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Journal ArticleDOI

A qualitative study of anabolic steroid use amongst gym users in the United Kingdom: motives, beliefs and experiences

10 Jul 2015-Journal of Substance Use (Informa Healthcare)-Vol. 20, Iss: 4, pp 288-294

TL;DR: Anabolic steroid users’ drug use and associated behaviour were influenced by numerous sources of information, in particular, first-hand accounts of their peers, along with personal opinion and anecdotes on the Internet, which contributed to their belief that these drugs can be used relatively safely.

AbstractThe illicit use of anabolic steroids amongst the gym population continues to rise in the United Kingdom presenting serious challenges to public health. This study used qualitative interviews to explore the experiences of 24 users of anabolic steroids and investigate their motives and experiences. Body satisfaction was a motivating factor in the use of anabolic steroids. Anabolic steroid users’ drug use and associated behaviour were influenced by numerous sources of information, in particular, first-hand accounts of their peers, along with personal opinion and anecdotes on the Internet. As a result of this knowledge, users expressed their belief that these drugs can be used relatively safely. The prevailing viewpoint, that the harms associated with anabolic steroids can be managed and that this behaviour is part of a healthy lifestyle, contributes to the potential health risks.

Topics: Population (53%)

Summary (2 min read)

Introduction

  • The use of anabolic steroids and, more broadly, prohibited doping substances in elite sport has been well-known, and thoroughly debated, for decades.
  • While doping techniques and specific substance use in competitive athletes varies tremendously (for example, depending on type of sport), the overarching aim of this form of drug use is to improve performance and to win.
  • Of note is that concerns have been raised regarding the accuracy of these estimates (ACMD, 2010; Evans-1 Brown et al., 2012).
  • Due to the growing use of anabolic steroids in the United Kingdom this study explores the experiences of the users and investigates their motives, beliefs and steroid-related experiences.

Background literature

  • Use in women can lead to growth of body and facial hair, deepening of voice, clitoris enlargement, increased libido, menstruation irregularities, and reduced fertility (EvansBrown et al., 2012).
  • Severity of effects is partly idiosyncratic, but would also appear to be dose dependent.
  • This knowledge, based predominantly on personal experience and anecdotes, includes information on methods to reduce or avoid adverse effects (Monaghan, 2001).

Method

  • Qualitative interviews with 24 users of anabolic steroids were conducted between 2009 and 2011 as part of a study of harm reduction services for anabolic steroid users in England and Wales (for an overview of respondents see Table 1).
  • The study had ethical 2 approval granted by Liverpool John Moores Research Ethics Committee.
  • Seven steroid users were recruited from fixed-site needle and syringe programmes; three from an outreach service; nine from steroid clinics; one from a gym; and, four from a prison.

Insert table 1

  • Semi-structured interviews were conducted, lasting between 30 to 75 minutes, including questions on body (dis)satisfaction, motivations for steroid usage; patterns of steroid use, sources of steroid-related knowledge and accounts of health harms.
  • Most interviews were recorded, and subsequently transcribed, except when prison regulation prohibited the use of electronic devices, or when respondents felt uncomfortable about discussing sensitive issues of using or supplying anabolic steroids.
  • In such cases, a written record was compiled immediately after the interview.
  • Written interview records were subjected to thematic content analysis in order to identify and verify themes relevant to the experiences of steroid usage (Burnard et al., 2008).
  • Themes were continuously 3 developed and refined as the study progressed (Miles & Huberman, 1994).

Body satisfaction and drugs

  • In line with previous research into the use of anabolic steroids (Grogan et al., 2006; EvansBrown & McVeigh, 2009), findings clearly indicated that anabolic steroid usage was linked to getting a better looking body.
  • Importantly, reasons to use these drugs may shift over time, providing further insights into why users behave as they do:.
  • At this moment in time, I’m not looking to get any bigger as a bodybuilder for example.
  • I wouldn’t wish to be any heavier than that, 4 because carrying more than 15 stone, you are just going to give yourself health.
  • The article presents quotes only from interviews recorded on audio.3.

Gaining and using knowledge

  • Drug using patterns were complex and highly personalised with no two respondents reporting identical regimens.
  • If I get problems with cholesterol, I’ll take statins, which is a drug that can lower cholesterol.
  • (Steroid user aged 35) More complex drug regimens included the use of various anabolic steroids together with synthetic growth hormones and insulin to enhance muscle size and lose body fat.
  • Additionally, some respondents included sexual enhancement products and skin darkening drugs in their drug repertoires (for an overview see Table 2).

Insert table 2

  • An important part of acquiring knowledge about anabolic steroids—commonly referred to by respondents as doing ‘research’—was to ask other users for advice: (Steroid user aged 21) In fact, there were no indications that any of the respondents engaged in the use of steroids on their own.
  • (Steroid user and competing bodybuilder aged 45) 8.
  • Who kept detailed records of their steroid regimes, users also revealed elements of irrationality as they ignored the commonly accepted ‘guidelines’ for steroid use and in spur-of-the-moment behaviour adopted practices based on rumours which they perceived as ‘emerging evidence’.
  • In other cases, recording specific regimes and doses of users presented difficulties (partly because of difficulties in remembering the exact duration of previous courses and partly because users were unaware of precise amounts or measurements).

Discussion

  • Numerous factors including perceptions of the ideal body, steroid knowledge shared amongst users, the function of the illicit market, and personal assessments of health influenced the motivations and beliefs amongst steroid users.
  • Overall, this appeared to serve multiple purposes, including questioning the trustworthiness of information about the potential harms of these drugs from health authorities, and coping with insecurities about the use of these drugs by increasing the sense of security and well-being (Wills, 1981).
  • The accounts of steroid users revealed tremendous inconsistencies in the perception of the harms of anabolic steroids between users and health authorities, the media and policymakers with serious implications for the promotion of public health.
  • This may also offer a potential opportunity to deliver accurate information via an established and credible communication network.
  • Considering these limitations is important when extrapolating the findings to the wider population of anabolic steroid users.

