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AAS use is associated with psychopathology, yet this relationship is complex and not fully understood. We aimed to assess the presence of AASs and other misused substances in athletes' biological samples and link toxicological to psychopathological findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicentre, cross\u2010sectional study in fitness centres in Italy recruited 122 professional and amateur athletes training in several sports (84 men; age range\u00a0=\u00a018\u201045 years). Athletes completed questionnaires, interviews, and toxicology testing for AASs, other PIEDs, illicit drugs, and non\u2010prescribed psychotropics. Toxicology was conducted in blood, urine, and hair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Self\u2010reported and toxicologically detected use rates of AASs and other misused substances showed slight\u2010to\u2010fair agreement (Fleiss' <jats:italic>\u03ba<\/jats:italic>\u00a0=\u00a00.104\u20100.375). There was slight\u2010to\u2010moderate agreement among the three biological samples used for AAS testing (<jats:italic>\u03ba<\/jats:italic>\u00a0=\u00a00.112\u20100.436). Thirty\u2010one athletes (25.4%) tested positive for AASs. More sport hours\/week, narcissistic or antisocial personality disorders, and higher nonplanning impulsiveness scores predicted AAS use (pseudo\u2010<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.665). AAS users did not differ significantly from non\u2010users in major psychopathology, but their Hypomania Checklist\u201032 score, which also predicted AAS use, was significantly higher (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), suggesting increased odds for cyclothymic disorder or subthreshold hypomania.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results have implications for studying AAS users, as they identify a cluster of variables that may be relevant in future understanding of AAS use risks (e.g., personality disorders). Possible disagreements between AAS assessment methods should be considered when implementing harm reduction interventions, such as needle and syringe distribution, health education, and counselling, as well as surveillance programmes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hup.2815","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T03:59:00Z","timestamp":1631764740000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Anabolic androgenic steroids used as performance and image enhancing drugs in professional and amateur athletes: Toxicological and psychopathological findings"],"prefix":"10.1002","volume":"37","author":[{"given":"Daria","family":"Piacentino","sequence":"first","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section Translational Addiction Medicine Branch National Institute on Drug Abuse Intramural Research Program National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore Maryland USA"},{"name":"Center on Compulsive Behaviors National Institutes of Health  Baltimore Maryland USA"},{"name":"Department of Neurosciences, Mental Health, and Sensory Organs School of Medicine and Psychology Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Sani","sequence":"additional","affiliation":[{"name":"Department of Neuroscience Psychiatry Section Catholic University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios D.","family":"Kotzalidis","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Mental Health, and Sensory Organs School of Medicine and Psychology Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Cappelletti","sequence":"additional","affiliation":[{"name":"Department of Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Mental Health, and Sensory Organs School of Medicine and Psychology Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Rizzato","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Mental Health, and Sensory Organs School of Medicine and Psychology Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fabi","sequence":"additional","affiliation":[{"name":"Center for Statistical and Social Studies (CE3S)  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Frati","sequence":"additional","affiliation":[{"name":"Department of Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Fineschi","sequence":"additional","affiliation":[{"name":"Department of Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Leggio","sequence":"additional","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section Translational Addiction Medicine Branch National Institute on Drug Abuse Intramural Research Program National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore Maryland USA"},{"name":"Center on Compulsive Behaviors National Institutes of Health  Baltimore Maryland USA"},{"name":"Medication Development Program National Institute on Drug Abuse Intramural Research Program National Institutes of Health  Baltimore Maryland USA"},{"name":"Center for Alcohol and Addiction Studies Department of Behavioral and Social Sciences Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Division of Addiction Medicine Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Performance and image enhancing drugs. 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