Anabolic androgenic steroid use and risk of diabetes mellitus in males

Aims: Anabolic androgenic steroids (AASs) are used to enhance performance and appearance. While their use is associated with a substantial cardiovascular burden, the long-term effects on glucose metabolism and diabetes mellitus (DM) risk remain unclear. This study aimed to assess the incidence of DM among Danish males sanctioned for AAS use, compared with age-matched controls from the general population. Materials and Methods: We conducted a nationwide cohort study including 1189 males sanctioned for AAS use between 2006 and 2018. Each AAS user was matched with 50 male controls. Participants were followed using national health registers until DM, death, emigration, or 2023. DM was defined by hospital diagnoses or redeemed prescriptions for glucose-lowering medications. Incidence rate ratios (IRRs) were estimated using Poisson regression, with and without socio-demographic adjustment. Results: During follow-up, 2.0% of AAS users and 2.3% of controls developed DM, yielding an IRR of 0.84 (95% confidence interval [CI]: 0.56–1.26). After adjustment, the IRR was 0.70 (95% CI: 0.46–1.07). In a sensitivity analysis, glucagon-like peptide-1 receptor agonist use as sole indicator did not count as DM; AAS use was significantly associated with a reduced risk of DM (adjusted IRR: 0.42; 95% CI: 0.23–0.78). Conclusions: In this population-based cohort study, AAS use was not associated with an increased risk of DM. These findings provide observational data that may contribute to the understanding of the potential metabolic effects of AAS exposure during long-term follow-up. However, confounding from lifestyle factors such as exercise and diet, as well as body mass index, cannot be excluded.