tag:theconversation.com,2011:/uk/topics/anabolic-steroids-3777/articlesAnabolic steroids – The Conversation2022-08-04T03:51:49Ztag:theconversation.com,2011:article/1809472022-08-04T03:51:49Z2022-08-04T03:51:49ZIs it ethical to allow soldiers to take performance enhancing drugs such as steroids?<figure><img src="https://images.theconversation.com/files/472660/original/file-20220705-23-xb41r9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3537%2C2476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There’s a <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/tsm2.186">long history and growing evidence base</a> that the use of performance enhancing drugs such as anabolic-androgenic steroids to build muscle mass and strength is common in the armed forces, including in Australia. </p>
<p>This isn’t surprising considering the pressures soldiers face to complete missions successfully, achieve elite levels of fitness, and deal with the physical and mental stresses of their profession.</p>
<p>The Australian Defence Force (ADF) is also constantly looking for ways to amplify the performance of soldiers, which includes the <a href="https://researchcentre.army.gov.au/sites/default/files/flwr_web_b5_final.pdf">consideration of technologies</a> both “in” (such as drugs) and “on” (for example exoskeletons) soldiers.</p>
<p>In 2016, the Department of Defence also created the <a href="https://www.dst.defence.gov.au/partner-with-us/university/human-performance-research-network-hprnet">Human Performance Research Network</a>, which is focused on enhancing the physical and cognitive performance of military personnel.</p>
<p>At the same time, the ADF has <a href="https://researchcentre.army.gov.au/library/land-power-forum/anti-doping-sport-and-human-enhancing-technologies-army">adopted</a> parts of the World Anti-Doping Code – a code developed to govern drug use in sport – to manage the governance of human enhancing drugs within the military. Under the code, using steroids isn’t allowed.</p>
<p>But considering the military is constantly looking for means to create “super soldiers”, should we consider allowing the use of steroids and other enhancement drugs?</p>
<p>The answer to this question isn’t clear cut. But there’s no reason to believe the use of enhancement drugs such as steroids by soldiers is, in and of itself, unethical. </p>
<h2>Are the ethics of using steroids on the battlefield the same as those in sport?</h2>
<p>In sport, critics of drug use are concerned with the integrity of the contest. Many consider a level playing field in sport to be an essential element of the fairness of a contest.</p>
<p>But there’s a fundamental difference of purpose between a drug policy designed to protect the integrity of sport and one to protect the integrity of armed forces.</p>
<p>The thought that one side in a battle shouldn’t employ technologies unavailable to their opponents is irrelevant to the conduct of war.</p>
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<a href="https://theconversation.com/steroids-in-sport-zero-tolerance-to-testosterone-needs-to-change-48774">Steroids in sport: zero tolerance to testosterone needs to change</a>
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<p>Two things matter for the integrity of a military conflict, according to traditional “just war theory”. Firstly, that the cause is just, or fair. Within just war theory, self-defence is generally regarded as one such just cause.</p>
<p>And second, that the means employed to wage war discriminate between innocents and genuine combatants, and are proportionate.</p>
<p>The use of performance enhancing drugs therefore does not, as such, affect whether a war is fair, at least according to the just war theory.</p>
<h2>Risks and benefits</h2>
<p>The use of steroids is a serious issue when considering the health of soldiers. There’s evidence people who use steroids have a higher risk of various <a href="https://academic.oup.com/edrv/article/35/3/341/2354633">physical and psychological harms</a>, including cardiovascular disease and steroid dependence. </p>
<p>However, there are several issues with using such a simple dichotomy. First of all, life is generally full of risks, and simply avoiding them would mean we would live very sheltered and restricted lives.</p>
<p>Second, it has been well-established that many people use illicit drugs (including steroids) for <a href="https://pubmed.ncbi.nlm.nih.gov/17728122/">pleasurable</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S2211266918300707">functional</a> reasons without necessarily experiencing serious harms. For these people, the benefits of using illicit substances outweigh their potential harms.</p>
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<p>The <a href="https://www.ipedinfo.co.uk/resources/downloads/2016%20National%20IPED%20Info%20Survey%20report%20FINAL.pdf">benefits of steroids</a> are obvious. Their use is associated with an increase in muscle strength and mass, reduced risk of injuries, and quicker recovery from injuries.</p>
<p>The use of battlefield medicine and technological developments (such as armour) have long sought to protect the physical and mental health of soldiers. For example, the prescription drug Modafinil, a drug licensed for the treatment of narcolepsy, <a href="https://www.chathamhouse.org/sites/default/files/2020-11/2020-11-11-pharma-enhancement-military-goodley_0.pdf">is approved for use</a> by the Republic of Singapore Air Force, and has been tested for military application in both the US and the UK.</p>
<p>Individuals who are sleep deprived have decreased psychological and physical capabilities. Soldiers often operate over long hours and are deprived of sleep. So using <a href="https://pubmed.ncbi.nlm.nih.gov/22764609/">stimulants like Modafinil</a> can support maintaining alertness, cognitive function, judgement, and situation awareness in sleep-deprived soldiers.</p>
<p>In a similar manner, steroids could potentially prove useful in protecting the bodies of soldiers.</p>
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Read more:
<a href="https://theconversation.com/doping-soldiers-so-they-fight-better-is-it-ethical-117236">Doping soldiers so they fight better – is it ethical?</a>
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<p>Having said this, special consideration needs to be given to the link between steroid use and aggression.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33745011/">study</a> published in 2021 provides evidence of an increase, although small, in self-reported aggression in healthy males following steroid use. However, the relationship between aggression and steroid use is complex, and there are generally other mediating factors (such as other substance use and personality traits).</p>
<p>Regardless, the fact that steroid use may increase aggression when split-second decisions are required on the battlefield can be morally significant given these are often matters of life and death.</p>
<h2>Consent and coercion</h2>
<p>On the one hand, steroid use is a matter of personal and individual choice.</p>
<p>But on the other, there are tremendous social and cultural pressures to perform and succeed.</p>
<p>Competitive environments particularly, such as the military, have the potential to become highly stressful. As such, soldiers might well feel coerced by their peers and their superiors to undertake bodily or performance enhancement.</p>
<p>If steroids were to be allowed in the military, this would require informed consent.</p>
<p>But considering these pressures, satisfying the requirements of voluntary and informed consent for the use of illicit enhancement drugs within the military might well be challenging.</p>
<p>Such consent will often be undermined due to the pressures on soldiers to perform and succeed within the military.</p>
<h2>Not unethical, but studies needed</h2>
<p>There’s no reason to believe the use of enhancement drugs such as steroids is, in and of itself, unethical.</p>
<p>But there are concerns, such as the long-term health of soldiers, and any possible effects these drugs might have upon the behaviour of soldiers when in combat situations and when they return to society.</p>
<p>What’s required are robust empirical studies to determine the extent of the dangers.</p>
<p>Our list of such concerns isn’t intended to be exhaustive, but rather represents a list of issues that need to be addressed when developing any regulatory frameworks for the use of enhancement drugs in a military context.</p><img src="https://counter.theconversation.com/content/180947/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Just like armour protects soldiers’ bodies, steroids do too. There’s no reason to believe steroid use by the military is unethical, but further studies are needed.Katinka van de Ven, Senior Lecturer, Centre for Rural Criminology, HASSE, University of New England & Visiting Fellow, Drug Policy Modelling Program, SPRC, University of New South Wales, University of New EnglandAdrian Walsh, Professor of Philosophy and Political Theory, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1477062020-10-09T13:34:02Z2020-10-09T13:34:02ZMuscle dysmorphia: why are so many young men suffering this serious mental health condition?<figure><img src="https://images.theconversation.com/files/362640/original/file-20201009-19-172af9o.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C4985%2C3315&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Muscle dysmorphia can lead to other mental health conditions, such as anxiety or depression.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/attractive-muscular-man-admiring-his-muscles-689811460">F8 studio</a></span></figcaption></figure><p><a href="https://www.mentalhealth.org.uk/news/millions-men-uk-affected-body-image-issues-mental-health-foundation-survey">Body image concerns</a> among men are increasingly common and can have a serious impact on mental health. And for an estimated <a href="http://www.bbc.co.uk/newsbeat/article/34307044/muscle-dysmorphia-one-in-10-men-in-gyms-believed-to-have-bigorexia">one in ten young men</a> who go the gym in the UK, these body image concerns can result in a mental health condition known as muscle dysmorphia.</p>
<p>Though researchers are only just beginning to understand the complexities of the condition, it appears young men are currently being affected by it at a higher rate compared to other populations. It’s believed there are many reasons driving this, but researchers have found that media and social media pressure, alongside changing ideas of masculinity may both be major causes.</p>
<p>Sometimes referred to as “<a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144505000744">bigorexia</a>” or “reverse anorexia”, people with muscle dysmorphia believe their body is too small, skinny, or insufficiently muscular – even though the opposite may be true. This distorted view causes a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0033318297714002?via%3Dihub">preoccupation</a> with becoming <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144512000125">overly muscular and lean</a>, often leading to the development of dangerous habits, such as excessive weight training, restrictive dieting and the use of substances such as anabolic steroids. It can also lead to anxiety, depression and may affect their daily life.</p>
<p>But currently diagnosing muscle dysmorphia is still difficult. Though several <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144504000269">self-report surveys</a> exist to help physicians diagnose patients, these surveys only <a href="https://www.dovepress.com/muscle-dysmorphia-current-insights-peer-reviewed-article-PRBM">assess related symptoms</a> (such as a desire for bigger muscle, or body image issues) rather than offering a robust diagnosis. </p>
