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An additional challenge in assessing the safety profile of testosterone and anabolicandrogenic steroid misuse is the high prevalence of polypharmacotherapy among non-medical users, which substantially confounds attribution of adverse effects to any single agent ( Stimulants and sympathomimetics (including high-dose caffeine-containing preparations and other weight-loss agents), thyroid hormones, growth hormone, insulin and insulin-like growth factor-1related strategies, and selective androgen receptor modulators (SARMs) are also reported, further increasing cardiometabolic and endocrine risk through complex pharmacodynamic and pharmacokinetic interactions ( Importantly, such multi-drug regimens may contribute to several of the adverse outcomes attributed to AAS in observational studies