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DOI:
10.3109/14659891.2014.911977
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Citation for published version (APA):
Kimergård, A. (2014). A qualitative study of anabolic steroid use amongst gym users in the United Kingdom:
Motives, beliefs and experiences. Journal of Substance Use, 20(4), 288-294.
https://doi.org/10.3109/14659891.2014.911977
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Download date: 10. Aug. 2022

A qualitative study of anabolic steroid use amongst gym users
in the United Kingdom: Motives, beliefs and experiences
Andreas Kimergård
1,2
1
Centre for Public Health, Liverpool John Moores University, Liverpool, United Kingdom
2
Department of Public Health, Aarhus University, Aarhus, Denmark
Correspondence: Andreas Kimergård, Centre for Public Health, Liverpool John Moores
University, Henry Cotton Campus, Level 2, 15-21 Webster Street, Liverpool, L3 2ET,
United Kingdom;
E-mail: A.Kimergard@ljmu.ac.uk
Running head: Anabolic steroid use: Motives, beliefs and experiences!
1

A qualitative study of anabolic steroid use amongst gym users
in the United Kingdom: Motives, beliefs and experiences
Abstract
The illicit use of anabolic steroids amongst the gym population continues to rise in the
United Kingdom presenting serious challenges to public health. This study used qualitative
interviews to explore the experiences of 24 users of anabolic steroids and investigate their
motives and experiences. Body satisfaction was a motivating factor in the use of anabolic
steroids. Anabolic steroid users’ drug use and associated behaviour were influenced by
numerous sources of information, in particular, first-hand accounts of their peers, along
with personal opinion and anecdotes on the Internet. As a result of this knowledge, users
expressed their belief that these drugs can be used relatively safely. The prevailing
viewpoint, that the harms associated with anabolic steroids can be managed and that this
behaviour is part of a healthy lifestyle, contributes to the potential health risks.
Keywords
Anabolic steroids, gym population, motivations for use.!
2

A qualitative study of anabolic steroid use amongst gym users
in the United Kingdom: Motives, beliefs and experiences
Introduction
The use of anabolic steroids and, more broadly, prohibited doping substances in elite sport
has been well-known, and thoroughly debated, for decades. While doping techniques and
specific substance use in competitive athletes varies tremendously (for example,
depending on type of sport), the overarching aim of this form of drug use is to improve
performance and to win. Yet most people who use anabolic steroids do not compete in
organised sport (Baker et al., 2006; Pope et al., in press) and most studies into anabolic
steroid usage indicate that the main reasons to use these drugs are to enhance the
performance of muscle, for example by increasing strength, or improving the appearance
of the body (Evans-Brown et al., 2012).
The use of anabolic steroids amongst gym users has been reported in countries in
Europe, Australasia, and North America (Sagoe et al., in press), and, more recently, in
countries such as Brazil (Santos et al., 2011), the United Arab Emirates (Al-Falasi et al.,
2008), and Iran (Allahverdipour et al., 2012). The Crime Survey for England and Wales
found that 0.2% of those aged 16-59, estimated at 59,000, had taken anabolic steroids in
the past year (2012/2013) (Home Office, 2013). Data collected from needle and syringe
1
programmes in Merseyside and Cheshire, North West England, shows a significant
increase in the number of new steroid injecting clients attending such harm reduction
services from the 1990s onwards (ACMD, 2010). These data, along with arrests of illicit
retailers, seizures of illicit market products, media reports, monitoring of discussion forums
on the Internet, and case reports/series of adverse events, indicate that the use of
anabolic steroids and other drugs for the purpose of human enhancement is steadily
growing (Evans-Brown et al., 2012).
Anabolic steroid usage in the gym population presents a challenge to public health, in
relation to adverse effects (both acute and chronic) amongst users (Pope et al., in press)
as well as potential exposure to blood borne viruses from the sharing of contaminated
Of note is that concerns have been raised regarding the accuracy of these estimates (ACMD, 2010; Evans-
1
Brown et al., 2012).
3

needles, syringes and drug vials (Hope et al., 2013). Due to the growing use of anabolic
steroids in the United Kingdom this study explores the experiences of the users and
investigates their motives, beliefs and steroid-related experiences.
Background literature
Perceptions and management of anabolic steroid-related health harms
Case reports/series, along with observational studies, indicate that acute adverse
reactions from the pharmacotoxicological actions of anabolic steroids are diverse in their
characteristics and severity, and include acne, hair loss, gynaecomastia, disruption of
growth, damage to tendons and ligaments, testicular atrophy, erectile dysfunction, liver
damage (especially with oral products), and cardiovascular events (Pope et al., in press).
Use in women can lead to growth of body and facial hair, deepening of voice, clitoris
enlargement, increased libido, menstruation irregularities, and reduced fertility (Evans-
Brown et al., 2012). Adverse psychological effects have also been reported in the
literature, including increases in aggressive behaviour, and depression following the
cessation of use (Haug et al., 2004; ACMD, 2010). Severity of effects is partly
idiosyncratic, but would also appear to be dose dependent.
One survey conducted amongst members of 18 gyms in the United Arab Emirates
reported that 59% believed that the benefits of using anabolic steroids outweighed the
risks (Al-Falasi et al., 2008). A similar study included steroid users attending two needle
and syringe programmes in the United Kingdom, and found that nearly all of the
respondents said that they have been given information regarding the potential health
harms of anabolic steroids and yet more than half had no intention of stopping their use of
these drugs in the next 12 months (Walker & Joubert, 2011). While these and similar
studies are beneficial in determining the perceived hazards of steroid use, they offer little
insights into the reasons behind, and experiences with, the use of these drugs and the
potential impact on behaviour. In relation to motivation and drivers to use anabolic
steroids, a significant issue is the apparent relationship between social as well as cultural
ideals and body satisfaction in men (Mishkind et al., 1986). In terms of studies into body
image satisfaction, it has been shown that body dissatisfaction, along with the desire to
enhance muscularity, can prompt the use of anabolic steroids in men (Grogan, 2008). The
few existing qualitative studies show that users exchange anabolic steroid-related
knowledge and will often defer to opinion leaders (sometimes referred to as ‘steroid gurus’)
4

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Abstract: As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published. We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users’ polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n = 22), followed by Sweden (n = 7), England only (n = 5), and the United Kingdom (n = 4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. Our classification of the various substances used by AAS users resulted in 13 main groups. These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy.