<p>Diagnosis also relies on patients meeting a specific <a href="https://www.sciencedirect.com/science/article/abs/pii/S0033318297714002?via%3Dihub">set of criteria</a>, such as having a preoccupation with being lean and muscular, weight lifting excessively and dieting. But since so many different methods are used to diagnose muscle dysmorphia, this can make fully understanding the condition difficult. </p>
<p>However, in general, most experts agree people with muscle dysmorphia tend to engage in <a href="https://www.tandfonline.com/doi/full/10.1080/10640260902848477?needAccess=true">steroid use</a>, have <a href="https://www.sciencedirect.com/science/article/pii/S1740144517300529">symptoms of eating disorders</a> (such as compulsive exercise and eating habits) and higher body dissatisfaction, usually with their <a href="https://www.tandfonline.com/doi/pdf/10.1080/23311908.2016.1243194">general appearance, weight and muscularity</a>.</p>
<p>People with muscle dysmorphia also tend to have lower self-esteem, higher anxiety levels when their physique is exposed, <a href="https://www.cogentoa.com/article/10.1080/23311908.2016.1243194">higher rates of depression</a>, and obsessive compulsive behaviours towards <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/erv.1088">exercise and diet</a>. For example, people may prioritise training over <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/erv.1016">work or social activities</a> or <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144512000125">strictly eat every three hours</a> to ensure muscle gain. And if these behaviours are disrupted, it causes anxiety and emotional disturbance.</p>
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Read more:
<a href="https://theconversation.com/exercise-addiction-is-a-real-mental-health-condition-yet-still-poorly-understood-133577">Exercise addiction is a real mental health condition, yet still poorly understood</a>
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<p>Muscle dysmorphia tends to affect men in their <a href="https://connect.springerpub.com/content/sgrjcp/31/4/255">mid-20s to mid-30s</a>, though average age of onset is <a href="https://www.tandfonline.com/doi/abs/10.1080/hrp.9.5.254.259">19 years old</a>. Research suggests it’s most common in <a href="https://journals.sagepub.com/doi/10.1177/0004867415614106">weightlifting</a> and <a href="https://www.karger.com/Article/Abstract/12362">bodybuilding</a> communities. </p>
<p>However, research also shows <a href="https://link.springer.com/article/10.1186/s12967-014-0221-2">almost 6% of US students</a> have it. Another study found 4.2% of women and 12.7% of men in the US military <a href="https://academic.oup.com/milmed/article/181/5/494/4158268">have muscle dysmorphia</a>. So while it appears to predominantly affect young men, there’s limited research on its prevalence in other populations.</p>
<h2>The ‘ideal’ body</h2>
<p>There are many reasons a person may develop muscle dysmorphia, and it’s unique to each person. However, research suggests that the media (and social media), as well as pressure from family and friends, are likely causes.</p>
<p>For example, media portrayals of men over time have become more muscular. Specifically, over several decades <a href="https://onlinelibrary.wiley.com/doi/10.1002/1098-108X(200101)29:1%3C90::AID-EAT15%3E3.0.CO;2-F">male models in magazines</a> have become significantly larger and leaner. Even <a href="https://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291098-108X%28199907%2926%3A1%3C65%3A%3AAID-EAT8%3E3.0.CO%3B2-D">male action figures</a> have changed over time, becoming unrealistically muscular.</p>
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<img alt="Superhero action figures, including Captain America." src="https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Portrayals of unrealistic male physiques are everywhere.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kuala-lumpur-malaysia-october-6-2018-1197291274">Aisyaqilumaranas/ Shutterstock</a></span>
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<p>Muscle dysmorphia is linked to the belief that a <a href="https://www.tandfonline.com/doi/full/10.1080/23311908.2016.1243194">muscular physique is ideal</a>. So being exposed to these images and ideals in the media may cause concern and a distorted view of one’s body. Studies also show <a href="https://link.springer.com/article/10.1007/s10964-019-01190-0">social media use</a> is directly linked to the idolisation of muscularity in young boys. Viewing images of <a href="https://psycnet.apa.org/buy/2020-23347-001">fit people on social media</a> also predicts a fixation with becoming more muscular.</p>
<p>The view that <a href="https://www.sciencedirect.com/science/article/abs/pii/S2211266920300207">being muscular is valuable</a> is typically learned from friends and family, and pressure to be muscular may come in the form of <a href="https://www.tandfonline.com/doi/full/10.1080/23311908.2016.1243194">comparisons or comments</a> about appearance from loved ones. Research shows some men even seek a muscular physique to cope with bullying and emasculation from <a href="https://www.semanticscholar.org/paper/The-Muscled-Self-and-Its-Aftermath%3A-A-Life-History-Sparkes-Batey/009cb96b6a5be6fed9b0d99d8c0576198d9fe697">family members</a> and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037/men0000072">romantic partners</a>.</p>
<p>Some researchers also believe believe a so-called “<a href="https://journals.sagepub.com/doi/10.1177/000276486029005004">masculine crisis</a>” may be contributing to increased cases of muscle dysmorphia. This reflects the perceived belief there are less opportunities for men to <a href="https://www.semanticscholar.org/paper/The-Fitness-Revolution.-Historical-Transformations-Andreasson-Johansson/b67cca687f646e256b97d97ac6383d21f032d7dc">assert their masculinity</a> through manual and industrial labour. This may leave some men feeling threatened and emasculated. </p>
<p>As a result, men have learned to use a muscular physique to <a href="https://books.google.co.uk/books/about/Little_Big_Men.html?id=z-ax2426Kw0C&redir_esc=y">visually show their masculinity</a>. Increasingly, masculinity in modern culture represents not what you do, but <a href="https://journals.sagepub.com/doi/abs/10.1177/1469540519846196?journalCode=joca">how you look</a>. So, the value that society has placed on being muscular may explain why muscle dysmorphia is more common in men.</p>
<p>Given muscle dysmorphia is potentially under-reported, we cannot accurately know how common it is. Instead, we can only speculate based on the limited evidence we have. The uncertainty is partly because of inconsistent diagnostic tools, and the notion it’s <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025923">taboo</a> for men to be concerned with appearance or sharing their feelings.</p>
<p>Little research has explored the treatment options for muscle dysmorphia, but <a href="https://connect.springerpub.com/content/sgrjcp/31/4/255">one review</a> suggests that cognitive behavioural therapy, thought restructuring (a technique that helps people understand and challenge their thoughts, feelings, and beliefs), and family therapy could all be beneficial. </p>
<p>Given that internal experiences are hard to change, people suffer with the condition long-term. But seeing as the condition is similar to <a href="https://www.nhs.uk/conditions/body-dysmorphia/">body dysmorphic disorder</a>, which causes people to obsess over perceived flaws in their appearance more generally, researchers may already have promising potential solutions to help manage emotions and symptoms associated with muscle dysmorphia.</p><img src="https://counter.theconversation.com/content/147706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ieuan Cranswick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Social media and changing ideas about masculinity are making more and more young men believe their body is too small, skinny or insufficiently muscular.Ieuan Cranswick, Senior Lecturer in Sport and Exercise Therapy, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1442492020-09-02T13:51:10Z2020-09-02T13:51:10ZMen are buying potentially risky steroid substitutes online to get the ‘ideal body’<figure><img src="https://images.theconversation.com/files/354966/original/file-20200826-7087-dhrj2z.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C6809%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Selective androgen receptor modulators (SARMs) may be perceived as a safer muscle-building alternative to steroids.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Unapproved muscle-building drugs are being <a href="https://doi.org/10.1210/jc.2018-01706">sold over the internet</a>. These chemicals, called SARMS or selective androgen receptor modulators, are popular in part due to their <a href="https://www.uspharmacist.com/article/recreational-use-of-selective-androgen-receptor-modulators">perceived safety compared to anabolic steroids</a>, but the health risks of these drugs are still widely unknown and potentially serious.</p>
<h2>Images in society influence our body image</h2>
<p>Images of bodies surround us in our daily life, in advertising, media, the Twitterverse and dating apps, informing <a href="http://hdl.handle.net/10523/7863">the way we feel and think about our bodies</a>. We come to understand ourselves through the images circulating in our culture and society that define what it means to belong to a particular gender. </p>
<p>For many men, social images create an understanding of what their bodies should look like to be <a href="https://doi.org/10.1177/1557988316669042">considered masculine</a>. Often the dominant ideal, both celebrated and desired, is fat-free, with bulging muscles and well-defined pecs: a celebration of <a href="https://doi.org/10.1080/14680777.2017.1367701">strength and power</a>.</p>
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<img alt="A young man in a hoodie looks pensive with his arms folded across his chest. Behind him, on a blackboard, a drawing of caricatured muscular arms lines up with his shoulders." src="https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354704/original/file-20200825-15-5cxmst.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">For many men, social images create an understanding of what their bodies should look like to be considered masculine.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
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<p>Many men strive to embody this idealized image of masculinity, but it’s not one everyone can achieve. The difference between men’s actual bodies and the cultural ideas about masculinity that may <a href="https://doi.org/10.1176/appi.ajp.157.8.1297">explain the rise of muscle dysmorphia and anabolic steroid abuse</a>. </p>
<p>We suggest that more discussion is needed surrounding both masculine body image ideals and the potential dangers of SARMs in our society.</p>
<h2>Body image standards affect men differently</h2>
<p>For many <a href="https://www.apa.org/pi/lgbt/programs/safe-supportive/lgbt/key-terms.pdf">sexually diverse men</a> (gay, bi, pansexual, queer, men who have sex with men, etc.), the consequences of not living up to idealized standards for masculine bodies <a href="https://doi.org/10.1176/appi.ajp.157.8.1297">can be toxic</a>, including negative body image and <a href="https://doi.org/10.1016/j.bodyim.2019.08.007">body dissatisfaction</a>. </p>
