Case studies are always interesting as they tend to only publish the extreme or odd deaths. Earlier this year Australian researchers conducted an analysis of a large database composed of information from autopsies on non-natural causes of death. They were specifically looking for anabolic steroid users, which were identified when anabolic steroid metabolites were found in the urine during the autopsy.
Keep in mind this was a huge database and they looked for steroid users over 16 years, sifting through over 32,000 deaths (the database includes 2000 to 2500 deaths per year). Of those deaths they found 24 related to steroid use (all men). The autopsies were quite thorough and tested for everything including alcohol, weed, psychostimulants (meth, heroin, etc), anti-psychotic drugs, GHB, and anti-depressants. Basically they wanted to determine the major causes of death in these AAS users.
Table 1 shows the general demographic of the men who were analyzed. Overall this appears to be a pretty standard picture of your typical 31 year old male. Notably the sample size is actually quite small. 24 people in a database of over 32,000 cases is less than 1%. So to say anabolic related steroid deaths are rare – is probably true.
The other thing you might notice is that 13 of the 24 of the deaths were attributed to accidental drug toxicity. 8 deaths were directly attributed to psychostimulant overdoses, such as a herion over dose. And 7 were directly attributed to opoid toxicity, meaning that 15 of the 24 deaths were not specifically the fault of steroid use. It simply tells us that some recreational drug users also use steroids. Another 7 of the 24 deaths were homicide or suicide related, and the 1 accidental death was a pilot who crashed and died. Which means 22 of the 24 deaths were virtually not at the fault of steroid use.
Which came first? The chicken or the egg?
Table 2 highlights what they found in steroid users. As you glance through the table you will quickly notice, again, that most were using some form of recreational drug. Interestingly none of them were using cannabis, which actually has been a common finding in steroid using bodybuilders. Also of note is that most were using testosterone (as measured by a testosterone to epitestosterone ratio greater than 4). And the most popular stack appears to be test and deca (long considered the bread and butter of bodybuilding stacks).
Above all else is the rampant use of cocaine, meth, pain killers, and benzodiazepines. Together this table does not prove any of the deaths were specifically attributable to anabolic steroid use. Rather it simply convolutes the data and what the true issue may have been for each individual.
Steroids Shrink Your Nuts – We knew that already
Table 3 is a summation of autopsy findings as they are related to various disease and organ measures. The authors of this case study present their case that seems to suggest most of these issues are related to the steroid use in these 24 men. This of course is somewhat silly considering the rampant use of recreational drugs you see in Table 2.
The items marked “Steroid-related pathology” are the only items the authors can specifically blame on steroid use. All others could be a result of the various recreational drugs used, or quite simply genetic issues that some of the men may have been predisposed too.
All of this doesn’t tell us much more than anabolic steroid related deaths (at least documented ones such as these) are a very very small percentage of all non-natural deaths. In fact, one could argue that steroids were not the result of any death in a database of well over 32,000 non-natural deaths! There are very few, if any, drugs that could have such a pristine record. Again this isn’t to suggest steroid or prohormone abuse cannot lead to eventual death, but more so that’s it’s an extremely rare scenario. I would like to say it’s close to impossible, but we need more research to fully elucidate what can truly happen with long term, high dose, steroid use (which will never happen because of the ethical implications).