid use in Latin America: A systematic review and meta-analysis

The non-clinical use of anabolic-androgenic steroids (AAS) is a growing global concern. While early data suggested high prevalence in South America, evidence remains fragmented. This study estimated AAS prevalence across Latin America by a systematic review and meta-analysis (PROSPERO CRD420251056436), searching databases up to December 2025. Prevalence, confidence intervals (95%CIs), and prediction intervals (95%PIs) were calculated using a random-effects model, with subgroup analyses by country, sex, age, fitness level, research recruitment setting, and sampling method. Fifty-one studies (n = 57,121) were included, 48 from Brazil. The pooled prevalence was 14.2% (95%CI:11.2–17.6%; 95%PI:0.3–43.4%), and 10.7% (95%CI:8.2–13.6%) without bodybuilding population. The prevalence rose from 9.0% (95%CI:6.1–12.4%) in studies published until 2014 to 19.3% (95%CI:13.6–25.7%) from 2014 onward. Higher rates were observed among bodybuilders (62.3%) and physically active (18.2%) compared to non-bodybuilding athletes (2.8%); in males (20.5%) compared to females (10.4%); and older (22–30 yrs:19.0% and >30 yrs:32.4%) compared to younger (<22 yrs:1.4%) adults (all p < 0.05). Notably, studies with a high risk of bias yielded significantly higher estimates compared to low/moderate-risk studies (19.0%vs 3.2%). Testosterone-derived compounds were the most common AAS substance reported. Frequent adverse effects included dermatological, sexual, and behavioral changes, while positive perceptions focused on body image. The AAS use in Latin America, largely driven by Brazil, is higher than previous estimates and may have increased in recent years. However, heavy reliance on unvalidated questionnaires and convenience sampling likely inflates these overarching estimates. These findings highlight a regional public health issue, necessitating standardized research methods and tailored harm-reduction strategies.