Meta-regression analyses provided in R software were conducted to explore the association between studies’ publication year and outcome measures . Data extraction was performed independently by two reviewers (RM and LF), with disagreement resolved by discussion. • Levels of AI detected are not between the acceptable range defined for [https://lawrencewilbert.com/read-blog/36877_testosterone-what-it-does-and-doesn-039-t-do.html](https://lawrencewilbert.com/read-blog/36877_testosterone-what-it-does-and-doesn-039-t-do.html) original productsa (quantitative) • Levels of active pharmaceutical ingredients (AI) detected are between the defined range of the declared formulation defined by the individual studya (quantitative) Injectable [testosterone store](http://112.124.40.88:5510/randygoodson93/randy2021/wiki/11-natural-remedies-for-erectile-dysfunction-ED), synthetic AAS, other hormones and adjunctive therapies can easily be purchased over the internet and are delivered to a consumer’s home without prescription 4, 6, 8. Due to lack of reporting, precise prevalence and demographic information on the use of these substances is challenging . Historically, [116.198.44.217](http://116.198.44.217:8040/larahopetoun58) the majority of AAS users were professional or competitive athletes, [playxtream.com](https://playxtream.com/@gisellemclane?page=about) but nowadays survey data has revealed that over 75% of AAS users are non-competitive bodybuilders or [http://113.177.27.200:2033/uweharwood650/1334git.m.ctf.arrobe.fr/wiki/How-Cold-Therapy-Affects-Testosterone-and-Sexual-Wellness](http://113.177.27.200:2033/uweharwood650/1334git.m.ctf.arrobe.fr/wiki/How-Cold-Therapy-Affects-Testosterone-and-Sexual-Wellness) athletes, who are mostly motivated by cosmetic benefits over performance enhancement from AAS use 4, 6, 8–13. AAS belong to the broader group of image and performance enhancing drugs (IPEDs) and are widely used as a convenient and easy method to improve body image and sport performance goals . All authors contributed to refinement of the literature review and approved the final manuscript. LF/PB provided statistical and methodological expertise of the review. In some cases, [guateempleos.com](https://guateempleos.com/companies/testosterone-cypionate-api-market-data-driven-value-chain-optimization/) 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 . It is described that in order to provide good drug testing services, [https://git.anagora.org/garyjaynes0212](https://git.anagora.org/garyjaynes0212) there must be a close collaboration between different stakeholders and actors, such as politicians, the police and [https://www.liveactionzone.com/@tracybirchell1?page=about](https://www.liveactionzone.com/@tracybirchell1?page=about) medical treatment services . Research in the Americas was only done in Brazil, which alone includes 7 of the 19 studies. The peer-reviewed literature of qualitative and quantitative analyses of AAS has considerably increased in the last few years. All study characteristics can be viewed in detail in Table 4. All quality appraisal results can be found in Supplementary file 1. Additional articles were excluded after full-text assessment for the reasons mentioned in the flowchart (Fig. 1). We retrieved a total of 24 full-text articles from these different sources. Most samples (74%) originated from seized compounds by the police, custom authorities, or justice departments and a minority of samples were bought directly from the black market or provided by gyms and users themselves. One study was a retrospective database analysis of the Brazilian federal police database . Most included study designs (95%) were nonclinical laboratory studies. Characteristics of 19 published studies presenting qualitative and quantitative data of fake AAS on the black-market Among the included studies, the majority (53%) were published in the last five years of this current study (2017–2022) and the vast majority (79%) were published within the last decade (2012–2022) of this current study. The detailed search and screening strategy has been published within the review protocol . Furthermore, [159.75.131.235](http://159.75.131.235:3001/ladonnastorkey) we continued pursuing relevant references to articles and manually tracked electronic citations related to the topic in order to identify sources in obscure locations, also called the snow-ball method . With this systematic review we aim to further elaborate on these threats and suggest evidence-based approaches to reduce harms for this user population. These drugs may contain [buy testosterone online no prescription](https://ashkert.am/%D5%A1%D5%B7%D5%AF%D5%A5%D6%80%D5%BF%D5%AB-%D5%B0%D5%A1%D5%B4%D5%A1%D6%80/finger-prick-blood-test-for-free-testosterone/) active ingredient, or [46.202.189.66](http://46.202.189.66:3000/marilynnsalomo) in another amount than that labeled, a wrong active ingredient, as well as not all or more active ingredients than were labeled.