Toward a Coordinated Global Response to Anabolic-Androgenic Steroid Consumption: Lessons From the World's Current Steroid Checking Initiatives.

Anabolic-androgenic steroid (AAS) use presents a growing global public health issue. Despite evidence of significant physical, psychological and social harms, responses to non-medical AAS use remain fragmented, under-resourced and lacking in coordinated clinical and policy frameworks. This commentary synthesises emerging evidence and outlines priorities for developing a comprehensive harm reduction approach. Recent innovations in Australia and Switzerland have introduced steroid checking programs, where people who use AAS can anonymously submit products for chemical analysis. Findings from both countries indicate widespread product misrepresentation and consumer engagement with results. Peer involvement was critical to the success of these programs, suggesting that trusted, community-led harm reduction models are both feasible and effective. To address AAS-related harms, we outline four priorities: expanding AAS inclusion in drug checking programs; embedding peer-led education in service design; developing clinical pathways that reflect the complexities of AAS use; and building international consensus on harm reduction and treatment. These steps are essential to creating a coordinated global response that prioritises equity, evidence and lived-living experience.