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Abuse of performance-enhancing drugs (PEDs) isn't just a problem of top athletes -- it's a large-scale public health problem that affects some 3 million people who use them in the U.S., according to a new scientific statement from The Endocrine Society.

The majority of users are non-athlete weightlifters who are focused on looking leaner and more muscular, according to , director of the research program in men's health at Brigham & Women's Hospital in Boston, the lead author of the statement.

PED use can lead to infertility, gynecomastia, sexual dysfunction, hair loss, acne, and testicular atrophy, and it has also been linked to risks of death and other complications including cardiovascular, psychiatric, metabolic, renal, and musculoskeletal disorders, Bhasin said.

The statement, , notes that the most frequently used PEDs are anabolic drugs that increase muscle mass and reduce fat mass. Anabolic-androgenic steroids are the most heavily abused, followed by human growth hormone, insulin-like growth factor, stimulants, erythropoietin, diuretics, and thyroid hormone.

Those who develop a dependence on PEDs – which happens in about a third of those who take anabolic steroids -- tend to have many years of exposure and are at the greatest risk of complications, Bhasin said.

He said studies are needed to assess which interventions to treat steroid dependency work best.

Researchers also need to start registry studies of PED users to assess long-term effects, because gold-standard randomized controlled trials would be unethical in this population given the large doses of PEDs they typically take.

Bhasin also warned of the potential tide of major adverse effects in the near future, since widespread PED use didn't appear in the general population until the 80s and 90s. With the majority of PED users still under 50, the next decades could see potentially damaging effects on common chronic age-related conditions.

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