99 citations


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  • ...Perry 1990 [44] USA Interview and questionnaire† 20 male weightlifters aged 18 to 28 years Gymnasium Human chorionic gonadotropin (hCG) Perry 2003 [45] USA Interview 10 male weightlifters aged 21 to 40 years Gymnasium Aspirin®, caffeine, clomiphene, creatine, dietary supplement, ephedrine, glutamine, liothyronine, protein powder, yohimbine Peters 1997 [46] Australia Interview and questionnaire† 100 persons (6 female) aged 18 to 50 years Advertisements, gymnasium, interviews, radio, sports shops and associations, syringe exchange centre Alcohol, aminogluthimide, amphetamine, antibiotics, beta blockers, caffeine, cannabis, chromium picolinate, clenbuterol, cocaine, daonil®, dietary supplement, diuretics, ecstasy, ephedrine, growth hormone, human chorionic gonadotropin (hCG), hydroxocobal amin, insulin-like growth factor 1, insulin, oestrogen antagonist, pregnyl®, proviron®, teroxin (T3), thyroxine Pope 1988 [47] USA Interview 41 male bodybuilders and footballers Gymnasium Alcohol, cannabis, cigarettes, cocaine, human chorionic gonadotropin (hCG) Pope 1994 [48] USA Interview 88 athletes; mean age 26 years Gymnasium Alcohol, cannabis, tobacco Rashid 2000 [49] USA Case study 40-year-old male Clinic Cocaine, cannabis, ‘uppers’, ‘downers’, lysergic acid diethylamide (LSD) Schäfer 2011 [50] Denmark Case study 26-year-old male bodybuilder Clinic Erythropoietin Silvester 1995 [51] USA Interview 22 former athletes aged 36 to 66 years Not specified Growth hormone Skårberg 2007 [52] Sweden Interview and questionnaire† 18 male drug users; mean age 35 years Clinic Alcohol, narcotics/other drugs Skårberg 2008 [53] Sweden Interview 6 drug users (2 female) Clinic Alcohol, amphetamine, analgesics, anti-catabolics, anti-oestrogens, aspirin®, benzodiazepines, bronchodilators, buprenorphine, caffeine, cannabis, cocaine, codeine, conjugated linoleic acid, creatine, dietary supplements, ecstasy, ephedra, ephedrine, growth hormone, Herbal products, insulin growth factor 1, insulin, protein powder, testosterone releasers Skårberg 2009 [54] Sweden Interview and questionnaire† 32 male drug users Clinic Alcohol, amphetamine, anti-oestrogen (clomid), analgesics, anti-acne drug, anti-catabolics, anti-depressants, anti-hypertensive drugs, anti-oestrogens, benzodiazepines, bronchodilators, cannabis, cocaine, creatine, dietary supplements, diuretics, ephedrine, fat-loss agents, gamma hydroxybutyrate, growth hormone, heroin, insulin, insulin-like growth factor 1, levodopa, muscle oil (synthol), non-steroidal anti-inflammatory drugs, opioid, plant steroid compounds, protein powder, stimulants, testosterone boosters, thyroid hormone Strauss 1985 [55] USA Interview 10 weight-trained female athletes; mean age 33 years Personal contact Acetaminophen, aspirin®, benoxaprofen, Ben-Gay®, caffeine, calcium, choline and inositol, dietary supplements, dimethyl S a g o e et a l. Su b sta n ce A b u se T rea tm en t, P reven tio n , a n d P o licy (2 0 1 5 ) 1 0 :1 2 P a g e 6 o f 1 9 Table 1 Characteristics of qualitative/descriptive studies presenting data on polypharmacy in AAS users (Continued) sulfoxide, codeine, electrolyte solution, epinephrine, furosemide, growth hormone, levodopa, lidocaine, naproxen, oxycodone hydrochloride, phenylbutazone, piroxicam, potassium, suntan pills, thyroglobulin, vitamins Tallon 2007 [56] Scotland Interview and questionnaire† 30 males aged 18 to 43 years; mean age 27 years Gymnasium Alcohol, cannabis, cocaine, clenbuterol, dietary supplements, diuretics, ecstasy, growth hormone, insulin, tamoxifen Wilson-Fearon 1999 [57] England Case study 29-year-old bodybuilder Not specified Clenbuterol, dietary supplements, diuretics, growth hormone, human chorionic gonadotropin (hCG), thiomucase Wines 1999 [58] USA Interview 11 weightlifters (5 female) aged 19 to 42 years Gymnasium Alcohol, buprenorphine, heroin, hydrocodone, nalbuphine, other drugs †We relied on the qualitative results generated from the interview....

    [...]

  • ...Clenbuterol Anabolic effects, burning fat, removing skin fluid, weight loss Chandler [12]; Gruber [21]; Kimergård [30]; Klötz [31]; Lenehan [36]; McBride [39]; Peters [46]; Wilson-Fearon [57] Anabolic effects, burning fat, removing skin fluid, weight loss Chandler [12]; Gruber [20-22]; Hope [25]; Kimergård [30]; Klötz [31]; Korkia [33]; Larance [35]; Lenehan [36]; McBride [39]; Peters [46]; Tallon [56]; Wilson-Fearon [57] 14...

    [...]

