The social perception of performance enhancement and body modification: A systematic review and meta-analysis on anabolic steroids, tattoos, and cosmetic surgery.

We conducted an exploratory investigation of the relationship between personality and willingness towards performance enhancement and body modification in Norway. The study is based on Norwegian Monitor data from a cross-sectional survey of a nationally representative sample of 4,233 (females: 49.9%) persons aged 15 to 96 (45.92 ± 18.02) years. Data were collected using a questionnaire containing demographic questions and measures of physical appearance satisfaction, physical activity level, personality (five-factor model), and willingness towards performance enhancement (e.g., substances that improve creative thinking) and body modification (e.g., use of muscle-building substances). Data were analyzed using descriptive statistics and multiple regression analyses. We found that 62.2% and 50.1% of our sample were either willing to use or contemplating using substances that reduce memory failure and enhance physical fitness respectively. Our sample was most willing or contemplating tattooing (30.0%) and generally skeptical of the other body modification methods with willingness to use or contemplating using substances to enhance muscularity least accepted (3.9%). Higher fantasy/openness and lower agreeableness were associated with higher willingness towards both performance enhancement and body modification. Additionally, higher extraversion and lower control/conscientiousness predicted higher willingness towards body modification. Our findings corroborate previous indications that performance enhancement and body modification are now mainstream. They also underline the importance of personality traits in willingness towards these practices.

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

This article is based on a study of young people's understandings and experiences of body work (or body modification) in relation to gender and health. Drawing on feminist and Deleuzian–Spinozan approaches to the body, the article explores the embodied sensations, or affects, associated with the body's physical modification through cosmetic surgery as one practice of body work. This approach pursues a non-dualist analysis of the body and contributes to new understandings of body-modification practices such as cosmetic surgery as processes influenced, and informed, by affect. Through examples of differing experiences and trajectories relating to the practice of cosmetic surgery, which has long been a contentious issue in feminism, the article makes evident what a feminist Deleuzian approach means in practice and what it can contribute to analyses of the body in/and society. This approach can assist in exploring the complex ways in which gendered embodiments assemble, and in understanding the dynamics and processes informing differing bodily possibilities related to gender.

PurposeThis study examined what is associated with self-objectification, body uneasiness, body investment, and depersonalization in adults who altered their bodies. We tested adults involved in body modification (BM) or plastic surgery (PS), and we compared them to controls to clarify these associations.MethodsWe conducted an observational cross-sectional study of 235 adults (72.8% female) and grouped them into three categories: BM (n = 63), PS (n = 48), and controls (n = 124). Participants completed the Objectified Body Consciousness Scale, the Body Investment Scale, and the Body Uneasiness Test. We used analysis of covariance to compare groups while controlling for age and gender. We tested mediation by Body Investment Scale subscales and moderation by the number of BM and PS interventions in the relationship between self-objectification and depersonalization.ResultsPS showed the highest self-objectification and body uneasiness, BM was intermediate, and controls were lowest. Body investment, particularly the body image subscale, mediated the association between self-objectification and depersonalization. The number of BM interventions strengthened the association between body investment and depersonalization, and PS tended to moderate the direct link between self-objectification and depersonalization.ConclusionThese findings suggest that body investment partly explains the connection between self-objectification and depersonalization, and that BM and PS relate differently to depersonalization in nonclinical adults. Given the cross-sectional design, we can only draw associative (not causal) conclusions.Level of Evidence: III, observational cross-sectional study.

