Stacking the Risks: Fatal Consequences of Anabolic Steroid Misuse and Stacked Substance Use in FAERS Data

Background: Misuse of anabolic-androgenic steroids (AAS), especially through “stacking” multiple substances, poses significant health risks. This study leverages data from the FDA’s Adverse Event Reporting System (FAERS) to assess these risks and identify factors predicting severe outcomes. Methods: We analyzed 286 FAERS reports of intentional AAS misuse. After removing duplicates, the final dataset included 218 unique cases involving men, 7 involving women, and 14 cases with unspecified sex. Drugs, adverse drug reactions (ADRs), and demographic data were categorized. Statistical analyses, including logistic regression, evaluated associations between substance combinations and serious outcomes. Results: Serious cases constituted 46.8% of the total among men, with cardiovascular, endocrine, and psychological ADRs being most frequent. Stacking other drugs on top of AAS was highly associated with serious outcomes (P < .001). Stacking central nervous system (CNS) depressants (P = 3.50 × 10⁻⁸), fat-burning agents (P = 1.51 × 10⁻¹⁰), endocrine modulators (P = 6.26 × 10⁻⁶), and other CNS-active substances (P = 3.34 × 10⁻⁵) were strongly associated with serious outcomes. Logistic regression revealed younger age (P = .0188, negative coefficient −0.117) and higher drug count (P = .0458, positive coefficient 0.991) and recent report year (P = .0006, negative coefficient −0.467) as significant predictors of life-threatening events. Conclusions: AAS misuse, especially through high-risk stacking, significantly elevates the risk of serious health outcomes, particularly in younger individuals. Public health interventions—including targeted outreach, harm reduction, and enhanced healthcare provider awareness training—are necessary to educate on and mitigate these risks.