There is an increasing knowledge about the negative effects of Anabolic Androgenic Steroid (AAS)-use but few studies have investigated possible long-term effect. The aim of the present study was to investigate the long-term effects of AAS-use concerning substance abuse and occurrence of mental health problems in male elite power sport athletes in Sweden. All male elite power sport athletes in Sweden, defined as being in the top 10 ranking lists during the years 1960-1979 in wrestling, Olympic lifting, power lifting and the throwing events in track and field, were identified (n = 1199). Out of these athletes 996 were traceable and alive. 683 athletes completed a structured questionnaire concerning socio-demographic data, sport issues, mental health problems and substance use (including AAS use). The lifetime prevalence of AAS-use was 20.9% (n = 143). AAS-users, compared to non AAS-users, had significantly more often been offered AAS, were older when they started training and trained more hours during their active years. AAS-use was associated with higher lifetime prevalence of other substance use, especially illicit drugs and with a higher lifetime occurrence of mental health problems, especially depression and anxiety. The results show that Swedish male elite power sport athletes, who used AAS during their active sport career in the 1960s and 1970s, differed significantly concerning sport patterns, substance use and occurrence of mental health problems in this retrospective follow-up study. These results indicate that AAS-use may have several negative long-term effects on mental health.