Background: Performance-enhancing substances are used by adolescent athletes to help improve performance. Anabolic steroids (AS) are performance-enhancing substances that pose significant health problems when used by adolescents. Objectives: Objectives were to: (1) examine the extent to which parents and adolescents discuss AS and (2) test whether parent–adolescent communication about AS can generalize to, and influence, decisions to use other types of performance-enhancing substances. Method: Adolescent athletes (n = 244) completed an anonymous questionnaire that assessed the extent to which the adolescents discussed with their parents the performance outcomes and protective factors associated with AS, their intentions to use AS, and their willingness to try a newly developed, potentially illegal performance-enhancing substance. Data were collected during 2009–2010. Results: Adolescents reported relatively low levels of communication with their parents about anabolic androgenic steroids (AAS). Communication with parents about the performance outcomes associated with AS was a positive predictor of willingness to try a newly developed performance-enhancing substance (b = 0.31, p < .01) and intentions to use AS (b = 0.54, p < .01). Communication with parents about protective factors predicted willingness to try a new performance-enhancing substance (b = −0.24, p < .01), but not intentions (b = −0.20, p > .77). Conclusions/Importance: Parents should highlight the protective factors and avoid emphasizing the performance outcomes associated with AS in discussions with their adolescents. Discussions about AS may influence adolescents’ decisions to use other types of performance-enhancing substances.

In 1991, Robert Voy, MD, former Chief Medical Officer of the United States Olympic Committee, commented: If we will have reached a point of no return with this win at all costs attitude, the gold medals won't shine as brightly, the flags won't wave as boldly, the torch will flicker dimly, and we will have lost one of the greatest treasures ever known.1 It appears that Dr. Voy's predictions have already come to pass. In 1998 and 1999 alone, the public was bombarded with a constant stream of drug scandals that included, among others: • Chinese swimmers being ejected from the World Championships in Australia after having tested positive for banned substances; • former East German coaches and physicians tried and fined for their roles in the systematic doping of East German athletes over three decades; • a Canadian snowboarder, Ross Rebagliati, testing positive for marijuana after having won a gold medal at the Winter Olympics in Nagano, Japan; • Olympic gold medalist swimmer Michelle Smith deBruin being accused and found guilty of manipulating her urine sample in an out-of-competition drug test; • cyclists, coaches, physicians, and trainers participating in the Tour de France implicated in a widespread, systematic doping scheme; • Olympic champion shot putter Randy Barnes testing positive for androstenedione; • baseball home run king Mark McGwire admitting using androstenedione; • Olympic sprint champion Florence Griffith-Joyner dying at age 38, and rumors of prior performance-enhancing drug use that surrounded her victories at the Seoul Olympic Games being resurrected; • Uta Pippig, three-time winner of the Boston Marathon, testing positive for a high level of testosterone; and • Australian Open tennis champion Petr Korda testing positive for an anabolic steroid. When discussing the problem of performance-enhancing drug use, it is important to remember that sport is a microcosm of our society, and that the problems surrounding sport are by no means limited to drug use. During the 1980s, 57 of 106 universities in National Collegiate Athletic Association (NCAA) Division I-A were punished by the NCAA via sanctions, censure, or probation for rule violations. 2 These offenses did not involve illicit drug use by athletes, but rather unethical behavior of coaches, athletic administrators, staff, and faculty, the very men and women who should be setting the example for those athletes. More recently, United States collegiate athletes have been convicted of criminal offenses related to sports gambling. In addition, an NCAA survey of 2,000 Division I male football and basketball players found that 72% had gambled in some form and that 25% reported gambling on collegiate sports; 4% had even bet on games in which they played. 3 Among members of the International Olympic Committee (IOC), bribery, graft, and other corruption appear to be entrenched in the culture of the organization (Swift E, “Breaking point,”Sports Illustrated, February 1, 1999, pp. 34–35). 4 A common factor among all of these scandals is money. In the 1990s, there is no doubt that sport has become a multinational industry of huge proportions. The IOC, NCAA, National Football League (NFL), National Basketball Association (NBA), and Major League Baseball (MLB), among others, are all billion-dollar businesses (“A survey of sport: not just a game,”Economist, June 6, 1998, pp. 2–23; Hiestand M, “The B word—billion—no longer out of bounds,”USA Today, January 12, 1999, pp. 1A–2A). A free society often relies on the news media to inform the populace regarding the incidence and magnitude of problems, such as doping in sport. Even though the epidemic of drug use in sport has been common knowledge among insiders, the news media, especially in the United States, does not appear to have engaged in a widespread, concerted effort to chronicle this issue. Unfortunately, the media, particularly television news programs, are often influenced by conflicts of interest within their parent companies between those reporting the news and those responsible for the broadcast of major sporting events. Few would argue that an in-depth exposé of drug use, for example in the NFL or the Olympics, would enhance the marketing of these highly lucrative sporting events. Before any effort can be made to address the issue of doping in sport, it is critical that all of the stakeholders acknowledge that a problem exists. In this regard, we need to fully appreciate the high entertainment value placed on sport by society. Some go so far as to argue that sport is the “opiate of the masses,” a contention made by Karl Marx regarding religion. If sport has become the opiate of the masses, then we must be prepared for indifference on the part of the public regarding drug use in sport, at least at the elite level. Moreover, it could be argued that if substantial inroads are made regarding the epidemic of doping, fans may express anger rather than appreciation toward those fighting drug use. Many people view competitive sport as an escape from the problems of daily life, and do not wish to be confronted with the moral and ethical aspects of doping. Further, if antidoping efforts are successful, once bigger-than-life idols could begin to appear all too human in stature, and breaking of records at national, Olympic, and world levels could become so rare that the fervor of fans will wane and the sport business will suffer. In the United States, even high school sport appears to be expanding as a source of entertainment for adults, as shown by the increasing level of television coverage of high school football and basketball games. Consequently, it can be argued that the growth of the high school sport entertainment business is contributing to the increase in anabolic steroid use among adolescents that has been observed during the 1990s. Sport has also been used by governments as a tool to control the masses or as justification for their social, political, and economic systems. “Bread and circuses” (panem et circenses) were used in this fashion by the emperors of Rome. 5 Nazi Germany, the Soviet Union, East Germany, and Communist China all have used sport for political advantage. 6 Consequently, such governments arguably would be less than enthusiastic participants in the fight against doping, or for that matter, even publicly acknowledging the existence of widespread doping. On the contrary, there is a reasonable amount of evidence that the governments of the Soviet Union, East Germany, and Communist China all played significant roles in the systematic doping of their athletes. With many societal problems, identifying potential solutions is easy, but agreeing on a proper course of action and successfully completing it are difficult. The following are our alternative suggestions for dealing with the use of anabolic steroids and other performance-enhancing drugs: legalization, interdiction, education, and alteration of societal values and attitudes related to physical appearance and winning in sport. Legalization: An End to Hypocrisy? The legalization of illicit drugs has for some time been the subject of heated debate: comments range from “morally reprehensible” to “accepting reality.” Legalization would reduce the law enforcement costs associated with illicit anabolic steroid use and the substantial cost of drug testing. Even some opponents of legalization must concede that such an action would lessen the level of hypocrisy in sport. It can be argued that society and sport federations have turned a blind eye or have subtly encouraged drug use in sport as long as the athletes have not been caught or spoken publicly about their use of anabolic steroids. 1,7,8 In the United States, legalization of anabolic steroid use in sport would involve two levels of authority. At one level, federal and state laws related to the possession, distribution, and prescription of anabolic steroids would have to be changed. If in the future anabolic steroids become an accepted means of contraception or as treatment for “andropause,” it is difficult to understand how anabolic steroids could remain a Schedule III controlled substance in the United States. At the second level, bans on anabolic steroids now in place in virtually every sport would have to be rescinded. Legalization would bring cries that the traditional ideals of sport and competition were being further eroded. However, given the continued litany of drug and other sport scandals that have taken place in full public view, in this jaundiced age it is hard to imagine that many people believe the so-called traditional ideals even exist in elite sports. It has long been asserted that legalization of anabolic steroids would force athletes to further expose themselves to the potential for physical harm or to compete at a disadvantage. Some have even questioned the basic premise that banning drugs in sport benefits the health of athletes and have argued that “the ban has in fact increased health risks by denying users access to medical advice and caused users to turn to high-risk black market sources.” 