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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.
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.

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
Document Version
Peer reviewed version
Link to publication record in King's Research Portal
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

Citations
More filters
Journal ArticleDOI
TL;DR: In this article, a socio-ecological framework is presented based upon the international literature examining men's use of anabolic androgenic steroids (AAS), which is the result of the interaction of a range of factors at the individual, social network, institutional, community and societal levels.
Abstract: Research into men’s use of anabolic androgenic steroids (AAS) over the past three decades has identified many factors that contribute to decision making in this area However there are limited theoretical frameworks to synthesize this research and guide practice, such as interventions to prevent use or reduce health risks To address this gap a socioecological framework is presented based upon the international literature examining AAS use Socioecological models recognize that individuals and behaviors exist within complex physical and social systems and are useful tools for guiding interventions to ensure consideration is given to multiple influential factors This framework proposes that use of AAS is the result of the interaction of a range of factors at the individual, social network, institutional, community and societal levels that are likely to change over time and with experience Viewed through this framework it becomes clear that AAS use can be a complex behavior with many influential environments and relationships impacting on a diverse population in different ways and at different times The implications of findings for engaging with people who use AAS and delivering interventions are discussed, such as the identification of important transition times and influencing norms within social groups and communities

21 citations


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

  • ...The growth of the Internet has increased the amount of information available on AS, which may enhance feelings of capability and safety amongst users (Kimergård, 2015) and make available information that previously would have been predominantly transferred within sub cultures....

    [...]

  • ...Work exploring the experiences of individuals who use AAS has consistently identified social recognition and peer approval as important benefits from the physique gains achieved with the help of AAS (Dennington et al., 2008; Hanley Santos & Coomber, 2017; Kimergård, 2015; Olrich, 1999; Olrich & Ewing, 1999; Petrocelli et al., 2008; Ravn & Coffey, 2016)....

    [...]

  • ...It is commonly identified that individuals may initiate use of AAS to overcome perceived genetic physical limitations (Grogan, Shepherd, Evans, Wright, & Hunter, 2006; Hanley Santos & Coomber, 2017; Kimergård, 2015; Van Hout & Kean, 2015)....

    [...]

Dissertation
16 Feb 2016
TL;DR: In this article, the authors explored the understudied phenomenon of performance and image enhancing drug (PIED) markets by examining the structure and formation of the market for PIEDs in the Netherlands and Belgium.
Abstract: This research explores the understudied phenomenon of performance and image enhancing drug (PIED) markets by examining the structure and formation of the market for PIEDs in the Netherlands and Belgium. Furthermore, this study aims to understand and analyse the actors that operate in the PIED dealing environment. In particular bodybuilding is adopted as a case study. Finally, this thesis examines how the PIED control system and its application influence these respective markets. Chapter one introduces the global PIED problem, the policy options currently available to deal with it, and its connection to anti-doping and sport. Chapter two begins by reviewing the literature on PIED use and its supply, and reflects on the anti-doping and PIED policies that seek to regulate this market. In chapter three the theoretical contours of this dissertation are developed. Chapter four describes the research methods which form the empirical bases of the findings chapters. Chapter five focuses on the general characteristics of PIED suppliers, and the ways in which the actions of PIED dealers are influenced by the market cultures in which they operate. Chapter six examines the importance of socio-cultural factors in the formation and development of PIED dealing networks within bodybuilding subcultures. Chapter seven analyses and describes the characteristics of the Belgian and Dutch PIED markets, and unravels the complex relationship between the two. Chapter eight explores the illegal production of steroids in the Netherlands and the flourishing Internet trade in Belgium. Chapter nine assesses the harms related to the production and distribution of PIEDs, and accounts for the effects that Belgian and Dutch PIED policies may have on this illicit market. Finally, in chapter ten, the main findings of this dissertation are summarized, future research endeavours are considered and policy implications are drawn from the analysis. This thesis illustrates that social systems of rules and values, and in particular the embeddedness of culture, are important factors in our efforts to comprehend illicit PIED markets. Specifically, ‘the beliefs, norms, ‘tools’, rules and behaviours appropriate to a cultural setting are key factors for understanding the structure of PIED markets and greater attention must be given to the role played by socio-cultural factors in influencing the market behaviour of criminal groups and individuals. Nevertheless, this thesis also demonstrates that it is imperative to examine the production, distribution and use of PIEDs, as embedded within a diverse combination of social, economic and cultural processes. Indeed, the structure and formation of illicit PIED markets are shaped by a variety of factors including the types of PIEDs dealt within them, the characteristics of the users, the social structures which sustain them, the cultural and economic context in which the markets exist, and market forces (e.g. technical innovations, drug policies).

