Recreational drug testing services became available in the 1990s . Another strategy could entail the introduction of specialized drug checking services for this user community. In the opioid field, one of the most effective harm reduction measures is the medical prescription of opioids (opioid agonist therapy), together with psychosocial, interdisciplinary care . Different harm reduction strategies could be employed to limit this user community from either getting in contact with fake AAS from the black market or to promote safer use and informed decision making. Therefore, it is of great importance that clinicians, politicians and law-makers are aware of this considerable individual and public health threat, given the significant negative long-term health impact of AAS misuse and exposure to fake AAS. Information about the use of AAS is commonly acquired from non-medical sources, such as word of mouth propaganda from athletes, dealers and bodybuilders , as there is major distrust and lack of confidence by AAS users towards medical doctors 4, 9, 14. Furthermore, due to punitive laws, stigma, and inexperience of health care professionals, this user population is widely unaccessed. Firstly, defined ranges of declared labels could vary massively between articles, had a quantitative analysis been performed, with defined ranges between 50–200% , 80–130% , 80–120% or 90–110% . For most original substances, we were able to extract qualitatively analyzed data (accurately labeled) and only for 37% were we able to extract qualitatively and quantitatively analyzed data (accurately labeled and concentration within range as declared on the label). The full extraction form can be found in Supplementary file 2; the summary form used for data analysis can be found in Supplementary file 3. Importantly, whenever anabolic agents were analyzed with other classes of substances, anabolic agents made the highest proportion of analyzed classes. He was told his testosterone levels were that of a pensioner, and he had effectively given himself andropause, the male menopause, because he had taken too high a dose of testosterone at a young age. After learning more about the possible long-term effects of taking too much testosterone - such as high blood pressure and liver damage - Chris sought professional help from Dr Robert Stevens, who runs The Men's Health Clinic in Dorset. As well as taking too much testosterone, he wasn't monitoring his levels with regular blood tests, which is recommended by qualified doctors. The Mirror spoke to one young man who fell for the testosterone-maxxing trend and was left with the T levels 'of a 70-year-old man'. LF/PB provided statistical and methodological expertise of the review. In some cases, the published data had to be manually adapted and transferred to fit our classification system. These harm reduction interventions may be especially effective in this user population as these drugs are used for an average of 20 weeks , compared to recreational illicit drug use that is often only used sporadically. Unfortunately, there are currently major limitations in identifying these fraudulent products by users and such services may become a cornerstone in accessing this hard-to-access user population . Ever since, recreational drug testing is being conducted in a growing number of countries. We retrieved a total of 24 full-text articles from these different sources. Meta-regression analyses provided in R software were conducted to explore the association between studies’ publication year and outcome measures . The pooled proportions for primary outcomes and corresponding 95% confidence interval (CI) were calculated using a random-effect model, using the procedure for meta-analysis of single proportions "metaprop" from the library "meta", provided in R software for statistical computing. Data extraction was performed independently by two reviewers (RM and LF), with disagreement resolved by discussion. Substitution means that different active ingredients than that indicated on the label are included, whereas adulteration refers to more, or not all active ingredients that are included as indicated on the label. Navigating bureaucracy, being incorrectly identified—or misgendered—and facing outright transphobia from health care providers, he adds, "can just become too much for folks." Trans-friendly health care providers are rare, and booking an appointment can stretch out over many weeks. While not directly touching on the new health care rule, some experts think the Supreme Court’s decision may make legal challenges to it more likely to succeed.