9 Legalization would allow athletes to use pharmaceutical-grade steroids while being monitored by a physician. It can also be argued that the dangers of steroid use are not, in itself, a realistic deterrent, given the existing levels of use of tobacco, alcohol, and other illicit drugs that pose similar risks. In 1999, it seems that legalization of anabolic steroid use in sport is not acceptable. However, if the impotence of drug testing, which is now in full public view, persists for much longer, it is easy to imagine the IOC or other sport federations throwing up their hands in frustration and allowing the athlete with the best chemist to prevail. Interdiction: A Question of Cost-Effectiveness The United States federal government and all state governments currently have laws regarding distribution, possession, or prescription of anabolic steroids. 10 The Federal Food, Drug, and Cosmetic Act (FFDCA) was amended as part of the Anti-Drug Abuse Act of 1988, such that distribution of steroids or possession of steroids with intent to distribute without a valid prescription became a felony. This legislation not only increased the penalties for illicit distribution of steroids but also facilitated prosecution of these crimes under the FFDCA. In 1990, the Anabolic Steroids Control Act was signed into law by President Bush and added anabolic steroids to Schedule III of the Controlled Substances Act. This law institutes a regulatory and criminal enforcement system whereby the United States Drug Enforcement Administration (DEA) controls the manufacture, importation, exportation, distribution, and dispensing of anabolic steroids. However, the act did not provide extra resources to the DEA for shouldering the added responsibility. As the use of anabolic steroids is increasingly criminalized, drug use will likely be driven further underground, and the source of the drugs will increasingly be clandestine laboratories, the products of which are of questionable quality. It also appears that in some areas criminalization has already altered the distribution network for anabolic steroids; athletes used to sell to other athletes, but sellers of street drugs are now becoming a major source of anabolic steroids. 11 Even though the legal apparatus to control steroid trafficking exists, enforcement agents already are struggling to handle the problems of importation, distribution, sales, and use of other illicit drugs such as cocaine and heroin. 11 Based on what we know about the physical, psychological, and social effects of steroids, it is neither realistic nor prudent that enforcement efforts for steroids should take precedent over those for more harmful drugs. This line of reasoning should not be used as a rationale for a lack of effective action against steroids; nevertheless, the outlook that limited resources can be stretched to cover yet another class of drugs is not optimistic, 11 especially given recent increases in recreational drug use among adolescents. 12 The availability of anabolic steroids in this country suggests that there is reason to believe that the United States simply may not have the law enforcement manpower to deal with apprehending and punishing sellers of anabolic steroids and other performance-enhancing drugs. Nonetheless, between February 1991 and February 1995, 355 anabolic steroid investigations were initiated by the United States DEA. 13 There have been more than 400 arrests, and more than 200 defendants have been convicted. However, because of the way criminal penalties were developed for steroid infractions, an individual brought to court on charges of distribution or selling must be a national-level dealer to receive more than a “slap on the wrist” and/or a short visit to a “country club” prison. For this reason, United States law enforcement agents often do not bother pursuing small cases because the costs of prosecution vastly outweigh any penalties that will be assessed. Drug testing by sport federations is yet another form of interdiction. Such testing has been partially successful when directed at performance-enhancing drugs that, to be effective, must be in the body at the time of competition, such as stimulants and narcotics. Drug testing has been even less effective against anabolic steroids, which are used during training or used to enhance an athlete's capacity to train. Testing can be circumvented by the steroid user in several ways. Generally, to avoid a positive test result, athletes can determine when to discontinue use before a scheduled test or, in the case of an unannounced test, titrate their dose using transdermal patches or skin creams containing testosterone so as to remain below the maximum allowable level. Further confounding the issue are other drugs used by athletes, such as human growth hormone and erythropoietin, for which no effective tests currently exist. Moreover, testing for anabolic steroids is expensive (∼$120.00/test), and although organizations like the IOC, NFL, or NCAA may be able to institute such procedures, the cost is prohibitive for the vast majority of secondary schools. Consequently, only a handful of secondary