• Levels of active pharmaceutical ingredients (AI) detected are between the defined range of the declared formulation defined by the individual studya (quantitative) Classification of prohibited substances coded according to the WADA prohibited list (updated version as of 01 January 2021) Classification of prohibited substances are according to the world anti-doping agency (WADA) prohibited list (Updated version as of 01 January 2021) (Table 2). • to increase the homogeneity, article with mixed samples (e.g., if the analysis includes different classes of IPED) in which data on AAS are 5a-Hydroxy Laxogenin which tests have shown that protein synthesis increased by over 200%, the key to lean muscle growth and accelerated repair. (6) The Dianabol® formulation also contains various compounds to increase anabolic properties and protein synthesis. There have been several products on the market in the past that only got mediocre results. We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA) statement . To our knowledge, this is the first systematic literature review analyzing fake black-market AAS within the published literature. Counterfeit products can potentially lead to negative health outcomes and are considered an individual and public health threat . Injectable testosterone, synthetic AAS, other hormones and adjunctive therapies can easily be purchased over the internet and are delivered to a consumer’s home without prescription 4, 6, 8. Due to lack of reporting, precise prevalence and demographic information on the use of these substances is challenging . AAS belong to the broader group of image and performance enhancing drugs (IPEDs) and are widely used as a convenient and easy method to improve body image and sport performance goals . In 1965, the FDA pressured CIBA to further document its legitimate medical uses, and re-approved the drug for treating post-menopausal osteoporosis and pituitary-deficient dwarfism. FDA began the DESI review process to ensure the safety and efficacy of drugs approved under the more lenient pre-1962 standards, including Dianabol. Early adopters included players for Oklahoma University and San Diego Chargers head coach Sid Gillman, who administered Dianabol to his team starting in 1963. The country with the highest number of included studies in this region is Germany with a total of three studies. The geographic scope of the included studies is limited to two world regions, where 37% and 63% respectively were conducted, and these studies reported findings from the Americas (AMR) and Europe (EUR). Characteristics of 19 published studies presenting qualitative and quantitative data of fake AAS on the black-market Among the included studies, the majority (53%) were published in the last five years of this current study (2017–2022) and the vast majority (79%) were published within the last decade (2012–2022) of this current study. The full-text screening stage of 24 articles led to 21 potential articles relevant in this systematic review and were thus eligible for quality appraisal. This provides the perfect foundation for a counterfeit drug market for all IPEDs. These products pose a considerable individual and public health threat, and the very wide range in proportions of fake black-market AAS puts the user in a situation of unpredictable uncertainty. Overall, 19 studies, which in total comprised 5,413 anabolic samples, met the inclusion criteria, and passed the quality appraisal from two WHO world regions that reported findings, the Americas and Europe. As with other 17α-alkylated steroids, methandienone poses a risk of hepatotoxicity and use over extended periods of time can result in liver damage without appropriate precautions. As the CIBA product Dianabol, metandienone quickly became the first widely used AAS among professional and amateur athletes, and remains the most common orally active AAS for non-medical use. Side effects of metandienone include symptoms of masculinization like acne, increased hair growth, voice changes, and increased sexual desire, estrogenic effects like fluid retention and breast enlargement, and liver damage. Metandienone, also known as methandienone or methandrostenolone and sold under the brand name Dianabol (D-Bol) among others, is an androgen and anabolic steroid (AAS) medication which is mostly no longer prescribed. As an anabolic steroid, Dianabol is characterized by a moderate to high anabolic rating with a relatively low androgenic rating. The main active ingredient in Dianabol is Methandrostenolone, which is known for its ability to promote significant muscle growth and strength gains. Dianabol 10 La Pharma is a potent anabolic steroid that has long been a favorite among athletes and bodybuilders looking to enhance their physical performance.