  • ...Sagoe et al. Substance Abuse Treatment, Prevention, and Policy (2015) 10:12 Page 9 of 19 Table 3 Use of non-AAS substances, reason(s)/motive(s) for use, and studies Current polypharmacy (Combined with AAS) Lifetime polypharmacy (Ever use) Substance Reason(s) for use Studies (First author, reference) Reason(s) for use Studies (First author, reference) Number of studies 2,4-dinitrophenol NS Chandler [12] NS Chandler [12]; Dunn [15]; Hope [25]; Larance [35] 4 Acetaminophen NS Strauss [55] NS Strauss [55] 1 Alcohol Better sleep and relaxation Chandler [12]; Hegazy [23]; Kanayama [28]; Kusserow [34]; Lundholm [37]; Malone [38]; Peters [46]; Perry [48]; Skårberg [52-54] Better sleep and relaxation Chandler [12]; Dunn [15]; Fudala [17]; Gruber [21,22]; Hegazy [23]; Hoff [24]; Hope [25]; Kanayama [26-28]; Katz [29]; Kusserow [34]; Malone [38]; Peters [46]; Perry [48]; Skårberg [52-54]; Tallon [56]; Wines [58] 23 Aminogluthimide Reducing receptors’ attraction to cortisol Peters [46] Reducing receptors’ attraction to cortisol Gruber [22]; Peters [46] 2 Amyl nitrate NS Chandler [12] NS Chandler [12] 1 Analgesics/opioids† Pain relief Ahlgrim [9]; Hegazy [23]; Kanayama [28]; Klötz [31]; Kusserow [34]; Lundholm [37]; Malone [38]; McBride [39]; Pappa [43]; Skårberg [53] Pain relief Ahlgrim [9]; Fudala [17]; Gruber [22]; Hegazy [23]; Kanayama [26,28], Klötz [31]; Kusserow [34]; Malone [38]; McBride [39]; Pappa [43]; Rashid [49]; Skårberg [53,54] 14 Anti-acne drugs† – – Combating acne Skårberg [54] 1 Antibiotics† Combating acne Peters [46] Combating acne Korkia [32]; Peters [46] 2 Anti-catabolics† NS Skårberg [53] Facilitating synthesis of hepatic protein and nitrogen economy Skårberg [53,54] 2 Anti-depressants† Combating side effects Klötz [31] Combating side effects, depression relief, boosting levels of serotonin and noradrenaline Klötz [31]; Skårberg [54] 2 Anti-oestrogens† Burning fat, combating gynecomastia, reducing effects on oestrogen Klötz [31]; Kusserow [34]; Peters [46]; Skårberg [53] Combating gynecomastia, burning fat, reducing effects on oestrogen Gårevik [18]; Hope [25]; Klötz [31]; Korkia [32]; Kusserow [34]; Larance [35]; Peters [46]; Skårberg [53,54] 9 Aromatase inhibitors† NS Chandler [12] NS Chandler [12] 1 Aspirin® NS Klötz [31]; Perry [45]; Skårberg [53]; Strauss [55] NS Klötz [31]; Larance [35]; Perry [45]; Skårberg [53]; Strauss [55] 5 Ben-Gay® NS Strauss [55] NS Strauss [55] 1 S a g o e et a l. Su b sta n ce A b u se T rea tm en t, P reven tio n , a n d P o licy (2 0 1 5 ) 1 0 :1 2 P a g e 1 0 o f 1 9 Table 3 Use of non-AAS substances, reason(s)/motive(s) for use, and studies (Continued) Benoxaprofen NS Strauss [55] NS Strauss [55] 1 Benzodiazepines† Better sleep, combating side effects, relaxation Klötz [31]; Larance [35]; Lundholm [37]; McBride [39]; Skårberg [53] Combating side effects, enhancing sleep and relaxation, self-control, sedation Gårevik [18]; Klötz [31]; Larance [35]; Lundholm [37]; Malone [38]; McBride [39]; Skårberg [53,54] 8 Beta blockers† Burning fat Peters [46] Burning fat Peters [46] 1 Beta-2-agonists† – – NS Bilard [11] 1 Blood pressure regulators† NS Kusserow [34] Lower blood pressure Kusserow [34]; Skårberg [54] 2 Bronchodilators† Energy and boosting training Skårberg [53] Burning fat, energy and boosting training, increasing strength Skårberg [53,54] 2 Buprenorphine NS Skårberg [53] NS Skårberg [53]; Wines [58] 2 Caffeine Burning fat Klötz [31]; Pappa [43]; Perry [45]; Peters [46]; Skårberg [53]; Strauss [55] Burning fat Gruber [22]; Klötz [31]; Larance [35]; Pappa [43]; Peters [46]; Perry [45]; Skårberg [53]; Strauss [55] 8 Calcium – – NS Strauss [55] 1 Cannabis/cannabinoids Enhancing sleep, relaxation Chandler [12]; Kanayama [27,28]; Klötz [31]; Kusserow [34]; Lundholm [37]; Malone [38]; McBride [39]; Pappa [43]; Peters [46]; Perry [48]; Skårberg [53,54] Enhancing sleep, relaxation Bilard [11]; Chandler [12]; Dunn [15]; Fudala [17]; Gruber [21,22]; Hoff [24]; Kanayama [27,28]; Klötz [31]; Kusserow [34]; Larance [35]; Malone [38]; McBride [39]; Pappa [43]; Peters [46]; Perry [48]; Rashid [49]; Skårberg [53,54]; Tallon [56] 21 Captopril NS Ahlgrim [9] NS Ahlgrim [9] 1 Carvedilol NS Ahlgrim [9] NS Ahlgrim [9] 1 Choline and inositol NS Strauss [55] NS Strauss [55] 1 Chromium picolinate Reducing body weight Peters [46] Reducing body weight Peters [46] 1 Clenbuterol Anabolic effects, burning fat, removing skin fluid, weight loss Chandler [12]; Gruber [21]; Kimergård [30]; Klötz [31]; Lenehan [36]; McBride [39]; Peters [46]; Wilson-Fearon [57] Anabolic effects, burning fat, removing skin fluid, weight loss Chandler [12]; Gruber [20-22]; Hope [25]; Kimergård [30]; Klötz [31]; Korkia [33]; Larance [35]; Lenehan [36]; McBride [39]; Peters [46]; Tallon [56]; Wilson-Fearon [57] 14 Clomiphene citrate NS Chandler [12]; Moss [41,42]; Perry [45] NS Chandler [12]; Moss [41,42]; Perry [45] 4 Cocaine Boosting training, burning fat, increasing strength Chandler [12]; Kanayama [28]; Larance [35]; Lundholm [37]; Malone [38]; Peters [46]; Skårberg [53,54] Boosting training, burning fat, increasing strength Chandler [12]; Dunn [15]; Fudala [17]; Gårevik [18]; Gruber [21]; Hoff [24]; Hope [25]; Kanayama [26-28]; Katz [29]; Larance [35]; Lundholm [37]; Malone [38]; Peters [46]; Rashid [49]; Skårberg [53,54]; Tallon [56] 19 Codeine Boosting training Skårberg [53]; Strauss [55] Boosting training Skårberg [53]; Strauss [55] 2 Conjugated linoleic acid Burning fat Skårberg [53] Burning fat Skårberg [53] 1 S a g o e et a l. Su b sta n ce A b u se T rea tm en t, P reven tio n , a n d P o licy (2 0 1 5 ) 1 0 :1 2 P a g e 1 1 o f 1 9 Table 3 Use of non-AAS substances, reason(s)/motive(s) for use, and studies (Continued) Corticosteroids† NS Lenehan [36] NS Bilard [11]; Korkia [32]; Lenehan [36] 3 Creatine Enhancing the effects of training Klötz [31]; Skårberg [53]; Perry [45] Anabolic effects, endurance booster, enhancing the effects of training, recovery aid Davies [14]; Filiault [16]; Hoff [24]; Klötz [31]; Perry [45]; Skårberg [53,54] 7 Daonil® Increasing insulin release Peters [46] Increasing insulin release Peters [46] 1 Dehydroepiandrosterone (DHEA) – – NS Larance [35] 1 Diazepam – – NS Gårevik [18] 1 Dietary/nutritional supplements† Energy and boosting training, nutrition Pappa [43]; Perry [45]; Peters [46]; Skårberg [53,54]; Strauss [55]; Wilson-Fearon [57] Energy and boosting training, anabolic effects, endurance booster, nutrition, recovery aid Davies [14]; Filiault [16]; Gruber [21]; Korkia [32]; Pappa [43]; Perry [45]; Peters [46]; Skårberg [53,54]; Strauss [55]; Tallon [56]; Wilson-Fearon [57] 12 Digoxin NS Ahlgrim [9] NS Ahlgrim [9] 1 Dimethyl sulfoxide NS Strauss [55] NS Strauss [55] 1 Diuretics† Combating side effects, masking doping drugs, reducing fluid levels Chandler [12]; Klötz [31]; Lenehan [36]; Pappa [43]; Peters [46]; Wilson-Fearon [57] Combating side effects, masking doping drugs, reducing fluid levels Chandler [12]; Goldfield [19]; Hope [25]; Klötz [31]; Korkia [32]; Larance [35]; Lenehan [36]; Pappa [43]; Peters [46]; Skårberg [54]; Tallon [56]; Wilson-Fearon [57] 12 Electrolyte solution NS Strauss [55] NS Strauss [55] 1 Ephedra/Ephedrine Energy and boosting training, enhancing weight loss Chandler [12]; Kimergård [30]; Klötz [31]; McBride [39]; Perry [45]; Peters [46]; Skårberg [53] Energy and boosting training, burning fat, enhancing weight loss, increasing strength Chandler [12]; Gårevik [18]; Gruber [20]; Gårevik [18]; Hope [25]; Kimergård [30]; Klötz [31]; Larance [35]; McBride [39]; Perry [45]; Peters [46]; Skårberg [53,54] 14 Epinephrine NS Strauss [55] NS Strauss [55] 1 Erythropoietin (EPO) NS Pappa [43]; Schäfer [50] NS Hope [25]; Pappa [43]; Schäfer [50] 3 Esiclene – – NS Korkia [32] 1 Fat-loss agents† – – Burning fat Skårberg [54] 1 Furosemide Weight loss Ahlgrim [9]; Strauss [55] Weight loss Ahlgrim [9]; McKillop [40]; Strauss [55] 3 Gamma hydroxybutyrate (GHB) Enhancing sleep Chandler [12]; Klötz [31]; Skårberg [54] Enhancing sleep Chandler [12]; Dunn [15]; Gruber [22]; Klötz [31]; Skårberg [54] 5 Genotropine NS Klötz [31] NS Klötz [31] 1 Glutamine NS Perry [45] NS Perry [45] 1 Growth hormone Anabolic effects and strength, burning fat, weight loss Chandler [12]; Kimergård [30]; Kusserow [34]; Lenehan [36]; Peters [46]; Skårberg [53,54]; Strauss [55]; Wilson-Fearon [57] Anabolic effects, burning fat, endurance booster, recovery aid, weight loss Chandler [12]; Filiault [16]; Fudala [17]; Gårevik [18]; Hope [25]; Kimergård [30]; Korkia [32,33]; Kusserow 18 S a g o e et a l. Su b sta n ce A b u se T rea tm en t, P reven tio n , a n d P o licy (2 0 1 5 ) 1 0 :1 2 P a g e 1 2 o f 1 9 Table 3 Use of non-AAS substances, reason(s)/motive(s) for use, and studies (Continued) [34]; Larance [35]; Lenehan [36]; Peters [46]; Silvester [51]; Skårberg [53,54]; Strauss [55]; Tallon [56]; Wilson-Fearon [57] Growth hormone releasing peptides† NS Chandler [12] NS Chandler [12] 1 Hallucinogens† NS Larance [35]; Malone [38] NS Dunn [15]; Larance [35]; Malone [38] 3 Herbal products† NS Skårberg [53] Increasing strength Skårberg [53,54] Heroin Enhancing sleep, pain relief Cornford [13]; Larance [35]; Skårberg [54] Enhancing sleep, pain relief Gårevik [18]; Cornford [13]; Kanayama [27]; Larance [35]; Skårberg [54]; Wines [58] 6 Human chorionic gonadotropin (hCG) Minimizing depressive symptoms upon AAS cessation/withdrawal, improving testosterone production, preventing weight loss, stopping testicular atrophy, increasing strength Chandler [12]; Kimergård [30]; Lenehan [36]; McBride [39]; Moss [41,42]; Perry [44]; Peters [46]; Perry [47]; Korkia [32]; Wilson-Fearon [57] Anabolic effects, increasing testosterone production, minimizing depressive symptoms upon AAS cessation/withdrawal, preventing weight loss, stopping testicular atrophy, increasing strength Chandler [12]; Fudala [17]; Gruber [22]; Gårevik [18]; Hope [25]; Kimergård [30]; Korkia [32]; Larance [35]; Lenehan [36]; McBride [39]; McKillop [40]; Moss [41,42]; Perry [44]; Peters [46]; Perry [47]; Wilson-Fearon [57] 17 Hydrochlorothiazide Weight loss Ahlgrim [9] Weight loss Ahlgrim [62] 1 Hydrocodone – – NS Wines [58] 1 Hydroxocobal amin Weight gain Peters [46] Weight gain Peters [46] 1 Inhalants† NS Larance [35] NS Dunn [15]; Larance [35] 2 Insulin Anabolic effects and strength, burning fat, weight loss Chandler [12]; Kimergård [30]; Klötz [31]; Peters [46]; Skårberg [53,54] Anabolic effects and strength, burning fat, weight loss Chandler [12]; Gårevik [18]; Hope [25]; Kimergård [30]; Klötz [31]; Larance [35]; Peters [46]; Skårberg [53,54]; Tallon [56] 10 Insulin-like