school systems in the United States test for anabolic steroid use. Although interdiction through law enforcement and drug testing has intuitive appeal, its impact on the nonmedical use of anabolic steroids and other performance-enhancing drugs is open to debate. Since the flurry of legislative activity at the state and national levels regarding control of the manufacture, distribution, prescription, and possession of steroids in the late 1980s and the early 1990s, use among adolescents in the United States has increased significantly. As to the future of testing, it is difficult to be optimistic: over the past 30 years, drug users have consistently outplayed the drug testers. In addition, one can only speculate as to the future challenges posed by impending advances in genetic engineering. Will we be able to genetically enhance muscle mass, aerobic capacity, vision, and neurologic response? 14 Education: Is Anybody Listening? Since the 1980s, the United States Public Health Service, the United States Department of Education, and many state education departments, state and local medical societies, private foundations, and sports federations have been involved in prevention efforts related to steroid abuse. For the most part, these have centered on development and distribution of educational materials and programs such as posters, videos, pamphlets, and workshops. For example, the Iowa High School Athletic Association has developed an educational booklet that provides information on the effects of steroid use but also includes strength-enhancing alternatives to steroids and prevention ideas. 15 The United States Department of Education and other sources have developed a variety of informational posters targeted at high school students to provide facts about steroids, their adverse effects, alternatives to their use, and their illegal status. 16,17 Video distributors now have a wide range of videotape programs available on steroid use prevention and body building techniques. 18 Educational consulting firms provide antisteroid training, program, and curriculum development to junior and senior high schools across the United States. 19,20 Major television networks have presented special programming targeted at adolescent audiences to relay the possible consequences of steroid use (“Testing Dirty,” American Broadcasting Company Afterschool Special; “The Fourth Man,” Columbia Broadcasting System Schoolbreak Special; “Benny and the Roids,” Walt Disney Educational Productions). United States health educators have made some inroads in changing several high-risk behaviors, such as high-fat diets, sedentary lifestyles, and smoking. However, educators are well armed with vast quantities of scientific data regarding the deleterious nature of these activities. Further, these are behaviors on which society has increasingly frowned. In sports, however, athletes who use anabolic steroids have enjoyed significant improvements in physical performance and appearance, and society is much less likely to shun these behaviors. Adulation of fans, the media, and peers is a strong secondary reinforcement, as are financial, material, and sexual rewards. Another fly in the education ointment is the possibility that anabolic steroids taken intermittently in low to moderate doses may have only a negligible impact on health, at least in the short term. In 1989, several experts at the National Steroid Consensus Meeting concluded that according to the existing evidence, these drugs represent more of an ethical dilemma than a public health problem. 21 Although there is still little available evidence regarding the long-term health effects of anabolic steroids, many current or potential anabolic steroid users unfortunately mistake absence of evidence for evidence of absence. Even more frustrating is the fact that in two national studies, a large percent of the anabolic steroid users surveyed expressed no intention to stop using anabolic steroids if deleterious health effects were unequivocally established. 22,23 Clearly, the paucity of scientific information has impeded the formulation of effective health education more than that, the of health effects made by some in sports and by the news media have further between athletes and However, even if long-term deleterious effects were well for use of anabolic steroids, with and suggests that substantial would of these problems and in and effective prevention and could in part the significant increase in anabolic steroid use among adolescents a behavior that has in major benefits to the such as appearance and athletic a and education to tobacco, alcohol, and drug prevention have not been In there is evidence that a prevention that to adolescents from becoming involved with anabolic steroids may to increased because information their This to a prevention and to Steroids in part on positive educational related to and The also on increasing of the of social they are likely to to use anabolic steroids and to against these are for and media to use anabolic steroids. and reporting of anabolic steroid use among adolescents was in an effort to the widespread use of anabolic steroids among peers as is an This has been successful in attitudes and behaviors related to steroid use and effective over several Unfortunately, the of the is open