Tircova and colleagues analyzed 358 voluntarily obtained anabolic steroids and identified 49 different manufacturers, the majority of them being underground labs and only the minority being pharmaceutical companies. Funnel plot for counterfeit AAS (left), funnel plot for substandard AAS (right). In some studies, the contained active ingredients in "under-concentrated" preparations was much lower than 50% of that indicated (e.g. 0.5–1.5% , 9% or 16% ) if quantitative data was available. We provide evidence that AAS are more likely to be under-concentrated than over-concentrated if they are of substandard quality. In this systematic review we demonstrate that the real composition, the type of production, concentration, quantity, quality, and purity are often not declared on the label, and labels are even misleading. Importantly, there are more than 60 different anabolic androgenic steroids listed on the WADA prohibited list and novel compounds are frequently detected on the market. Different anabolic steroids come with compound or class-specific and unspecific adverse events. We further show a limited geographical scope of included studies, with all studies being from countries in Europe or Brazil. Underground laboratories emerged both locally and in countries with lax legal regulations and it is described that an 'anabolic steroid tourism' and large networks of online resellers emerged, simplifying the illegal acquisition of anabolic steroids . Earlier this year, Christine suffered two health emergencies within the span of a week, in which she says her blood pressure spiked, potentially causing organ damage. When her service ended, she was ready to start taking hormones right away. And Jaime Lynn Gilmour, a trans woman using the full name she chose to match her gender identity, turned to informed consent after struggling to find DIY hormones. In 2016, Entropy, a non-binary trans woman who lives in Nashville, Tennessee, considered illegally buying hormones online. That’s how Christine received her hormones from Fenway Health before she moved from Boston to Cape Cod. Another way to increase access to hormones is through informed consent, a system which received a green light from the newest WPATH guidelines. "People can increasingly get hormone therapy from their pre-existing family doctor," Scheim says, "which is really ideal because people should be able to have a sort of continuity of health care." Therefore, it’s crucial to consult with a healthcare professional in your area to get the most up-to-date and accurate information. Remember that testosterone use guidelines and regulations vary from country to country and can change over time. Due to its potential for misuse and side effects, obtaining it without a prescription or through unlawful means can lead to serious legal consequences and health risks. Buying Testosterone legally always involves consulting with a qualified healthcare professional and obtaining a prescription. Always follow a doctor’s or healthcare provider’s guidance for the safe and legal use of Testosterone. Among the included studies, most approaches are based on liquid chromatography coupled to mass spectrometry (LC–MS/MS) 32, 42, 47, 49, 50, or gas chromatography coupled to mass spectrometry (GC–MS) 32, 35, 40, 42, 47, 49, 51–54. Characteristics of 19 published studies presenting qualitative and quantitative data of fake AAS on the black-market • peer-reviewed original articles with full-text available The effect of supraphysiologic doses of anabolic androgenic steroids (AAS) on muscles, especially combined with strength training, has been described and recognized in literature for decades 1–5. Rather than caused by study design issues, the differing proportions of counterfeit or substandard AAS reflect the selection of the tested AAS samples, with real differences in the quality of AAS found on the black market. We searched PubMed/Medline, Embase and Google Scholar for studies published before March 29, 2022 that analyzed the quality and quantity of AAS to determine the proportions of substandard and counterfeit products found on the black market. Fake anabolic androgenic steroids on the black market – a systematic review and meta-analysis on qualitative and quantitative analytical results found within the literature. With this systematic review and meta-analysis on black-market AAS, we have demonstrated that substantial mean proportions may be of substandard quality or counterfeit. ‘Drug checking’ allows people who consume illegal and legal drugs acquired from unregulated drug markets to submit samples for chemical analysis and receive feedback on the quantity, quality, and purity of those substances. He was told his testosterone levels were that of a pensioner, and he had effectively given himself andropause, the male menopause, because he had taken too high a dose of testosterone at a young age. After learning more about the possible long-term effects of taking too much testosterone - such as high blood pressure and liver damage - Chris sought professional help from Dr Robert Stevens, who runs The Men's Health Clinic in Dorset. As well as taking too much testosterone, he wasn't monitoring his levels with regular blood tests, which is recommended by qualified doctors. The Mirror spoke to one young man who fell for the testosterone-maxxing trend and was left with the T levels 'of a 70-year-old man'.