<p>This can influence the way people live, such as eating and exercising. For example, one study noted a small association with social media use and <a href="https://doi.org/10.1089/cyber.2017.0375">body dissatisfaction, eating disorder symptoms and thoughts about using anabolic steroids</a>. Sexually diverse men have also reported engaging in <a href="https://doi.org/10.1136/bmjopen-2014-005205">intensive anaerobic training, the use of protein powders and the use of anabolic steroids</a> to achieve their desire to become muscular. </p>
<p>Ethnicity can also intersect with body image for sexually diverse men. <a href="https://doi.org/10.1016/j.bodyim.2013.03.006">In one study</a>, Black, East/Southeast Asian, South Asian, Latino/Brazilian gay and bisexual men report skipping meals, vomiting and taking steroids to achieve bodies that cultural messages and images define as the most masculine. </p>
<h2>Potential danger</h2>
<p>Anabolic steroids can be viewed by men with body dissatisfaction as <a href="https://doi.org/10.1001/jama.2016.17441">a way to achieve this idolized masculine body</a>. Now SARMs, which are not steroids per se but <a href="https://www.uspharmacist.com/article/recreational-use-of-selective-androgen-receptor-modulators#:%7E:text=Discovered%20in%20the%20late%201990s,and%20facilitate%20recovery%20from%20exercise.&text=SARMs%20are%20not%20anabolic%20steroids,to%20androgen%20receptors%20">act in a similar way</a> by increasing muscle mass and strength, are perceived as a safer alternative to steroids and are easily purchased online: A potential danger for those desperate to achieve these hyper-muscular bodies.</p>
<figure class="align-right ">
<img alt="A black dumbbell with drug capsules in the foreground" src="https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354706/original/file-20200825-18-1edejsp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anabolic steroids can be viewed by men with body dissatisfaction as a way to achieve the idolized masculine body. Now SARMS may be viewed as an alternative to steroids.</span>
<span class="attribution"><span class="source">(Pexels)</span></span>
</figcaption>
</figure>
<p>SARMS have been researched for more than 20 years as treatments for medical conditions including cancer, osteoporosis, Alzheimer’s disease and muscle-wasting, but no SARMs are approved by the FDA for any medical condition yet and they are not authorized for use in Canada. In fact, Health Canada released a <a href="https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/72293a-eng.php">public health advisory</a> in March 2020 advocating against the use of SARMs, and reported a seizure of various SARMs from stores in Alberta.</p>
<p>We know little about the safety and toxicity of these drugs, which is what makes them risky. A 32-year old male recently suffered <a href="https://doi.org/10.14309/crj.0000000000000370">severe liver injury</a> after taking a SARM for two weeks, suggesting there are indeed health risks.</p>
<p>A factor that may have contributed to this case is that recreational steroid users often take <a href="https://doi.org/10.1210/jc.2018-01706">much higher doses than what is prescribed for medical patients</a>. SARMs, like other drugs, can have <a href="https://doi.org/10.1111/bcp.13316">dose-dependent effects</a>. If men are taking high doses to achieve the dominant image of a masculine body, it is likely that their health risks are higher as well. </p>
<p>Although SARMs may end up being safe drugs when properly used for medical conditions, there are still major <a href="https://doi.org/10.1080/13543784.2020.1777275">health concerns</a> involved with taking SARMs currently, including liver damage, cardiovascular issues and testosterone suppression. Furthermore, the purity of SARMs bought online is currently <a href="https://doi.org/10.1002/dta.2908">highly questionable</a>.</p>
<h2>What can we do?</h2>
<p>In light of these safety concerns, the <a href="https://www.congress.gov/bill/116th-congress/senate-bill/2895/text">SARMs Control Act of 2019</a> was introduced to the United States Congress, which seeks to tighten regulatory control over these drugs. This act effectively equates SARMs with anabolic steroids on a regulatory level. This type of regulation is necessary to help contain a drug with health risks and potential for abuse.</p>
<p>Thus, we have a storm brewing. On one hand we have unrealistic masculine body image standards for gay men, which promote and even demand the use of anabolic drugs to reach that goal. On the other hand, SARMs promise the idolized body and are easily available over the internet.</p>
<p>We need to honestly discuss the dangers of promoting unattainable masculine body image standards for men of all sexual orientations and warn about easily accessible SARMs that may not be safe to use and almost certainly not safe to abuse.</p><img src="https://counter.theconversation.com/content/144249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Idealized standards for muscular, fat-free male bodies may be fuelling the use of SARMs, or selective androgen receptor modulators, unapproved muscle-building drugs that are easily available online.Stefan Heinze, Graduate student in Pharmacology, Dalhousie UniversityPhillip Joy, Assistant Professor, Mount Saint Vincent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/487742015-10-13T05:21:14Z2015-10-13T05:21:14ZSteroids in sport: zero tolerance to testosterone needs to change<figure><img src="https://images.theconversation.com/files/97640/original/image-20151007-7335-s8fbg5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Muscle magic</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=testosterone&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=243168082">BLACKDAY</a></span></figcaption></figure><p>After he injured his shoulder, Ryan Zimmerman <a href="http://mlb.nbcsports.com/2012/09/13/cortisone-injection-saved-ryan-zimmermans-season/">was described</a> as “one of baseball’s worst hitters”, but that didn’t affect his value as a stand-out third-baseman. In 2012, he <a href="https://www.washingtonpost.com/blogs/nationals-journal/post/ryan-zimmerman-nationals-agree-to-contract-extension/2012/02/24/gIQAnHgabR_blog.html">signed a six-year contract</a> extension with the Washington Nationals worth $100m (£65m), making him one of the <a href="https://www.baseballprospectus.com/compensation/cots/league-info/highest-paid-players/">highest-paid players</a> in Major League Baseball. By that summer, a shoulder injury had left his season in ruins. </p>
<p>He then began a series of injections of cortisol, a performance-enhancing steroid, which <a href="http://nats.dcsportsnexus.com/2012/07/ryan-zimmerman-cortisone-and-whats-next.html">turned his fortunes around</a> almost instantly. Between his third and fourth injections, Zimmerman went from being one of baseball’s worst hitters to one of its best, turning a batting average of 0.244 into <a href="http://mlb.nbcsports.com/2012/09/13/cortisone-injection-saved-ryan-zimmermans-season/">0.33</a> (the record for the 2013 season <a href="http://www.baseball-almanac.com/hitting/hibavg3.shtml">was 0.3477</a>). Far from being banned for using a performance enhancer, Zimmerman’s turnaround <a href="http://mlb.nbcsports.com/2012/07/23/ryan-zimmerman-is-on-fire-since-getting-a-cortisone-shot/">was lauded</a>. </p>
<p>Compare this to fellow baseballer Barry Bonds. He <a href="https://www.youtube.com/watch?v=cL3vNXIsEPM">smashed</a> lifetime home-run records in the 2000s but now lives under the cloud of having used anabolic steroids. He <a href="http://edition.cnn.com/2013/10/31/us/balco-fast-facts/">was outed</a> as part of the scandal around Californian laboratory BALCO, which was supplying numerous athletes with the drug. </p>
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<p>Needless to say, we divide steroids into good and bad categories. Cortisol, which is an anti-inflammatory, is sanctioned as legal in many sports if the athlete first obtains a therapeutic-use exemption. It functions in times of stress to allow the body to use stored energy in the muscles, liver and fat tissue. </p>
<p>The anabolic steroid testosterone is chemically very similar. Like cortisol, it is produced in the body from cholesterol. It functions <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686341/">to help</a> build muscle and bone, which is particularly important for older adults. Aside from some sports such as power lifting and bodybuilding which have non-tested federations where anything goes, anabolic steroids are banned throughout sport. Medical exemptions are rarely, if ever, issued. </p>
<h2>The testosterone effect</h2>
<p>Of course the <a href="https://www.wada-ama.org">World Anti Doping Agency</a> has good reason to be suspicious of potential abuse of testosterone therapy. Large doses of testosterone can <a href="http://www.nejm.org/doi/full/10.1056/NEJM199607043350101">significantly increase</a> a person’s strength and muscle mass even without training. Train at the same time and the effects <a href="http://www.nejm.org/doi/full/10.1056/NEJM199607043350101">are remarkable</a>. </p>
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<p>Yet the performance-enhancing effects of a cortisol injection can be no less impressive, as we saw with Ryan Zimmerman’s 35% batting improvement. The difference is that cortisol is judged as a recovery drug, which in ethical terms is not strictly performance enhancement. It’s not so cut and dried, though. Injecting cortisol into a joint does not heal the injury. It simply allows the athlete to play through it, which <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61160-9/abstract">can have</a> long-term health implications. In short, the line between the purpose of the rules and the health outcomes is blurred.</p>
<p>At the same time, testosterone is commonly used to treat hypogonadism, a condition in which sufferers produce low levels of the hormone. They are prone to low energy, bone and muscle problems, low libido and erectile dysfunction. The benefits of treatment <a href="http://www.ncbi.nlm.nih.gov/pubmed/24274081">can be</a> huge, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686341/">especially for</a> bone mass. </p>
<p>It is worth considering the health problems that the former British Olympic champion cyclist <a href="http://www.chrisboardman.com">Chris Boardman</a> is now suffering. He developed hypogonadism, probably brought on by his high training loads, and continued to compete without taking testosterone medication. The fact that he is <a href="http://www.dailymail.co.uk/health/diets/article-1227777/CHRIS-BOARDMAN-I-cycling-32-I-bones-old-woman.html">now suffering</a> from bone thinning confirms that he probably competed “clean”. In a sport where no medical exemption certificate was ever granted by the anti-doping authorities, accepting the treatment <a href="http://www.theguardian.com/sport/story/0,3604,380917,00.html">advised by</a> several experts would have risked a career ban. </p>
<h2>More inconsistencies</h2>
<p>At the other end of the scale is a group of drugs called short-acting beta2-agonists. They are used to treat <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445098/">exercise-induced bronchoconstriction</a> (EIB), a common condition among athletes, but the rules of the anti-doping authorities seem not to be as strictly applied. Even though EIB is <a href="http://www.ncbi.nlm.nih.gov/pubmed/22175650">commonly misdiagnosed</a>, therapeutic-use exemptions are <a href="https://wada-main-prod.s3.amazonaws.com/resources/files/wada-medical-info-asthma-5.1-en.pdf">no longer required</a> for therapeutic doses of the drug. Why do the anti-doping authorities apply one rule for one drug and disregard it for another?</p>