growth factor 1 (IGF-1) Anabolic effects and strength, burning fat Chandler [12]; Klötz [31]; Lenehan [36]; Peters [46]; Skårberg [53,54] Anabolic effects and strength, burning fat Chandler [12]; Fudala [17]; Klötz [31]; Larance [35]; Lenehan [36]; Peters [46]; Skårberg [53,54] 8 Ketamine NS Chandler [12] NS Chandler [12]; Dunn [15] 2 Laxative – – NS Goldfield [19] 2 Levodopa NS Strauss [55] Increasing growth hormone Strauss [55]; Skårberg [54] 2 Lidocaine NS Strauss [55] NS Strauss [55] 2 Liothyronine NS Perry [45] NS Perry [45] 1 Lysergic acid diethylamide (LSD) NS Skårberg [54] NS Rashid [49]; Skårberg [54] 2 Mechano growth factor NS Chandler [12] NS Chandler [12] 1 S a g o e et a l. Su b sta n ce A b u se T rea tm en t, P reven tio n , a n d P o licy (2 0 1 5 ) 1 0 :1 2 P a g e 1 3 o f 1 9 Table 3 Use of non-AAS substances, reason(s)/motive(s) for use, and studies (Continued) Melanotan Boosting training, skin tanning Chandler [12]; Kimergård [30] Boosting training, skin tanning Chandler [12]; Hope [25]; Kimergård [30] 3 Mephedrone NS Chandler [12] NS Chandler [12] 1 Meth/amphetamine Alertness, boosting training, burning fat, increasing aggression during exercise, increasing strength, psychological wellbeing Chandler [12]; Hegazy [23]; Kimergård [30]; Larance [35]; Lundholm [37]; McBride [39]; Pappa [43]; Peters [46]; Skårberg [53,54] Alertness, boosting training, burning fat, increasing aggression during exercise, increasing strength, psychological wellbeing Angoorani [10]; Chandler [12]; Gårevik [18]; Hegazy [23]; Hoff [24]; Hope [25]; Kimergård [30]; Larance [35]; Lundholm [37]; McBride [39]; Pappa [43]; Peters [46]; Skårberg [53,54]; Tallon [56] 15 Muscle oil (synthol) – – Anabolic effect Skårberg [54] 1 Muscle relaxing drugs† Combating side effects Klötz [31] Combating side effects Klötz [31] 1 Myoblast NS Klötz [31] NS Klötz [31] 1 Nalbuphine/nubain® NS Strauss [55]; Lenehan [36]; McBride [39] Treating pain from weightlifting injuries, “anti-catabolic”, mental high Gruber [22]; Hope [25]; Kanayama [27]; Korkia [33]; Lenehan [36]; McBride [39]; Strauss [55]; Wines [58] 8 Naproxen NS Strauss [55] NS Strauss [55] 1 Non-steroidal antiinflammatory drugs (NSAIDs) † – – Inflammation, pain, and fever relief Skårberg [54] 1 Oxycodone NS Strauss [55] NS Kanayama [27]; Strauss [55] 2 Peptide hormones† – – NS Bilard [11] 1 Phenylbutazone NS Strauss [55] NS Strauss [55] 1 Phosphodiesterase-5 inhibitors (PDE5i) † – – NS Hope [25] 1 Piroxicam NS Strauss [55] NS Strauss [55] 1 Potassium NS Strauss [55] NS Strauss [55] 1 Potency/testicular increasing drugs† Combating side effects Klötz [31] Combating side effects Klötz [31] 1 Pregnyl® Improved testosterone production Peters [46] Improved testosterone production Peters [46] 1 Protein powder Enhancing effects of training, increasing protein synthesis Perry [45]; Skårberg [53,54] Enhancing effects of training, increasing protein synthesis Perry [45]; Skårberg [53,54] 3 Proviron® Hardiness, improved testosterone production Peters [46] Hardiness, improved testosterone production Peters [46] 1 Recovery drinks† – – Endurance booster, recovery aid Filiault [16] 1 Sedatives† NS Malone [38] NS Malone [38] 1 S a g o e et a l. Su b sta n ce A b u se T rea tm en t, P reven tio n , a n d P o licy (2 0 1 5 ) 1 0 :1 2 P a g e 1 4 o f 1 9 Table 3 Use of non-AAS substances, reason(s)/motive(s) for use, and studies (Continued) Sildenafil/viagra®/cialis Enhanced sexual functioning Chandler [12]; Kimergård [30] Enhanced sexual functioning Chandler [12]; Gårevik [18]; Hope [25]; Kimergård [30] 4 Somatotropine NS Klötz [31] NS Klötz [31] 1 Spironolactone Weight loss Ahlgrim [9] Weight loss Ahlgrim [9] 1 Stimulants† NS Klötz [31]; Kusserow [34]; Malone [38] Increasing strength, burning fat Fudala [17]; Klötz [31]; Kusserow [34]; Malone [38]; Rashid [49]; Skårberg [54] 6 Suntan pills† NS Strauss [55] NS Strauss [55] 1 Tamoxifen Combating side effects Chandler [12]; Kimergård [30]; Lenehan [36]; McBride [39] Combating side effects Chandler [12]; Gruber [22]; Kimergård [30]; Korkia [33]; Lenehan [36]; McBride [39]; Tallon [56] 7 Teroxin (T3) Preventing weight gain Peters [46] Preventing weight gain Peters [46] 1 Testosterone releasers/ boosters† Combating side effects, increasing hormone production Skårberg [53] Combating side effects, increasing blood serum levels of testosterone or hormone production Skårberg [53,54] 2 Thiazides† – – NS McKillop [40] 1 Thiomucase NS Wilson-Fearon [57] Burning fat Korkia [32,33]; Wilson-Fearon [57] 3 Thyroxine Burning fat, increasing metabolism Chandler [12]; Lenehan [36]; Peters [46]; Skårberg [54]; Strauss [55] Burning fat, increasing metabolism Chandler [12]; Gruber [22]; Hope [25]; Korkia [32]; Larance [35]; Lenehan [36]; McKillop [40]; Peters [46]; Skårberg [54]; Strauss [55] 10 Tobacco NS Malone [38]; Perry [48]; Pope [47] NS Malone [38]; Perry [48]; Pope [47] 3 Torsemide NS Ahlgrim [9] NS Ahlgrim [9] 1 Triacana – – NS Korkia [33] 1 Yohimbine NS Perry [45] NS Gruber [22]; Perry [45] 3 Other IPEDs, licit and illicit substances NS Kanayama [28]; Klötz [31]; Kusserow [34]; Perry [48]; Skårberg [52] NS Gruber [20,21]; Hoff [24]; Hope [25]; Kanayama [26,28]; Klötz [31]; Kusserow [34]; Perry [48]; Skårberg [52,54]; Wines [58] IPEDs: Image and performance-enhancing drugs....

