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Most of the adverse effects of anabolic-androgenic steroid (AAS) use are dose dependent, and some are reversible with cessation of the offending agent or agents. The purpose of this article is to discuss what evidence there is of the potential for long-term risk of death from these agents that may be associated with their usage.Long-term outcomes of anabolic-androgenic steroid (AAS) users have recently become a major media issue. AAS users are at increased risk of death, stroke, liver problems, liver transplants or death in premature infants, as well as various other consequences of AAS use.1,4For over 50 years, the medical community has been aware of both the risk of the use of AAS, and the association between AAS use and these harms.1,4 However, for several reasons, the literature is still incomplete. For example, few studies have investigated the association of AAS usage to cardiovascular death and the association with death caused by cardiovascular causes. There has also been limited research into the effects of the use of AAS on endocrine function.5,6The objective of the current study was to update the knowledge on AAS use and all-cause mortality using the WHO classification of chronic diseases. This classification is based on the clinical relevance of the disease state, and the relation of the disease state to both the morbidity and mortality of a patient. The WHO classification is considered to be highly reliable and reproducible.4MethodsStudy objectives.We have previously published the number of deaths from different causes attributed to anabolic androgenic steroids per 100 000 population (ICD-10 codes) in a systematic review and meta-analysis (http://www.ncbi.nlm.nih.gov/pubmed/27441892), and we have published a detailed description of this information here (http://www.ncbi.nlm.nih.gov/pubmed/23691497), and published the incidence and mortality rates of various diseases in this age classification (http://www.ncbi.nlm.nih.gov/pubmed/18092127).The literature search involved all relevant databases and articles published in a MEDLINE/PubMed database. In a later phase of the review, we evaluated the search results and subsequently identified any additional articles. Since articles that addressed new topics and were previously published did not represent all articles reviewed, we also evaluated newly published articles.In January 2010, we completed an updated systematic review by searching Medline, Embase and Cochrane databases. The search was conducted using a combination of ASimilar articles: