Background Clinical risk severity among anabolic-androgenic steroid (AAS) consumers remains underexplored, despite growing evidence linking AAS consumption to physical and psychosocial harms. This study investigated how structural and social vulnerabilities relate to clinical risk severity among AAS consumers engaged with community-based alcohol and other drug (AOD) services in Australia. Methods Data was analyzed from 517 clients (93.4% male) reporting lifetime AAS consumption at Lives Lived Well services between 2020 and 2024, a subset of a larger adult dataset (N = 18,786). Two multiple linear regression models were conducted. The first included structural predictors (e.g. hospitalization, imprisonment); the second included social predictors (e.g. violence, trauma). The dependent variable in both models was the World Health Organization - Alcohol, Smoking and Substance Involvement Screening Test steroid risk score. Results Both models were statistically significant. In the structural model, recent hospitalization (B = 2.61, p = .004) and risk of homelessness (B = 2.55, p = .013) were significant positive correlates. In the social model, recent violence (B = 4.52, p < .001) and a lack of companionship (B = 3.51, p = .002) were significant positive predictors. Together, these findings suggest that structural and social vulnerabilities contribute uniquely to clinical risk among AAS consumers. Conclusions Clinical risk severity among AAS consumers engaged in AOD services is influenced by intersecting structural and social stressors. Service responses should incorporate targeted screening for recent violence, housing instability, and hospital interaction history, with tailored support pathways that reflect the complex lived realities of this cohort.