    [...]

  • ...Ephedra/Ephedrine Energy and boosting training, enhancing weight loss Chandler [12]; Kimergård [30]; Klötz [31]; McBride [39]; Perry [45]; Peters [46]; Skårberg [53] Energy and boosting training, burning fat, enhancing weight loss, increasing strength Chandler [12]; Gårevik [18]; Gruber [20]; Gårevik [18]; Hope [25]; Kimergård [30]; Klötz [31]; Larance [35]; McBride [39]; Perry [45]; Peters [46]; Skårberg [53,54] 14...

    [...]

  • ...Growth hormone Anabolic effects and strength, burning fat, weight loss Chandler [12]; Kimergård [30]; Kusserow [34]; Lenehan [36]; Peters [46]; Skårberg [53,54]; Strauss [55]; Wilson-Fearon [57] Anabolic effects, burning fat, endurance booster, recovery aid, weight loss Chandler [12]; Filiault [16]; Fudala [17]; Gårevik [18]; Hope [25]; Kimergård [30]; Korkia [32,33]; Kusserow 18 S a g o e et a l....

    [...]


Journal ArticleDOI
TL;DR: The findings elucidate the significance of psychosocial factors in AAS use initiation and demands better ways of dealing with the global public health problem of AASUse.
Abstract: To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use. We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation. Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.

64 citations


Cites background or result from "A qualitative study of anabolic ste..."

  • ...The year of publication of the studies ranged from 1980 [19] to 2014 [6-9,11]....

    [...]

  • ...Kimergård 2014 [6,8] 16 years; mean age 25 years Not specified Not specified Appearance, muscle, occupational, sports...

    [...]

  • ...…specified Sports Khorrami 2002 [30] Not specified Football, negative body image, weightlifting Gym employee Appearance, family influence, muscle, sports Kimergård 2014 [6,8] 16 years; mean age 25 years Not specified Not specified Appearance, muscle, occupational, sports Klötz 2010 [31] Not…...

    [...]

  • ...Kimergård 2014 [6,8] England and Wales Interview 24 males aged 21 to 61 years; mean age 34 years Gymnasium, prison, steroid clinic and charity, syringe exchange centre...

    [...]

  • ...Four recent studies [6-9] and five others [10-14] were later discovered and included in the analysis....

    [...]


Journal ArticleDOI
Abstract: Recent research into the use of anabolic androgenic steroids (AAS) in fitness and strength training environments have revealed great variance in users’ approach to AAS use and more specifically the...

60 citations


Cites background from "A qualitative study of anabolic ste..."

  • ...…2011; Christiansen & BojsenMøller, 2012; Cohen et al., 2007; Grogan, Shepherd, Evans, Wright, & Hunter, 2006; Ip, Barnett, Tenerowicz, & Perry, 2011; Kimergård, 2015; Kimergård & McVeigh, 2014; Nøkleby & Skårderud, 2013; Petrocelli, Oberweis, & Petrocelli, 2008; Sagoe, Andreassen, & Pallesen,…...

