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.
The use of performance-enhancing substances (PES) has expanded beyond elite sport and is increasingly prevalent among recreational gym-goers, some of whom engage in behaviors that may increase the risk of blood-borne virus transmission. This systematic review and meta-analysis aimed to synthesize evidence on the prevalence of HIV, HBV, and HCV among PES users, quantitatively estimate prevalence where comparable laboratory-confirmed data were available, and identify behavioral and contextual factors associated with infection risk. A systematic search was conducted in PubMed, Scopus, and Web of Science, and the review was reported in accordance with PRISMA 2020. Random-effects meta-analyses of sufficiently comparable laboratory-confirmed prevalence data were conducted using binomial-normal generalized linear mixed models with a logit link, while remaining evidence was synthesized narratively. Twenty-one studies met the inclusion criteria. Pooled prevalence was 0.75% (95% CI: <0.01–9.63%) for HIV, 5.60% (95% CI: 1.71–15.16%) for HBV based on anti-HBc, and 4.33% (95% CI: 1.47–9.34%) for HCV based on anti-HCV. These estimates were based on few independent studies and should therefore be interpreted cautiously. Higher HIV prevalence was reported in self-reported data from higher-risk subpopulations, particularly men who have sex with men. Key risk-related factors included sharing or reusing injection equipment, concomitant injection of psychoactive substances, risky sexual behaviors, and a history of incarceration. Low uptake of viral testing and HBV vaccination was also reported. These findings highlight the need for targeted harm-reduction, testing, vaccination, and education strategies for PES users, while further research using standardized diagnostic and reporting methods is needed to strengthen prevalence estimates.
Selective androgen receptor modulators (SARMs) are a group of experimental drugs that are used illegally by bodybuilders and athletes, for their demonstrated potential to stimulate muscle growth (anabolic effect). Due to these properties, SARMs are classified as World Anti-Doping Agency (WADA) Prohibited Substances within Group S1: Anabolic Agents (Other anabolic agents, subsection 2). As there are no SARMs approved for human use, it is illegal to manufacture, advertise or supply SARMs in Australia. Despite this, SARMs are readily available online. As these products are illegal and therefore unregulated, there is no guarantee that a product sold as SARM contains the substance declared on its label.Human and Supplement Testing Australia (HASTA) screened 33 products labelled as containing SARMs against a panel of over 250 WADA Prohibited Substances. Of the products screened, 97% were found to contain WADA Prohibited Substances, including SARMs, but also anabolic androgenic steroids (AAS), a beta-2-agonist, a diuretic, stimulants and the non-WADA Prohibited Substances sildenafil and tadalafil. Five products did not contain any of the listed compounds, however, did contain other WADA Prohibited Substances. The lack of correlation between the label and the contents of these products, and the presence of multiple unlabelled drugs in many of them, highlights the additional risks to both athletes and other users purchasing these products.
Bodybuilding has become a multidisciplinary research domain, yet its scholarship remains fragmented across performance science, enhancement, health, body image, and cultural inquiry. How these strands relate, develop, and reveal gaps in the evidence base remains insufficiently understood. This bibliometric and thematic review mapped 1033 Scopus-indexed records published from 2015 to 2025 using Bibliometrix/Biblioshiny and VOSviewer, complemented by interpretive thematic synthesis and population-visibility analysis. The findings revealed a field shaped by a persistent tension between physique optimization and its physiological, psychological, and social consequences. Training and nutrition formed a strong applied foundation, while enhancement and biomedical surveillance remained enduring concerns; psychosocial scholarship was substantial, whereas platformed physique visibility emerged more recently. The literature was also marked by uneven international collaboration and greater explicit visibility of male than female populations, alongside widespread demographic underreporting. These patterns suggest that the field’s multidisciplinary growth has not eliminated important population, geographical, and welfare-related blind spots. Hence. future research should couple evidence-informed physique preparation with broader attention to diversity, harm reduction, athlete welfare, and long-term sustainability.
Introduction Doping prevention increasingly emphasizes early intervention with education directed toward youth, parents, and coaches. Although adolescent athletes are a central focus of prevention efforts, little is known about how they learn about performance-enhancing drugs (PEDs) and other enhancement practices through everyday social interactions. Understanding these informal learning processes is important for effective prevention. Methods This qualitative study examined how youth athletes make sense of PEDs through interactions with peers, parents, and coaches. Twenty semi-structured interviews were conducted with elite Barbadian athletes (7 female, 13 male; aged 14–19). Guided by a domain-specific approach to socialization, thematic analysis examined athletes’ recollections of performance-related conversations with key socialization agents. Results Although athletes initially claimed that PEDs were “not discussed,” indirect peer conversations were common. Humor, speculation, and digital exchanges functioned as key sites of meaning-making, potentially shaping beliefs about prevalence, effectiveness, and necessity. Peers emerged as primary sources of informal learning through guided learning and group participation processes. In contrast, parents and coaches typically engaged through brief, one-directional exchanges aligned with control and protection domains, limiting dialogue and value internalization. Notably, athletes often educated peers and parents, reflecting bidirectional socialization. Conclusions Adolescent athletes actively construct understandings of PEDs through everyday conversations, particularly within peer networks, in the absence of adult engagement. Prevention strategies that rely solely on adult-led education may overlook these informal learning dynamics. Prevention strategies should promote open, dialogic conversations, leverage peer-based learning, and address the normalization of enhancement practices to better support adolescent athlete well-being and clean sport.
