Use of anabolic androgenic steroids in a Swedish forensic population: Associations with substance use and criminal convictions

Background The use of anabolic androgenic steroids (AAS) has been associated with adverse psychiatric effects and risk behavior, including increased aggressiveness. The aim of this study was to characterize AAS users in forensic settings and investigate criminal convictions, the use of other substances and sociodemographic factors. Methods This descriptive cross-sectional study used Swedish national register data. The study included 3548 men who tested positive for AAS at the National Board of Forensic Medicine between 2010 and 2022. The study population consisted of individuals undergoing forensic toxicological analysis following requests from the police. AAS-positive (AAS-pos) individuals were compared with 6595 men who tested negative for AAS (AAS-neg) and a matched control group of 17,744 men not tested for AAS. Results The prevalence of AAS was 35% and testosterone was the most frequently determined AAS. The AAS-pos group had a median of 2.0 rearrests during a two-year follow-up. Concomitant use of illicit and/or licit substances was observed in 50% of the AAS-pos individuals. Cannabis, followed by amphetamines, were the most commonly determined illicit substances across all groups. Compared with the other groups, AAS-pos individuals were more frequently sentenced to imprisonment ( p <0.05). Drug offences showed the largest difference between AAS-pos and AAS-neg individuals. A similar profile was observed for weapons offences. Conclusion AAS use in this forensic setting is linked to a pattern of risk behavior characterized by substance use and criminal involvement.