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Many commercially available PEDs, including but not limited to designer steroids or prohormones, have been found to contain anabolic-androgenic steroids (AAS) 5 not identified on product labeling.The potential association of these PEDs with adverse events raises important safety issues for patients and caregivers who use these medications for the treatment of ADHD and other adult mental health conditions. This article reports the findings of a prospective meta-analysis of efficacy and safety of the anti-androgenic medications, the use of which was associated with at least one clinically important adverse event.METHODSA database search was performed, using various databases to identify all available literature related to prescription anti-androgenic drugs (AHAs) for the treatment of adult ADHD. Articles were identified by keywords used in the literature searches with the combined search terms: "androgens," "ADHD," "androgenic," "androsterone," "ADHD drugs," "anti-androgens," and "ADHD pharmacopoeia". This article reviews randomized, controlled trials of AHAs for ADHD that have evaluated the use of anti-androgenic medications. Trials were excluded if there were major differences in dosage or dosing between the medication and placebo, a serious adverse treatment event, or other potential confounders, for which no adjustment was made for severity.The authors searched the MEDLINE and EMBASE databases through December 2000 with no specific date limitations. The included studies that reported the efficacy of AHAs for ADHD and the use of AHAs for the treatment of adult ADHD were extracted. Trials were then reviewed for statistical significance.Meta-analyses were performed using the Cochrane Collaboration's method, in which one author (SM, S) appraised the study's quality and extracted results. A two-sided P value <0.02 was used as a threshold to define the confidence level for any publication. In addition, all studies reporting adverse events were assessed using the following criteria: (1) any type I error (such as missing or unclear data; (2) no randomization (such that all patients were allocated); (3) no loss to follow-up (such that all participants were evaluated). A positive and an adverse event was deemed to be a significant difference (P < 0.01) according to the random-effects model. Studies not meeting criteria were further excluded and a final analysis was used.RESULTSInclusion criteria and exclusion criteria were similar to those previously reported in previous reviews. Two reviewers independently assessed each study that met inclusion criteria and were independently contacted the authors to confirm if the studies reported data. The studies were screened for the possible inclusion ofRelated Article: