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

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

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.

Figures

Table 1. Respondent profiles.a

Table 2. Respondents’ uses of drugs for human enhancement purposes.

Full text

King’s Research Portal
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
Citing this paper
Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may
differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination,
volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are
again advised to check the publisher's website for any subsequent corrections.
General rights
Copyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright
owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.
•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.
•You may not further distribute the material or use it for any profit-making activity or commercial gain
•You may freely distribute the URL identifying the publication in the Research Portal
Take down policy
If you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to
the work immediately and investigate your claim.
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