<p>The answer may lie with the three stated aims of the World Anti-Doping Agency: to protect athletes’ health, preserve the level playing field and protect the spirit of sport. The doses of beta2-agonists allowed by WADA are not considered <a href="http://www.ncbi.nlm.nih.gov/pubmed/24790479">performance enhancing</a>, so you can certainly argue that regulating this drug would not serve any of WADA’s anti-doping aims. But what about testosterone? Considering the negative health effects associated with low testosterone, surely refusing therapeutic-use medications for the steroid in hypogonadal men contravenes their first aim. And supplementing testosterone to below or approximately normal levels <a href="http://ajpendo.physiology.org/content/281/6/E1172.full.pdf+html?">does not increase</a> strength in any case. </p>
<p>An Australian <a href="https://www.mja.com.au/system/files/issues/199_08_211013/han10111_fm.pdf">study</a> has shown that using testosterone for both “real” medical problems and anti-ageing has increased more or less globally. This has created a dilemma for the US Anti-Doping Agency. Amateur athletes as old as 60 with medical prescriptions for testosterone <a href="https://theconversation.com/forget-lance-armstrong-the-next-big-cycling-doper-could-be-your-dad-36734">have either</a> tested positive and been banned or told that they cannot compete while taking the drug. The rules developed to stop cheating in the upper echelons of professional sport don’t make sense in such circumstances. </p>
<p>In sum, it is difficult to draw a convincing distinction between anabolic steroids and these other drugs. If the latter are permitted for medical exemptions, arguably anabolic steroids should be as well. There is a caveat. </p>
<p>One sport which has allowed exemptions for testosterone replacement therapy in the past is UFC (Ultimate Fighting Championship). It has been <a href="http://espn.go.com/espn/otl/story/_/id/10500652/therapeutic-use-exemptions-testosterone-mma-outpace-other-sports-lines-finds">suggested that</a> competitors have taken advantage of this to effectively “cheat legally”. This illustrates the risks if medical exemptions are not policed tightly. Refuse them altogether, on the other hand, and the inconsistencies and health risks are the price that some athletes have to pay.</p><img src="https://counter.theconversation.com/content/48774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anti-doping authorities divide steroids into good and bad ones. Yet the more you look at them close up, the more similar they actually are.Lee Hamilton, Lecturer in Sport, Health and Exercise Science, University of StirlingPaul Dimeo, Senior Lecturer in Sport, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/443272015-07-07T18:45:10Z2015-07-07T18:45:10ZTaking gym steroids can affect your learning and memory<figure><img src="https://images.theconversation.com/files/87497/original/image-20150706-1012-1q0js8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What was I lifting again?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-194099144/stock-photo-powerlifter-with-strong-arms-lifting-weights.html?src=5qYYnVLCixaT0KNLL6hFAA-1-0">Weights by Shutterstock</a></span></figcaption></figure><p>Although much is known about the physical and psychiatric effects of anabolic steroid abuse, very little is known about their putative impact upon learning and memory. In a new study <a href="http://benthamopen.com/contents/pdf/TOPJ/TOPJ-9-1.pdf">published in The Open Psychiatry Journal</a>, we wanted to find out if users reported any difference from using Anabolic-androgenic steroids, or AAS. Our findings suggest that the drug can affect recollection in long-term users. </p>
<p>Anabolic-androgenic steroids are synthetic compounds which resemble testosterone and promote lean body mass and muscle growth. Since the mid-twentieth century, they have been used by elite athletes and bodybuilders to trim body fat and increase muscle size in order to gain the edge over their rivals. But they are have now become <a href="https://theconversation.com/anabolic-steroid-use-is-not-just-about-bodybuilding-29180">much more widespread</a> within non-competitive recreational sports circles and are also often prescribed for medical conditions such as delayed puberty and for muscle-wasting diseases such as AIDS and cancer.</p>
<p>AAS are typically taken orally or injected directly into the muscles. Doses can be as high as 100 times greater than those normally prescribed medically. In some specialist gym user groups – such as bodybuilders and weightlifters – as many as 38% may take AAS. The abuse of AAS brings with it a range of potential <a href="http://www.ncbi.nlm.nih.gov/pubmed/18599224">physical side effects</a>, including skin lesions, oedema (where an excess of watery fluid collects in the body cavities or tissues), kidney and liver damage, heart problems, high blood pressure and cardiovascular disease. A number of <a href="http://www.ncbi.nlm.nih.gov/pubmed/16356691">psychiatric effects</a> have also been reported, from mild irritation and agitation, depression, and increased aggression and violence – so-called “roid rage” – towards others. The types and degree of problems experienced may differ depending upon what types of steroids are being abused, their pattern of abuse, the amount taken and the length of abuse. </p>
<h2>Mind as well as body</h2>
<p>In the first study of its kind in 2013, psychiatrist Harrison Pope and colleagues <a href="http://www.sciencedirect.com/science/article/pii/S0376871612004498">discovered that</a> long-term AAS users performed significantly worse on visuospatial memory task where they had to remember a collection a visual patterns that they were previously shown, compared with non-users. Pope explained the real-world implications by stating that problems in visuospatial memory might correspond to problems with finding a specific location, such as someone’s address or the location of a specific room in a building. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87503/original/image-20150706-1008-8yybs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prospective memory.</span>
<span class="attribution"><span class="source">Note by Shutterstock</span></span>
</figcaption>
</figure>
<p>For our study we examined whether the long-term use of AAS within a sporting context might affect everyday memory. We assessed almost 100 male regular gym users aged 18-30 in an online survey; half of whom used AAS and half of whom did not. As a relatively young group in our study, the participants reported using AAS regularly for an average of about four years (up to eight years) with doses. Each participant completed three memory-related questionnaires. The first measured retrospective memory – the recall of past memories or previous facts, for example the name of your favourite soap star. A second measured prospective memory – the process of carry out a planned activity at future point in time, for example remembering to post a birthday card or to take an important medication on time. Finally, a third questionnaire measured executive function – processes that help an individual pay attention, coordinate information and plan and execute tasks. </p>
<p>Significant failures in any or all of these domains could compromise everyday functioning. Our findings revealed that AAS users reported 28% more forgetting in terms of retrospective memory, 39% more forgetting in terms of prospective memory and reported 32% more problems in their executive function. The findings suggest that use of AAS has a significant detrimental impact on an individual’s everyday memory and ability to remember. </p>
<p>Such deficits could affect many spheres of life, including interpersonal, occupational, educational and health-related aspects, given the ubiquitous nature of everyday remembering. Of course, these findings need further verification before any firm conclusions can be reached given that self-reports can be subject to a range of biases, for example some people may think their memory is poor and respond accordingly, while some think it is better than perhaps it is. The next step would be to look at more objective measures and to show why the use of AAS affects memory and learning and what impact steroid abuse has on the brain and its cognitive functions.</p><img src="https://counter.theconversation.com/content/44327/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Heffernan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The physical impact of anabolic steroids are well known but there are also mental effects.Tom Heffernan, Programme Leader in Psychology with Criminology, Northumbria University, NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/399012015-05-05T05:20:54Z2015-05-05T05:20:54ZSafety of contaminated vitamins and nutritional supplements can’t be left to consumers<figure><img src="https://images.theconversation.com/files/80100/original/image-20150501-23856-ji0x2e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reading the label might not help.</span> <span class="attribution"><span class="source">Supplements by Shutterstock</span></span></figcaption></figure><p>The vitamin, mineral and nutritional supplement industry is one of the fastest-growing industries in the world. Millions of people take these supplements, from <a href="https://curve.coventry.ac.uk/open/file/acb74a88-b8d6-47d8-896a-55518f330479/1/Nutritional%20supplement%20use.pdf">elite level athletes</a> and sport and exercise enthusiasts, who hope to further their athletic aspirations or achieve better bodies, to <a href="http://tna.europarchive.org/20110116113217/http://www.food.gov.uk/multimedia/pdfs/viminsupconsumer.pdf">everyday men and women</a> seeking to defy the ageing process or who are generally interested in healthy living and well-being. </p>
<p>It’s big business. The supplements industry cleared <a href="http://www.forbes.com/sites/davidlariviere/2013/04/18/nutritional-supplements-flexing-their-muscles-as-growth-industry/">US$32 billion in revenue in 2012</a>, a figure which is projected by the <a href="http://newhope360.com/nbj-2014-supplement-business-report">Nutritional Business Journal</a> to increase to $60 billion by 2021. In UK sales are expected to rise <a href="http://www.nhs.uk/news/2011/05may/documents/BtH_supplements.pdf">from some £670m</a> (US$1 billion) <a href="http://www.euromonitor.com/vitamins-and-dietary-supplements-in-the-united-kingdom/report">to £786m</a> (US$1.2 billion) by 2018.</p>
<p>However, while growing at a rapid pace, the supplements industry is highly under-regulated. Indeed, its growth has been facilitated in large part by the ease at which supplements may be produced and sold, and their widespread availability in general health stores, pharmacies, and the internet among other places. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80098/original/image-20150501-23845-1q0lwlo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Big business.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/cleanwalmart/419584946/in/photolist-grzaj1-7Hg5UM-dd2bk6-D5tZd-jsEhS4-iHLoRL-f7o5ZW-83wQvW-5jFhHG-5jAZQn-96jDUs-dnd4f9-dmEuUb-q2GaHg-q2EuMK-gkd17R-oEgrYZ-eiY48Z-pnmavr-fJEJgy-7YXZBy-fXJFdM-fXJBvB-fXJ6mj-fXJ2xC-fXJpLV-fXJhhM-fXHLGA-fXJ2eo-jNEwz-Dcs55-q2xzQy-pn7Bmo-c3GqGY-c3GsfN-c3Gs1d-c3GrJU-c3GrtC-c3Gref-c3GqXA-c3GqqA-c3GqbA-c3GpFy-c3Gprq-c3Gpds-c3GoXW-c3Gsvf-r5kfGj-9DH4Qy-8UxLcu">Clean Wal-Mart</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In the UK the majority of supplements are considered to be foods and are therefore regulated under established food laws by the Food Standards Agency and the Department of Health (FSADH). In general, unless a medical claim is made by the manufacturer, supplements are not regulated as a medicine by the Medicines and Healthcare Regulatory Agency (MHRA). </p>
