Healthcare Costs Associated With Anabolic Steroid Use: A Cohort Study

Anabolic androgenic steroid (AAS) use is associated with various health risks, yet its impact on healthcare expenditures remains insufficiently explored. This nationwide register-based study examined direct healthcare costs among 1183 males sanctioned for AAS use in Denmark between 2006 and 2017, compared with 59 150 age- and sex-matched controls from the general population. Healthcare costs were calculated across primary care, hospital services, and prescription drugs, with up to 10 years of follow-up. AAS users had significantly higher total healthcare costs, with a mean excess of 3299 euros (EUR) per person (95% CI: 1857-4742; p < 0.0001) over the follow-up period, corresponding to approximately EUR 537 per AAS user per year. This represents a 45% increase over controls, whose average total costs were EUR 7393 per person. The cost difference was primarily driven by hospital care but was also evident in primary care and prescription medication use. Cumulative cost differences increased steadily over time and remained consistent across most diagnostic categories. AAS users were relatively young and otherwise expected to have low healthcare use, suggesting a notable health burden in this group. These findings add real-world evidence on the healthcare implications of AAS use and highlight a sustained cost difference between AAS users and controls over a prolonged period. Continued follow-up may be necessary to fully capture long-term costs, particularly as some complications may appear years after use.