to The on male high school football players and was not to address anabolic steroid use among among of steroid use have In addition, the long-term of this is still and the has yet to be in other Moreover, there are two important and as yet regarding the are school in an age of to time and to this it would be far and to to only to this problem and efforts to an by the and the use of available educational and The second is even more to school In an when some believe that the at all is the will some schools to will some schools to institute a that could reduce steroid use at the cost of an to an who to a no on the use of performance-enhancing This is given some by of high school coaches the use and in some so-called such as and to their athletes. Although athletes about the health risks and ethical associated with anabolic steroid use to some this be as a with legalization, interdiction, and education, our social appears to receive far less in many the social a more on drug use in sport than do the more A of performance-enhancing anabolic steroids, are not or after the for these drugs was by our societal on winning and physical An does not believe that a is our society games for but society the of at and is a culture that on competition, in business and in sport. However, we long that competition of all must exist within some A of competition is to win or be the very best in any many in our society appear to have taken a attitude, and winning to be the only of If we this then it easy to or be to the that one should win at any At that doping a very with the the means of anabolic steroids and other This at any take is not The in the Olympics were and of athletes to these are well Smith argued that the level of in at the turn of the what we Even the American football was as a and and a American football a further with that the only of drug use, have been at the and Olympic levels during the Moreover, because of in the news media and and by athletes, adolescents are of the part that anabolic steroids and other performance-enhancing drugs in the of many so-called athletes. on appearance, especially the of is also long An of men to the of by yet another who at the of who played in several in the with at the of and other and roles for a athletic In addition, a of such as and and some elite athletes, such as baseball Mark are in part for their bigger-than-life Anabolic steroid use among was given national during a steroid trafficking in The by President Bush of an individual who as a and at least in part as a of steroid use, as of the on and was yet another we our Such of and as a of and winning efforts of posters on and that students to no to Some argue that our attitudes and values related to sports and appearance are too entrenched to may be particularly when it to elite levels of there is simply too much However, if we control our competitive and we then must to anabolic steroid use, even among our current for dealing with the use of anabolic steroids in sport is and interdiction and However, 10 after our society was made that our were using steroids, our efforts to deal with this problem have not been very Since a of national on anabolic steroid use have been by the United States federal government or by sports and educational The of these was to and/or information or to a for At this all of these appear to have been a effort to deal with the but this of the while the social of drug use in sport has been If we our current course in the of increased high levels of anabolic steroid use use of other performance-enhancing then we as sports and coaches are guilty of for the of and distribute educational for the of and the of law of these our in the of our deal with our to sport and our on winning and

McCracken’s analysis of identity construction in contemporary culture sees the drive to transform oneself as the expression of consumer agency and individual freedom. Transformation is accessible through cosmetic surgery, enabling consumers with funds to purchase a ‘whole new me’. This consumer is an active participant in the transformation process, not content with observing beauty but actively engaged in the creative construction of new improved selves. In doing so, they have “mastered the codes of cultural production” making themselves “co-creators in the culture they consume” (McCracken xvi). An alternative and far less positive narrative of consumer transformation focuses on the pervasive influence of promotion on individual identity. Marketing and promotion constructs a deficiency in the lives of consumers which, marketers imply, can be remedied by the purchase of cosmetic surgery. Rather than being powerful co-creators of their own fluid identity, consumers are constructed as victims of a promotional culture which valorises external values and ‘the new’ and preys on consumer vulnerabilities (Fatah 1). In this paper I draw on consumer blogs, industry webpages and regulatory and professional publications to explore the tensions between these competing narratives of bodily transformation. In doing so, I argue that there is an inherent paradox in the discourse of consumer transformation which advocates consumer freedom and creativity yet limits these freedoms to certain forms of ideal beauty which can be marketed by the promotional industries.