<p>This means that supplement manufacturers do not need prior approval from the MHRA before producing or selling their product and there is no requirement for supplements to be licensed. Further, supplements sold in the UK have not been subjected to the same scientific scrutiny as medicines and are not as strictly regulated. </p>
<p>Most importantly, supplements are not tested on product safety, quality and efficacy before they hit the shelves because there is no legal obligation for supplement manufacturers to take part in testing products.</p>
<h2>Contamination</h2>
<p>There is a growing body of research which indicates that many supplements sold in the UK may be contaminated with “banned” and often dangerous substances. <a href="http://www.koelnerliste.com/fileadmin/user_upload/medien/pdf/ioc_studie_2004.pdf">A 2004 study</a>, for instance, tested 634 supplements purchased in 13 countries from 215 different suppliers. Of the 634 samples analysed, 94 (14.8%) contained anabolic androgenic steroids (AAS), 18.8% of which were purchased in the UK. Further, <a href="http://www.ukad.org.uk/athletes/high-performance/supplements/">a study in 2008</a> found that 10% of supplements and weight loss products purchased and tested in the UK were contaminated with steroids and/or stimulants. A more <a href="http://onlinelibrary.wiley.com/doi/10.1002/dta.1728/abstract">recent study</a> tested 24 products sold in fitness shops in the UK that were suspected of containing AAS. Of the 24 products tested, 23 contained steroids including known anabolic agents.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80099/original/image-20150501-23877-160xm0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Athletes must take special care.</span>
<span class="attribution"><span class="source">Athletics by Shutterstock</span></span>
</figcaption>
</figure>
<p>It is <a href="http://www.sciencedirect.com/science/article/pii/S0278691510006721">not just a UK phenomenon</a>. Mounting evidence indicates similar problems <a href="http://journals.cambridge.org/download.php?file=%2FPNS%2FPNS66_04%2FS0029665107005824a.pdf&code=ce3214fc944370c25eecd461067b11c3">throughout Europe</a> and North America. For example, in addition to being <a href="http://vorige.nrc.nl/multimedia/archive/00213/370030002_213599a.pdf">contaminated with illegal substances</a>, several supplements have also been found to contain <a href="http://www.biomedcentral.com/1741-7015/11/222">ingredients not listed</a> on the label, or cheaper alternatives and fillers – such as grass, wheat or rice – substituted for ingredients that are often used to bulk up herbal supplements and may cause allergies. Some have <a href="https://oig.hhs.gov/oei/reports/oei-01-11-00210.asp">false and misleading claims</a> surrounding the health benefits of the product. </p>
<h2>Chronic use</h2>
<p>The contamination of nutritional supplements is a risk to both public health and to athletes unaware that their legal supplements may contain substances banned by anti-doping authorities. The chronic consumption of such products could unwittingly expose users to significant health risks. For instance AAS such as testosterone may have particular side effects, from acne and lowered HDL to testicular atrophy and liver damage, to name a few.</p>
<p>Where supplements are mislabelled or contain fillers, users may be subject to mild to severe reactions as a result of unlisted ingredients. Even where supplements contain no “harmful” ingredients, replacing advertised supplements with something other than what is claimed on the label, or making false claims surrounding the quality of the product, is <a href="http://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/">tantamount to consumer fraud</a>. </p>
<p>In the case of athletes, using contaminated supplements may result in a positive doping tests, having detrimental effects on their athletic career. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25722470">A review of the available data</a> indicates that between 40–70% of athletes use supplements and that between 10 and 15% of supplements may contain prohibited substances. Consequently, there is considerable risk of accidental or inadvertent doping through the consumption of supplements. In fact in 2012, the <a href="http://informed-sport.com/sites/default/files/LGC%20Warns%20of%20the%20use%20of%20DMBA.pdf">UK Anti-Doping (UKAD) reported</a> that approximately 44% of positive dope tests in the UK were thought to have been the consequence of prohibited substances in supplements.</p>
<h2>Minimising risk</h2>
<p>More stringent regulation and oversight is clearly necessary to ensure the safety and quality of supplements for everyday consumers and athletes alike. But supplement users can employ strategies to minimise their risk.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=521&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=521&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=521&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=654&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=654&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80104/original/image-20150501-23887-17p1qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=654&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Same benefits from [eating a proper diet.</span>
<span class="attribution"><span class="source">Diet by Shutterstock</span></span>
</figcaption>
</figure>
<p>The first is abstinence – is supplementation necessary, or is it beneficial? The majority of consumers may be better off considering what they eat and whether they can get the same benefits from <a href="http://www.nhs.uk/chq/pages/1122.aspx?categoryid=51">eating a proper diet</a>. In addition to this the widely <a href="http://www.jissn.com/content/1/2/1">perceived benefits of certain supplements</a> have been <a href="http://phs.bwh.harvard.edu/">called into question</a> by many <a href="http://www.nhs.uk/news/2013/12December/Pages/Study-finds-vitamin-pills-have-limited-benefit.aspx">in the medical community</a> and that the excessive use of supplements may be <a href="http://www.sciencedaily.com/releases/2015/04/150420182403.htm">linked to certain health risks</a>. </p>
<p>If individuals decide to use legal supplements, they should ensure they choose products that contain only the substance they require – and purchase supplements from a reputable manufacturer. Athletes, in particular, have to take care by choosing supplements that have been rigorously <a href="http://www.dopingautoriteit.nl/nzvt/nzvt-english">tested</a> and <a href="http://www.informed-sport.com/">approved</a> prior to sale as they take personal responsibility for the risks that supplements carry. </p>
<p>None of this guarantees protection from <a href="http://bjsm.bmj.com/content/41/11/800.short">possible contaminations</a> and rather than placing responsibility for safety in the hands of often naive supplement consumers, the state should take on a greater role in the regulation of the industry.</p><img src="https://counter.theconversation.com/content/39901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kyle J.D. Mulrooney holds an Erasmus Mundus Fellowship for the joint doctoral programme, the Doctorate in Cultural and Global Criminology (DCGC), and receives funding from the Educational, Audiovisual and Cultural Executive Agency of the European Union.</span></em></p><p class="fine-print"><em><span>Katinka van de Ven does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The supplements industry is big business but do you know what’s really in the packet?Katinka van de Ven, Ph.D. candidate, Doctorate in Cultural and Global Criminology , University of KentKyle J.D. Mulrooney, Ph.D. Fellow, Doctorate in Cultural and Global Criminology, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/376052015-02-16T14:20:17Z2015-02-16T14:20:17ZUsing anabolic steroids harms your health and social image<figure><img src="https://images.theconversation.com/files/72123/original/image-20150216-18493-xjdesg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not a good look.</span> <span class="attribution"><span class="source">Muscles by Shutterstock</span></span></figcaption></figure><p>Performance enhancing or doping substances such as anabolic steroids and erythropoietin, a hormone that enhances the production
of red blood cells and increases oxygen consumption in the body, are no longer confined to the realm of competitive sports and increasingly now used by the <a href="https://theconversation.com/anabolic-steroids-a-serious-global-health-problem-amid-boom-in-cosmetic-use-24238">mainstream</a>. </p>
<p>The most popular doping substance appears to be anabolic steroids, and while users of anabolic steroids can experience benefits such as enhanced strength, stamina and body image – along with increased confidence and self-esteem – anabolic steroid use has been linked to various physical and psychological syndromes and adverse effects, including <a href="http://onlinelibrary.wiley.com/doi/10.1111/1556-4029.12424/abstract">suicide and premature death</a>. </p>
<p>However, the negative effects of anabolic steroid use transcend the individual user’s physical and mental health into society.</p>
<h2>Wider social problem</h2>
<p>The use of anabolic steroids has major negative effects on families and society. Anabolic steroids use has been associated with increased aggression and violent behaviour. And although the association between anabolic steroid use and criminal behaviour is still unclear, a recent population-based study in <a href="http://www.ncbi.nlm.nih.gov/pubmed/25170826">Sweden</a> found that people who had used anabolic steroids were more likely to have been convicted for a criminal offence. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72124/original/image-20150216-18474-1wb2n65.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Roid rage’ in a box.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:AbuGnost_anabolic_steroids_GHB_poppers_080810_48.jpg">Roberta F</a></span>
</figcaption>
</figure>
<p>Today, anabolic steroids are easily accessible. People can buy anabolic steroids from the internet without having to engage with the traditional sporting communities as was previously the case. This development seems to be attracting different sub-populations of users such as those with underlying mental health problems or vulnerabilities. </p>
<p>There are the stories that crop up in the media of so-called “roid rage” and at the extreme are cases like mass-killer Anders Behring Breivik, who despite his mental health and social problems, easily obtained anabolic steroids from the internet <a href="https://thinksteroids.com/news/norwegian-killer-anders-behring-breivik-wrote-about-anabolic-steroids/">and wrote about them in his “manifesto”</a>, discussed various anabolic steroids and even recommended websites and shops where readers could purchase them. </p>
<h2>Public perceptions</h2>
<p>In <a href="http://informahealthcare.com/doi/abs/10.3109/14659891.2015.1009510">a recent experimental study</a>, my colleagues and I investigated the effects of perceived doping on the perceived user’s personality or social image. Participants were randomly invited to rate the personality of four protagonists based on a storyline assigned to each one. There were four variations based on what the protagonist consumed before training: food, anabolic steroids, erythropoietin, and protein powder. Each participant then gave a rating for one of these users or non-user on the five-factor model of personality, a ratings system on openness, conscientiousness, extroversion, agreeableness, and neuroticism.</p>