    [...]

  • ...The Well-being type bears resemblance to the typical AAS user described by Cohen et al. (2007), and the values he has are also dominant in the portraits of users described by e.g. Bilgrei (2013), Hoberman (2005), Kimergård (2015), Pedersen et al. (2014) and Walker and Joubert (2011)....

    [...]


References
More filters

Book
12 Jan 1994
TL;DR: This book presents a step-by-step guide to making the research results presented in reports, slideshows, posters, and data visualizations more interesting, and describes how coding initiates qualitative data analysis.
Abstract: Matthew B. Miles, Qualitative Data Analysis A Methods Sourcebook, Third Edition. The Third Edition of Miles & Huberman's classic research methods text is updated and streamlined by Johnny Saldana, author of The Coding Manual for Qualitative Researchers. Several of the data display strategies from previous editions are now presented in re-envisioned and reorganized formats to enhance reader accessibility and comprehension. The Third Edition's presentation of the fundamentals of research design and data management is followed by five distinct methods of analysis: exploring, describing, ordering, explaining, and predicting. Miles and Huberman's original research studies are profiled and accompanied with new examples from Saldana's recent qualitative work. The book's most celebrated chapter, "Drawing and Verifying Conclusions," is retained and revised, and the chapter on report writing has been greatly expanded, and is now called "Writing About Qualitative Research." Comprehensive and authoritative, Qualitative Data Analysis has been elegantly revised for a new generation of qualitative researchers. Johnny Saldana, The Coding Manual for Qualitative Researchers, Second Edition. The Second Edition of Johnny Saldana's international bestseller provides an in-depth guide to the multiple approaches available for coding qualitative data. Fully up-to-date, it includes new chapters, more coding techniques and an additional glossary. Clear, practical and authoritative, the book: describes how coding initiates qualitative data analysis; demonstrates the writing of analytic memos; discusses available analytic software; suggests how best to use the book for particular studies. In total, 32 coding methods are profiled that can be applied to a range of research genres from grounded theory to phenomenology to narrative inquiry. For each approach, Saldana discusses the method's origins, a description of the method, practical applications, and a clearly illustrated example with analytic follow-up. A unique and invaluable reference for students, teachers, and practitioners of qualitative inquiry, this book is essential reading across the social sciences. Stephanie D. H. Evergreen, Presenting Data Effectively Communicating Your Findings for Maximum Impact. This is a step-by-step guide to making the research results presented in reports, slideshows, posters, and data visualizations more interesting. Written in an easy, accessible manner, Presenting Data Effectively provides guiding principles for designing data presentations so that they are more likely to be heard, remembered, and used. The guidance in the book stems from the author's extensive study of research reporting, a solid review of the literature in graphic design and related fields, and the input of a panel of graphic design experts. Those concepts are then translated into language relevant to students, researchers, evaluators, and non-profit workers - anyone in a position to have to report on data to an outside audience. The book guides the reader through design choices related to four primary areas: graphics, type, color, and arrangement. As a result, readers can present data more effectively, with the clarity and professionalism that best represents their work.

40,436 citations


"A qualitative study of anabolic ste..." refers methods in this paper

  • ...Written interview records were subjected to thematic content analysis in order to identify and verify themes relevant to the experiences of steroid usage (Burnard et al., 2008).3 Themes were continuously developed and refined as the study progressed (Miles & Huberman, 1994)....

    [...]


01 Jan 1994

2,639 citations


"A qualitative study of anabolic ste..." refers methods in this paper

  • ...Written interview records were subjected to thematic content analysis in order to identify and verify themes relevant to the experiences of steroid usage (Burnard et al., 2008).3 Themes were continuously developed and refined as the study progressed (Miles & Huberman, 1994)....

    [...]


Journal ArticleDOI
Abstract: The literature of social psychology contains a number of phenomena that appear to be paradoxical. For example, persons who face a threatening experience prefer to affiliate with threatened others rather than with nonthreatened others (Schachter, 1959), and persons in groups in which reward is equally distributed are less satisfied compared with persons in groups that include one particularly unfortunate member (Brickman, 1975). The purpose of this article is to show that these phenomena are best construed as social comparison processes and that various phenomena derive from one basic process termed downward comparison; the essence of this process is that persons can enhance their own subjective well-being by comparing themselves with a less fortunate other. In this article I show that downward comparison is a process evoked by negative affect, that there is considerable evidence for self-enhancing comparison processes, and that downward comparison effects are involved in several areas of social-psycho logical research.

2,290 citations


"A qualitative study of anabolic ste..." refers background in this paper

  • ...ness of information about the potential harms of these drugs from health authorities, and coping with insecurities about the use of these drugs by increasing the sense of security and well-being (Wills, 1981)....

    [...]

  • ...Overall, this appeared to serve multiple purposes, including questioning the trustworthiness of information about the potential harms of these drugs from health authorities, and coping with insecurities about the use of these drugs by increasing the sense of security and well-being (Wills, 1981)....

    [...]


MonographDOI

1,746 citations


Book
09 Dec 1998
Abstract: Sarah Grogan provides a comprehensive overview of the subject of body image, pulling together diverse research from the fields of psychology, sociology, media, and gender studies in men, women, and children. This second edition has been thoroughly revised and updated to reflect the significant increase in research on body image since the first edition was published, including new empirical data collected specifically for this text. In addition to examining evidence for sociocultural influences on body image, the book also reviews recent literature and includes new findings on body modification practices (cosmetic surgery, piercing, tattooing, and bodybuilding). It takes a critical look at interventions designed to promote positive body image and also attempts to link body image to physical health, looking in particular at motivations for potentially health-damaging practices such as anabolic steroid use and cosmetic surgery. The only text to date that examines the issue of body image, focusing on men and children as well as women, Body Image will be invaluable to students and researchers in the area as well as those with an interest in how to promote positive body image.

1,564 citations