Anabolic-androgenic steroids: Considerations for forensic psychiatry, sports psychiatry, and the law

The demand for appearance and performance enhancing substances, including muscle building supplements and anabolic androgenic steroids, is increasing in Australia. However, little is known about the associations between appearance and performance-based factors and appearance and performance enhancing substances (APES), particularly among adolescent boys. This study sought to examine (a) the prevalence of muscle building supplement use in a sample of adolescent boys and (b) how both performance and appearance factors relate to muscle building supplement use and favourable attitudes towards anabolic androgenic steroids in this sample. N = 488 adolescent boys aged 13-16 (Mage = 14.59) from nine Australian schools completed measures of supplement use, favourable attitudes towards using steroids, muscle dissatisfaction, body fat dissatisfaction, mesomorphic ideal internalisation, weight training, and sports participation. Hierarchical logistic regressions were used to examine cross-sectional correlates of muscle building supplement use and favourable attitudes towards using anabolic androgenic steroids. In the past three months, 12.7% of the sample had used muscle building supplements. Both appearance and performance-related factors - mesomorphic ideal internalisation and weight training - were related to muscle building supplement use. Only one appearance-related factor - body dissatisfaction - was related to favourable attitudes towards anabolic androgenic steroids. The findings from this study are important as they may help to guide intervention strategies regarding appearance and performance enhancing substance use by Australian adolescent boys, with the ultimate goal of ensuring this population's safety.

Introduction: Penile cosmetic augmentation surgery (cosmetic phalloplasty) is available in the cosmetic surgery field for about a quarter of century to enlarge penis length, girth, and glans of a man’s penis. This article describes penile cosmetic surgery augmentation (phalloplasty surgical techniques) using BellaDerm graft. Materials and methods: A total of 315 phalloplasty surgeries using BellaDerm graft were analyzed for this article. These surgeries were performed by the author during 15-year in multiple surgery centers in California, USA. BellaDerm is a graft that is a type of scaffolding or framework (matrix) that exists in human skin. This framework creates a place where cells and blood vessels can create new tissue. BellaDerm graft serves as a framework to support cellular repopulation and vascularization of the patient's own tissue. It's also performed penile augmentation based on the initial graft thickens. In cosmetic penile augmentation surgery, BellaDerm graft is used to enhance the girth and/or glans of the penis during cosmetic penile augmentation surgical procedures. Results: 63% percent of the patients, who underwent penile cosmetic augmentation surgery with BellaDerm graft, participated in postoperative survey. 89% of these patients reported great satisfaction with cosmetic penile augmentation surgery with BellaDerm graft. Complications: Infection, that required medical and surgical treatment, developed in 17 (5.4%) of these patients. All patients were cured from infection after graft removal and 2 weeks of continuous treatment with general and local antibiotics administered through the drain. All 17 patients were successfully signed off from the treatment with subsequent instructions regarding continuity of care. 9 patients were on anabolic steroids (anabolic steroids compromised post-surgical wound healing); 6 patients violated post-surgical protocol having been engaged in early sexual activity that lead to the skin separation on sub-coronal incision and let the wound open. 8 patients smoked heavily (chain smokers) and they did not disclose this matter before surgery. 24 patients (7.6%) reported post-surgical retraction that was successfully treated medically and surgically. Discussion: In 2002, the American Academy of Phalloplasty Surgeons established national and international standards for male cosmetic augmentation surgery, including the identification of indications, operative strategies, surgical techniques, and the assessment of results. These standards have been in effect for 15 years. When qualified surgeons, who completed education and training provided by the American Academy of Phalloplasty Surgeons have followed AAPS guidelines, these surgeries have become successful. Yet, despite successful physical results, the subjective evaluation of aesthetic results and the ethical implications of male cosmetic augmentation surgery continue to be debated. Conclusion: This article represents retrospective evaluation of patients who have undergone cosmetic penile augmentation surgery with BellaDerm graft. The study reported high satisfaction rate with this surgical technique for penile augmentation (Penile Dual and Triple Augmentation TM) developed, patented, and used by the author of this article.