<p>We found that the non-user was rated or perceived as less neurotic compared to the anabolic steroid and erythropoietin users who had similar high ratings on neuroticism. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792076/">Neuroticism</a> has been linked to irritability, anxiety, distress, aggression and violence, and antisocial personality disorder. </p>
<p>Thus, our finding suggests that whether or not a user of these substances actually suffers from these “neurotic” or negative effects, the wider perception is that they do. Taking this into account, use of anabolic steroids actually harms the perception of users’ personality and social image. </p>
<p>Most campaigns against anabolic steroids use fear campaigns highlighting the negative consequences on physical and mental health to encourage people to avoid these drugs. But these have been criticised for failing to reflect the experiences of most “healthy” or “healthy-looking” users. </p>
<p>A recent <a href="http://www.sciencedirect.com/science/article/pii/S2211266914000127">review</a> suggested this approach can be less effective than messages based on social disapproval. Our finding that anabolic steroid use harms the perception of users’ personality and social image could be brought to the fore in efforts to counter the rise in use of these drugs.</p><img src="https://counter.theconversation.com/content/37605/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic Sagoe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Performance enhancing or doping substances such as anabolic steroids and erythropoietin, a hormone that enhances the production of red blood cells and increases oxygen consumption in the body, are no longer…Dominic Sagoe, Research Fellow in Social Psychology, University of BergenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/310622014-09-02T04:39:59Z2014-09-02T04:39:59ZScapegoating steroids won’t make for a safer night out<figure><img src="https://images.theconversation.com/files/57971/original/hnmrxb24-1409621895.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Steroid use is growing in Australia but not among the usual suspects.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/japokskee/4391428993">Jhong Dizon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them. </p>
<p>Ostensibly, it is this perception of steroid users that has led the Queensland government to enact <a href="http://www.premiers.qld.gov.au/publications/categories/plans/assets/safe-night-out-strategy.pdf">tougher penalties</a> for steroids. The Safe Night out legislation increases the maximum penalty for possession or supply of steroids to 25 years in jail. </p>
<p>But tougher steroid laws are unlikely to have an impact on violence in the community because a) most steroid users are not violent, and b) other substances, including alcohol, are stronger risk factors for violent behaviour.</p>
<h2>Who uses steroids?</h2>
<p>The public perception of steroid users doesn’t match the reality. </p>
<p>The first red flag comes from demographic data. It turns out that in the United States, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/21923602">typical steroid user</a> is male, around 30 years old, has a bachelor’s degree, is employed full-time in a white-collar occupation, earns an above-average income, and does not play any form of competitive sport. Local data is lacking, but smaller studies of Australian steroid users <a href="http://www.sciencedirect.com/science/article/pii/S0376871600800113">corroborate this profile</a>.</p>
<p>In a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2131752/">large US study</a> of nearly 2,000 steroid users, the most-commonly reported occupations were in sales and marketing, information technology, banking and finance, health care, management and executives, and skilled labour. The least-commonly held occupations? Athletes, coaches, personal trainers and the military. </p>
<p>So these men don’t sound like a particularly violent bunch, but aren’t steroids still linked with increased aggression and violent behaviour?</p>
<h2>How steroids affect behaviour</h2>
<p>Some <a href="http://www.sciencedirect.com/science/article/pii/S0018506X96900215">studies suggest</a> that steroid users are more aggressive and irritable than non-users. Further, some <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636528/">population-based studies</a> have <a href="http://www.ncbi.nlm.nih.gov/pubmed/8355384">found links</a> between self-reported anabolic steroid use and self-reported involvement in aggressive and violent behaviour. </p>
<p>Arguably, however, the best data comes from studies where anabolic steroid use is objectively tested and violent behaviour is confirmed through legal records rather than self-report. </p>
<p>To this end, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17088508">Swedish retrospective cohort study</a> that compared registered criminal activity among individuals who had tested positive for anabolic steroids to those who had tested negative for steroids found that those who tested positive were no more likely to have committed violent crimes. </p>
<p>In fact, after controlling for substance abuse, the researchers found a lower risk for crimes against property among those individuals who tested positive for anabolic steroids. </p>
<p>A general limitation of studies on steroid use and violent behaviour is that few have controlled for other forms of substance use, including alcohol. </p>
<p>A <a href="http://uu.diva-portal.org/smash/record.jsf?pid=diva2:601819">recent Swedish study</a> examined the link between anabolic steroid use and violent crime in a sample of 3,594 remanded prisoners and found that 28% reported using steroids at least once in their lifetime. Prisoners who reported any lifetime use of steroids were 1.7 times more likely to be suspected of a violent crime. However, there was no temporal relation between the use of anabolic steroids and the suspected violent crime. </p>
<p>In contrast, there was a four-fold increase in the risk of violent crime if alcohol had been consumed 24 hours earlier. The average amount of alcohol consumed in the 24 hours prior to a violent offence was 107 grams, equivalent to 10.7 Australian standard drinks.</p>
<p>A <a href="http://uu.diva-portal.org/smash/record.jsf?pid=diva2:601819">second Swedish population study</a> of 10,365 men found that 4.9% had been convicted for a violent crime and 0.7% reported anabolic steroid use. Further examination showed that violent offenders were five times more likely to report anabolic steroid use than non-offenders. </p>
<p>But after controlling for other forms of lifetime substance abuse, including alcohol, this association lost statistical significance. In other words, once the researchers looked at alcohol and other drugs, it appeared that anabolic steroids were not at all associated with violent crime. </p>
<p>Steroid use is probably not a proximal risk factor for violent behaviour. Rather, co-occurrence of abuse of other substances, including alcohol, are probably more to blame. Another possibility is that using anabolic steroids <a href="http://www.ncbi.nlm.nih.gov/pubmed/12048171">makes people more susceptible</a> to the violence-inducing effects of other substances such as alcohol or <a href="http://www.ncbi.nlm.nih.gov/pubmed/15763599">amphetamines</a>, an idea which has some support in animal research.</p>
<h2>Cost of penalising steroid users</h2>
<p>The potential benefit of tougher laws on steroid use to curb violence and antisocial behaviour must be weighed against the potential costs. The proportion of steroid users who disclose their use to health professionals, which is already low, will likely fall. </p>
<p>Community health-promotion services, such as needle exchanges, may see a drop in visits from steroid users concerned about the potential for discovery and prosecution.</p>
<p>Steroid use is undoubtedly growing in Australia. In New South Wales in 2007, <a href="https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ANSPS_2008_2012%20KI.pdf">the proportion</a> of needle exchange service-users who reported that their last injection was steroids was just 2%. But by 2012 this had increased sixfold to 12%. Queensland <a href="https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ANSPS_2008_2012%20KI.pdf">fared no better</a>: rising from 2% in 2007 to 11% in 2012. By 2012, almost two-thirds of all new service-users, or “new initiates,” reported that their last injection was anabolic steroids. </p>
<p>These men are not competitive athletes or criminals. Overwhelmingly, they are men who are unhappy with their appearance and want to look better. </p>
<p>For some, large parts of their self-worth or self-esteem are tied to their bodies and their appearance. If building muscle becomes a preoccupation, a mental condition called <a href="http://www.ncbi.nlm.nih.gov/pubmed/9427852">muscle dysmorphia</a>, formerly named <a href="http://www.ncbi.nlm.nih.gov/pubmed/8131385">“reverse anorexia”</a>, may develop. Little wonder that <a href="http://ajp.psychiatryonline.org/article.aspx?articleID=174271">up to 50%</a> of men with muscle dysmorphia also use steroids. </p>
<p>Derisively labelling steroid users as vain or narcissistic “gym bros” and disparaging their culture as “<a href="http://www.abc.net.au/news/2014-08-27/qld-beefs-up-steroid-laws-after-drastic-rise-in-seizures/5698532">bruss</a>” betrays a deep lack of compassion. There is a reason why extreme dieting and self-induced vomiting <a href="http://www.jeatdisord.com/content/1/S1/O23">grew faster</a> among Australian males than Australian females between 1998 and 2008 and a reason why teenage boys <a href="https://www.missionaustralia.com.au/2020-strategy-page/doc_download/198-mission-australia-youth-survey-2013">consistently rank</a> body image among their top three major life concerns. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Male action figures are becoming bulkier.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ntxpeach68/6785168533">SandyJo Kelly./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Our culture celebrates physically attractive and “masculine” men: tall, muscular, stiff upper-lipped. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18089212">Research shows</a> that media portrayals of men have become <a href="http://www.sscnet.ucla.edu/comm/haselton/papers/downloads/frederickbodyimage.pdf">more and more muscular</a> during the past few decades and the rise in steroid use in contemporary Australia is a symptom of men succumbing to body image pressures. </p>
<p>Solving this problem demands a compassionate understanding of the psychology behind why men start to use steroids. Too often we turn to outright denigration. We do not publicly berate girls for their attempts to look more attractive, so why do we berate men?</p>
