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Krueger S, Niehl A, Lopez Martin MC, Steinhauser D, Donath A, Hildebrandt T, Romero LC, Hoefgen R, Gotor C, Hesse H (2009) Analysis of cytosolic and plastidic serine acetyltransferase mutants and subcellular metabolite distributions suggests interplay of the cellular compartments for cysteine biosynthesis in Arabidopsis

Results: Among a total of 682,274 patients with MASLD (70.3% non-Hispanic white (NHW), 18.8% Black/African American (AA), 8.3% Hispanic, and 1.7% Asian-Pacific Islander (API)) and 517,464 patients with MetALD (71.5% NHW, 18.2% AA, 7.9% Hispanic, 1.8% API), overall incidence of cirrhosis was 4.3 per 1000-py (95% CI 4.2-4.3) and 3.9 per 1000-py (95% CI 3.9-4.0), respectively

But its not always visible to others (think about the soreness in your arm after an immunization thats swelling, but its not usually visible to others)

Overall, the evidence supports the view that anabolicandrogenic steroid misuse represents a complex endocrinemetabolic and public-health issue rather than an isolated doping-related practice

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