20 citations


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

  • ...For example, there are increasing reports on an international level that the PIED market is becoming a public health concern such as the risk of HIV or hepatitis virus infection or the use of experimental PIEDs in sports (e.g., Dawson, 2001; McVeigh et al., 2003; Iversen et al., 2012; Kimergård, 2014b)....

    [...]

  • ...Consequently, due to a general lack of public health care services, users often create and adopt their own guidelines in an attempt to reduce risks (Dennington et al., 2008; Kimergård, 2014b)....

    [...]

  • ...In particular, the Internet is an important source for finding information about the types of AAS that are available on the illicit market (Kimergård, 2014b)....

    [...]

  • ...The knowledge of users and dealers is predominantly based on personal experience and anecdotes, and includes information on methods to reduce or avoid adverse effects (Kimergård, 2014b)....

    [...]

  • ...Some of these harm reduction strategies currently employed by users are not evidence based and may not be effective, or in some cases may even lead to greater harm (Kimergård, 2014b)....

    [...]

Journal ArticleDOI
TL;DR: In this article, the authors explored the ways in which national PIED policies in The Netherlands and Belgium and anti-doping measures are intertwined, and how the different approaches adopted in each nation are impacting on the illicit PIED market.
Abstract: Background Due to a growing awareness of the consumption of performance and image enhancing drugs (PIEDs), and the perceived associated adverse health effects, PIEDs have increasingly come to be viewed as a serious public health problem. However, there seems to be a tendency amongst policymakers to frame recreational PIED use as an issue within sport, and to call for the same types of policies that are being used in anti-doping. This paper explores the ways in which national PIED policies in The Netherlands and Belgium and anti-doping measures are intertwined, and how the different approaches adopted in each nation are impacting on the illicit PIED market. Methods This article draws on two years of fieldwork in various bodybuilding settings, 47 semi-structured interviews with individuals who are directly or indirectly involved in the PIED market, and a content analysis of 64 PIED-dealing cases initiated by criminal justice agencies in The Netherlands and Belgium. Findings The data indicates that both countries do not appear to be successful in disrupting the illicit PIED market. In Belgium the demand for PIEDs seems to be unaffected by the threat of criminal penalties or disciplinary measures and continued enforcement may worsen present health risks. However, due to the limited priority of controlling PIED production and/or distribution in The Netherlands, a large underground culture has developed, stimulated by the Internet, in which individuals and groups manufacture and distribute their own PIEDs. In both countries, the intertwinement of national efforts to address recreational PIED use, with sport policy, hinders the exploration of alternative measures and/or the inclusion of other substances and using populations in prevention and harm reduction initiatives. Conclusion Both the regulation and law enforcement practices around PIEDs in Belgium and the limited priority in The Netherlands may be contributing to increasing and exacerbating existing harms.

19 citations

Journal ArticleDOI
TL;DR: In this article, the authors describe and analyse the historical development of gym and fitness culture in general and doping use in this context in particular, and explore how a subcultural response can be used analytically in relation to processes of cultural normalisation as well as marginalisation.
Abstract: This article describes and analyses the historical development of gym and fitness culture in general and doping use in this context in particular. Theoretically, the paper utilises the concept of subculture and explores how a subcultural response can be used analytically in relation to processes of cultural normalisation as well as marginalisation. The focus is on historical and symbolic negotiations that have occurred over time, between perceived expressions of extreme body cultures and sociocultural transformations in society—with a perspective on fitness doping in public discourse. Several distinct phases in the history of fitness doping are identified. First, there is an introductory phase in the mid-1950s, in which there is an optimism connected to modernity and thoughts about scientifically-engineered bodies. Secondly, in the 1960s and 70s, a distinct bodybuilding subculture is developed, cultivating previously unseen muscular male bodies. Thirdly, there is a critical phase in the 1980s and 90s, where drugs gradually become morally objectionable. The fourth phase, the fitness revolution, can be seen as a transformational phase in gym culture. The massive bodybuilding body is replaced with the well-defined and moderately muscular fitness body, but at the same time there are strong commercialised values which contribute to the development of a new doping market. Finally, it is possible to speculate on the development of a fifth phase, in which fitness doping is increasingly being filtered into mainstream gym and fitness culture, influencing the fitness doping demography.

17 citations

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