<p>Tougher steroid laws are unlikely to have an impact on violence in the community. Rather, the steroid-using community will be driven further underground, making it more difficult to deliver health services to this misunderstood and under-served group of people, allowing the problem of steroids in Australia to grow even larger.</p><img src="https://counter.theconversation.com/content/31062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am currently affiliated with the Butterfly Foundation, the Redleaf Practice, the Australian and New Zealand Academy of Eating Disorders, and the National Association for Males with Eating Disorders.</span></em></p>Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them. Ostensibly, it is this perception…Scott Griffiths, PhD candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/291802014-07-14T14:58:36Z2014-07-14T14:58:36ZAnabolic steroid use is not just about bodybuilding<figure><img src="https://images.theconversation.com/files/53791/original/yp3b6g55-1405346369.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C722%2C475&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not just a man's game.</span> <span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:BodybuildingWoman.jpg">Roonb</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The use of anabolic steroids has been associated primarily with men. But over the past few decades, we’ve been discovering more about different groups who use these drugs – including women and younger men – and why. </p>
<p>With 3.3% of the world’s population having used anabolic steroids at least once – a figure so high that their use has to be considered <a href="https://theconversation.com/anabolic-steroids-a-serious-global-health-problem-amid-boom-in-cosmetic-use-24238">a serious global public health problem</a> – we wanted to learn more about the experiences that lead people to use. </p>
<p>In a recent analysis, <a href="http://www.substanceabusepolicy.com/content/pdf/1747-597X-9-27.pdf">published in</a> Substance Abuse Treatment, Prevention, and Policy, we gathered together information from qualitative studies featuring interviews with users, focus group discussion and case reports. Our findings provide a tapestry of use from the age of 14 – the youngest person we found to be using anabolic steroids – to the oldest, who was 54. However, most studies report that the majority of users start before the age of 30. </p>
<h2>Who starts using anabolic steroids?</h2>
<p>Looking at the characteristics and history of people who start using anabolic steroids, most participated in sports – especially power sports like weightlifting and bodybuilding – had family and relationship problems, and psychological issues such as depression, negative self-image and body dissatisfaction. Many had abused other substances before they began using anabolic steroids. </p>
<p>The most prominent feature in using anabolic steroids for the first time is participation in power sports – both recreational and competitive – because they help users bulk up muscle. Our study showed that for some, the use of anabolic steroids can begin less than a year after they take up the sport. Many also reported giving into pressure because coaches and officials didn’t question how other teammates or competitors gained unusually huge muscles and strength. </p>
<p>But sport isn’t only to blame. Many persons also reported psychological and social problems before using anabolic steroids. These included depression, poor self-esteem, eating disorders, problems with parents or poor social support, and some even reported use following bullying, rape, or divorce. One study that investigated weightlifting and anabolic steroid use <a href="http://www.ncbi.nlm.nih.gov/pubmed/10428186">among female rape victims</a>, found five women who had previously thought anabolic steroid users were “weak” but later felt the need to use them to bulk up to give themselves a stronger sense of physical security, which they felt they couldn’t achieve without help from steroids. </p>
<p>Low self-esteem and body issues may explain why most users reported first using anabolic steroids to enhance their appearance or body image, gain more muscles or strength, as well as improving sports performance. This could also be related to some reporting using these drugs to be more successful in finding partners or to enhance their love life. </p>
<p>Many people had also experimented with, or were regular users of, other licit and illicit substances such as alcohol, heroin, tobacco, marijuana, cocaine, and amphetamine before moving on to anabolic steroids. For instance, some heroin users indicated they started using anabolic steroids to deal with the weight loss resulting from heroin use. It was also a surprise to learn that some drug users were introduced to and started using anabolic steroids while receiving treatment for use of other drugs at addiction clinics. </p>
<h2>Working lives</h2>
<p>In the studies we looked out, we found some people also started using anabolic steroids to enhance their performance at work. These were mainly in jobs that required some kind of enhanced appearance or muscularity, <a href="http://nattyornot.com/fitness-models-using-anabolic-steroids/">like modelling</a> and <a href="http://www.theguardian.com/uk/2003/nov/14/drugsandalcohol">security work</a>– for example club doormen, police, and soldiers. Some even said anabolic steroids were an indispensable ingredient for success in their line of work. </p>
<p>For some, but not all, social pressure such as media influence, peer influence, and sport or social norms also emerged as an important driver behind anabolic steroid use. </p>
<p>Many users were aware of the long-term consequences of anabolic steroid use. Prior to starting, many sought information from various sources including health practitioners but nevertheless went ahead. Motives can also change with time. Some people start using anabolic steroids to enhance their muscle or strength and later move on to use for other reasons such as overcoming psychological problems. </p>
<p>Most users first obtain anabolic steroids from a strong illicit trade, not just from the internet and dealers, but from coaches, and even clinicians or health workers (doctors, pharmacists, and veterinarians). Friends or teammates, gym employees and relatives, were also sources. However, in the most recent studies we looked at, the only sources of anabolic steroids were the illicit market, relatives, and friends. This may be due to <a href="https://theconversation.com/anabolic-steroids-a-serious-global-health-problem-amid-boom-in-cosmetic-use-24238">the growing illegality</a> of these drugs since the 1990s. Nevertheless, the relatively easy availability of both legal and illegal substances, means that better interventions will need to be found to avert more people from using them. </p><img src="https://counter.theconversation.com/content/29180/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic Sagoe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The use of anabolic steroids has been associated primarily with men. But over the past few decades, we’ve been discovering more about different groups who use these drugs – including women and younger…Dominic Sagoe, PhD Research Fellow in Social Psychology, University of BergenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/242382014-03-13T06:18:58Z2014-03-13T06:18:58ZAnabolic steroids a serious global health problem amid boom in cosmetic use<figure><img src="https://images.theconversation.com/files/43733/original/7cyvxv72-1394640097.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How many sit-ups you doing then?</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A competitive spirit is an indispensable aspect of human life, where it could be argued that a failure to compete only results in participating in a competition to fail. Over a very long period of time, humans have relied <a href="http://www.drugfreesport.com/drug-resources/performance-enhancing-drugs-steroids.asp">on various kinds</a> of performance-enhancing substances. It has been suggested, for example, that the ancient Greeks <a href="http://news.nationalgeographic.com/news/pf/63532314.html">turned to potions</a> to improve performance. </p>
<p>Today, these substances range from “soft” or legal substances such as energy drinks to “hard” substances such as steroids and amphetamines, and other more “natural” methods, including blood doping to increase the number of rich red blood cells in the bloodstream.</p>
<p>In the exercise or athletic world, anabolic-androgenic steroids or anabolic steroids are a very popular performance-enhancing substance. But over the past 40 years they have increasingly been used for aesthetic or “beauty” reasons. This is what we found in a recent study, <a href="http://www.annalsofepidemiology.org/article/S1047-2797%2814%2900039-8/abstract">published in Annals of Epidemiology</a>, that suggested that 3.3% of the world’s population have used anabolic steroids at least once, most of whom were male (around 6.4% of males and 1.6% of females). </p>
<p>The biggest users were in the Middle East, followed by South America, Europe, North America, Oceania, Africa, and Asia. Use was highest among recreational sportspeople followed by athletes, prisoners and arrestees, drug users, high school students, and non-athletes.</p>
<p>Our finding suggests that use of anabolic steroids is now a serious global public health problem. Not confined to athletes, the spread of their use into the general population means millions of individuals across the world, many of whom have no athletic ambitions, are using them to increase and improve their physical strength and appearance. </p>
<p>A recent Australian survey suggested that two thirds of young men who began injecting drugs in the past three years <a href="https://theconversation.com/more-young-men-using-steroids-but-do-they-know-the-harms-3021">were using steroids</a> (rather than methamphetamine or heroin). </p>
<h2>Previous work</h2>
<p>Anabolic steroids are a group of hormones that include the natural male sex hormone testosterone and a set of synthetic versions. Early scientific forays into the effects of testosterone included one Harvard professor <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2800%2964118-1/fulltext">injecting himself</a> with a “rejuvinating elixr” that included extract from dog and guinea pig testicles in 1889. It wasn’t until the mid-1930s, however, that human testosterone was first “discovered” and then synthesised by Adolf Butenandt and Leopold Ruzicka (independently of each other) in 1939. Both were <a href="http://www.nobelprize.org/nobel_prizes/chemistry/laureates/1939/butenandt-bio.html">awarded the Nobel Prize</a> for their work.</p>
<p>All anabolic steroids – natural and synthetic – have two essential results: a “muscle building” effect that results in muscle growth, and an androgenic or virilising effect that results in masculinising characteristics such as deepening of the voice. Anabolic steroids increase the production of protein within cells, which decreases body fat as well as increasing muscle growth beyond natural limits.</p>
<p>Steroids are used in medicine for several purposes including the treatment of male <a href="http://www.mayoclinic.org/diseases-conditions/male-hypogonadism/basics/definition/con-20014235">hypogonadism</a>, a condition where the body doesn’t produce enough testosterone and which can limit the production of sperm. It is also used to treat delayed puberty, enhance appetite and stimulate growth. </p>
<p>Many “steroids” prescribed by medics are not anabolic, but <a href="http://my.clevelandclinic.org/drugs/corticosteroids/hic_corticosteroids.aspx">corticosteroids</a> which have neither anabolic nor addictive potential. But other people who use these steroids for fitness or aesthetic purposes clearly do it outside of these health reasons. </p>
<h2>Spread to general population</h2>
<p>Around the 1960s and 1970s, anabolic steroids were mainly used by elite athletes and bodybuilders motivated by the desire to develop bigger muscles and enhance their athletic performance. In the past three or four decades however, millions of non-competitive athletes such as recreational sportspeople and adolescents have been using them, motivated by the desire to look more attractive. This means their use has spread from the athletic community into the general population. While it has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/15525553">suggested that athletes</a> comprise the smallest group of anabolic users, in our study they were the second biggest. </p>