The Adonis Complex: The Secret Crisis of Male Body Obsession • Looking Good: Male Body Image in Modern America • Making the Body Beautiful: A Cultural History of Aesthetic Surgery • Body Modification

Little is known about the connection between body modification and borderline personality disorder (BPD). This study investigated the relation between a wide range of body modification practices (piercing, tattooing, scarification, pubic hair removal, and cosmetic surgery) and BPD features, with a special focus on identity and identity dysfunction, in an adult community sample (N = 330). Results indicated BPD features were positively correlated with total number of body modifications and breadth of body modification practices endorsed, as well as, specifically, increased piercings, tattoos, and scarifications. Furthermore, identity problems (i.e., identity diffusion and low self-concept clarity) were associated with body modifications. Implications of these findings are discussed, including their heuristic value in understanding body modification in light of its connection to BPD (and particularly identity/self-concept functions). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The most popular body modifications are tattoos and piercings and their prevalence has increased in recent years. The current study gathered statistics regarding tattoing, piercing and body-hair removal, differentiated by gender and attitude towards cosmetic surgery. The study was based on 2512 individuals and was performed as a population-based survey with the assistance of a demographic consulting company. In addition to sociodemographic questions, specific issues concerning body modification were asked. Men get tattoos more frequently while women more often choose piercings and body hair removal. Women are catching up in the tattoo department and one can no longer observe age differentiations among the younger age groups. Instead there is a decrease in piercings among men. Body hair removal is widespread above all women. People with body modifications tend to be more open-minded about cosmetic surgery. Tattoos and piercings continue to be the most popular body modification among young adults. The number engaged in tattooing is rising while piercings are still popular among women. Individuals being engaged in body modification are prone to consider cosmetic surgery procedures.

This study aimed to review the effects of performance enhancing drugs (PEDs), such as anabolic steroids, on clinical outcomes in critically ill patients. A systematic review and meta-analysis of randomized controlled trials comparing any of the known PEDs with placebo during intensive-care unit (ICU) admission was performed, excluding erythropoietin stimulating agents. Data were pooled using a random-effects model, while outcomes from non-eligible studies for meta-analysis were reported separately. Risk of bias was assessed through the cochrane risk of bias (ROB) 2 tool. Twenty-three studies were included. Only studies using growth hormone, nandrolone, and oxandrolone were found. Growth hormone improved nitrogen balance (standardized mean difference = 1.4g, 95% confidence interval 0.47-2.32). While mortality was unaffected, it caused increased ICU and hospital stay. A substantial heterogeneity and a concerning risk of bias were present among the studies. PEDs showed no survival benefit but may improve nitrogen balance. A possible subgroup that could benefit from growth hormone or anabolic steroids are critically ill patients who have surpassed the acute inflammatory phase of critical illness. Further research into various aspects of PEDs is needed within the context of current clinical practices.

Anabolic-androgenic steroids (AAS) are used for performance and image enhancement, yet their non-medical use in Australia is heavily criminalized and framed by sociocultural narratives that emphasize risk, deviance and harm. This study aimed to critically examine how people who use AAS experience these narratives, focusing on challenging their role in perpetuating stigma and reinforcing punitive responses. The study employed a peer-led approach to explore the lived-living experiences of people who use AAS in Australia. Semi-structured interviews were conducted with participants recruited through purposive sampling, leveraging the lead author's peer networks. The interview guide was designed to address sensitive topics, including law enforcement, health systems, and sociocultural attitudes. Data were analyzed using iterative categorization, followed by theoretical refinement of the developed categories. This process ensured the integration of participant accounts within broader sociopolitical discourses, recognizing the political dimensions of research. The analysis centred on a sample of 22 participants from Australia ( Median age = 30 years, range: 19–49), with 91% identifying as men and 9% as women. It highlighted how media narratives portraying AAS use as linked to crime and deviance maintain stigma and contribute to their experiences of symbolic violence. These portrayals shape social perceptions of AAS consumption, reinforce self-stigma among consumers, and discourage open dialogue. Participants described how societal judgment can complicate AAS use, pushing people into informal, risky avenues. Despite a preference for legal and legitimate access, people face barriers rooted in punitive laws and healthcare resistance. This cycle marginalizes people who use AAS, denying them agency and support, while amplifying epistemic injustice and structural exclusion. We conclude by arguing against punitive narratives surrounding AAS use in Australia, advocating for inclusive, health-oriented approaches to policy. We call for peer-led approaches which may serve to dismantle symbolic violence and fostering respectful dialogue to support informed choices and wellbeing.