<p>Until recently, several questions over the global use estimates were largely unanswered. The aim of our study was to estimate the global prevalence of use. Putting together findings from 187 studies (and subject to some limitations such as the paucity of anabolic steroid prevalence research in especially Africa and Asia), we estimate the problem is gradually increasing. Between 1990 and 1999 prevalence was about 2.9% but post 2000, this has risen to 3.2%.</p>
<h2>Harmful effects</h2>
<p>These findings should attract the attention of global public health officials because of the associated serious harmful effects of long-term use. These include high blood pressure, heart attack, stroke, acne and skin infections, liver damage, tendon rupture, premature baldness, stunted bone growth in adolescents, syringe exchange infections such as HIV and hepatitis, and death. There are psychosocial implications too. Users <a href="https://theconversation.com/muscling-up-are-steroids-an-emerging-criminal-threat-21636">can become violent or aggressive</a>, cause mood syndromes, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062678/">and addiction</a>. </p>
<p>There are also other gender-specific effects. In males, these include low sperm count, shrunken testicles, infertility and growth of breasts. In females, these include roughening of the skin, decreased breast size, deepening of the voice, growth of body hair, changes to the menstrual cycle and enlargement of the clitoris. </p>
<p>It has to be noted that the effects and harms of anabolic use are dose-dependent. So higher and longer term use leads to bigger muscles but more harmful effects. </p>
<h2>Laying down the law</h2>
<p>Since the 1990s there has been increasing legislation to combat the problem. Anabolic steroid use is illegal in the US, the UK, Australia, Argentina, Brazil, Portugal, and <a href="http://www.arabnews.com/node/265116">Saudi Arabia</a>. Though the US passed their Anabolic Steroid Control Act in 1990, and Sweden the Act Prohibiting Certain Doping Substances in 1991, other countries have been a bit slower – Norway only banned use in 2013. In many places they are unregulated and can be bought in some pharmacies. </p>
<p>An amendment to the US act in 2004 also added <a href="http://muscleandbrawn.com/are-prohormones-worse-than-steroids/">prohormones</a> to the list of controlled substances. These substances, a kind of precursor to a hormone (rather than a hormone itself), can amplify the effect of existing hormones. </p>
<p>But as the internet makes obtaining substances easy, even if illegal, it’s clear that better ways of dealing with the problem – and the probable harmful effect on population health – will need to be found.</p><img src="https://counter.theconversation.com/content/24238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic Sagoe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A competitive spirit is an indispensable aspect of human life, where it could be argued that a failure to compete only results in participating in a competition to fail. Over a very long period of time…Dominic Sagoe, PhD Research Fellow in Social Psychology, University of BergenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/30212012-09-07T04:57:48Z2012-09-07T04:57:48ZMore young men using steroids but do they know the harms?<figure><img src="https://images.theconversation.com/files/15184/original/6g2ptfgh-1346992203.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Steroids have a range of negative side-effects and harms that many may not know about.</span> <span class="attribution"><span class="source">arbyreed/Flickr</span></span></figcaption></figure><p>A <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2012.00499.x/abstract">recent national survey</a> has found two-thirds of young men who began injecting drugs within the past three years were using steroids, overtaking methamphetamine and heroin use.</p>
<p>Anabolic-androgenic steroids are synthetic forms of testosterone, the hormone that plays a key role in the development of male reproductive tissues as well as the development of secondary sexual characteristics, such as the growth of body hair and deepening of the voice. </p>
<p>Steroids have legitimate medical uses. They can be used as growth stimulators in children with growth failure and are given to people with chronic wasting conditions, such as AIDS, to help stimulate appetite and preserve muscle mass. But, when combined with exercise and a proper diet, steroids can help increase muscle size, strength, and help with the development of lean muscle mass.</p>
<h2>Unknown extent</h2>
<p>The <a href="http://www.crimecommission.gov.au">Australia Crime Commission</a> has reported that the number of steroid detections at the Australian border had increased by 74% in 2009-10, the highest recorded in the last decade. It also said the number of national steroid arrests had increased by 47%. A large number of detections involved small quantities, which suggest they are being imported for personal use. </p>
<p>It’s important to note that these numbers reflect what law enforcement detects and seizes. If we accept this as the tip of the iceberg, then it suggests that the use of steroids is increasing in our society. While steroid use has always been synonymous with bodybuilding, we have seen its use becoming increasingly acceptable among the average gym-going population. The figures in the just-released national survey attest to this. </p>
<p>But while we have a fair idea of who is using, there’s no actual profile of a typical steroid user in Australia. And the prevalence of steroid use varies depending on the group being surveyed.</p>
<h2>Who uses steroids?</h2>
<p>A large, <a href="http://www.aihw.gov.au/publication-detail/?id=32212254712&tab=2">general population survey</a> of over 26,000 Australians found less than 0.1% had used steroids for non-medical purposes in the last year. To put this into perspective, around 10% of Australians had used cannabis in the same time period, 3% had used ecstasy and 2% had used cocaine. Since this survey was first conducted in 1993, this level of steroid use has barely changed. </p>
<p>Meanwhile, a <a href="http://www.jsams.org/article/S1440-2440(10)00118-0/abstract">survey of over 22,000</a> high school students in Australia found that around 2% of 12- to 17-year-olds had used steroids “without a doctor’s prescription” in an attempt to make them “better at sport, to increase muscle size or to improve your general appearance”. Slightly fewer students had used steroids in recent time periods, indicating that use was generally not regular. Those who had used steroids had also used a range of other substances, such as alcohol, tobacco, cannabis, ecstasy, and cocaine. </p>
<p><a href="http://nchsr.arts.unsw.edu.au/publications/">Surveys</a> of men who have sex with men have found that around 2% in Sydney, Melbourne and Brisbane have used steroids in the past six months. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/15181/original/225shjb9-1346991807.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some of 100 bottles containing illegal liquid steroids hidden inside sexual lubricant packaging seized by Australian Customs in Melbourne in 2008.</span>
<span class="attribution"><span class="source">AAP Image/Australian Customs</span></span>
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</figure>
<p>What all these figures tell us is that we aren’t looking in the right places. We are probably never going to get an exact number of the people using steroids. But who are they? From all the research that has been done in Australia, we know that the people who use steroids, and other drugs to enhance their image or their performance, are not the same. </p>
<p>They do tend to be male. They do tend to be aged in their mid-twenties to early-thirties, though there are men who are younger and older who also report using steroids. They tend to have completed high school and be employed full time. A sizeable number identify as bisexual or homosexual. They do tend to use other drugs such as cannabis, cocaine and ecstasy, although that may be better explained by their sexual orientation rather than their steroid use.</p>
<p>While steroid users may be alike in some ways and different in some ways, what appears to be common is why they use them. Each person who takes steroids will have their own motivation for doing so, but we can broadly place these into one of three categories: to get a better body, to be better at sport, or to be better at their job. Some of these reasons may cross over. Having more strength may mean that you perform better on the footy field, and if you are a security guard or a bouncer, having a better body may be advantageous at work.</p>
<h2>Side-effects of steroid use</h2>
<p>Combined with exercise and a proper diet, steroids work. But they have a range of negative side effects and harms. Indeed, most of the people who have used steroids in Australia perceive and report harms; only a small minority report having no concern, and, in <a href="http://ndarc.med.unsw.edu.au/sites/ndarc.cms.med.unsw.edu.au/files/ndarc/resources/TR.239.pdf">one study</a>, 97% reported at least one physical side-effect. </p>
<p>Some of the harms associated with steroid use could be considered minor or inconvenient, such as acne or increased body hair. Other side-effects can include increased appetite, water retention, reduced teste size and sleeplessness. Many of these will subside once steroid use has stopped. </p>
<p>But, there are other side-effects that people often don’t consider. Steroids are injected, so there’s potential for harm from unsafe injecting practices, such as sharing or reusing needles or sharing multivial doses. Harms related to injecting may include persistent soreness or redness at the injection site, scarring or hard lumps, hitting a vein or persistent bleeding, swelling of the arm or leg, abscesses and nausea. </p>
<p>Steroid users do report concerns regarding their mental health. These include aggression or “roid rage”, and changes in mood and the impact of these on relationships with friends and family. Users have self-reported negative effects on mood, and these include mood swings or feeling more moody, and feeling anxious or depressed. </p>
<p>It’s also been suggested that steroid use can cause a dependence syndrome. This is probably the least explored aspect of steroid use. Interviews with steroids users have shown that some have continued to use despite experiencing negative physical or psychological effects, and some users indicate they are scared of stopping because they fear they will lose the physical benefits of using.</p>
<p>The latest research gives cause for concern and it’s really important that people who use steroids are aware of the harms they are opening themselves up to. </p><img src="https://counter.theconversation.com/content/3021/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Dunn has received funding from the Australian Government Department of Health and Ageing. </span></em></p>A recent national survey has found two-thirds of young men who began injecting drugs within the past three years were using steroids, overtaking methamphetamine and heroin use. Anabolic-androgenic steroids…Matthew Dunn, Senior Lecturer in Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.