Image-enhancing Drugs Research Articles

Is another relationship possible? Connoisseurship and the doctor–patient relationship for men who consume performance and image-enhancing drugs

Consumption of steroids and other performance and image-enhancing drugs (PIEDs) is thought to be on the rise in Australia. Along with the benefits experienced by consumers come a range of health risks. This article draws on interviews conducted for an Australian research project on men who inject PIEDs to consider the ways in which information about managing these risks can be provided, the sources of information men use and value, and the professional relationships most effective for securing the best outcomes for them. As we will show, the men in our project expressed a very strong desire for reliable, credible information about risks and how to manage them, but also described often having to rely on information gleaned from sources of questionable reliability such as online forums and friends and acquaintances. Among the sources of information, advice and monitoring they expressed a desire to access were general medical practitioners (GPs), but high-quality interactions with GPs were, they argued, rarely possible. Using the recent work of Isabelle Stengers, particularly the notions of connoisseurship and symbiosis, we argue that new modes of engagement need to be developed that might allow men who consume PIEDs to access the information and support they need, including through their GPs. Following Stengers, we characterise the men in our project as ‘connoisseurs’ of PIEDs, and we consider what might be at stake and made possible were GPs and PIED connoisseurs to enter into more collaborative relationships to manage PIED-related health issues. In conducting our analysis, we argue for greater recognition of the complexities GPs face when encountering people engaged in illegal forms of consumption and call for new symbiotic models of engagement beyond both zero tolerance-style refusals to help and narrowly focused harm reduction approaches.

Baseline characteristics of the HAARLEM study: 100 male amateur athletes using anabolic androgenic steroids.

The use of anabolic androgenic steroids (AAS) is common among visitors of fitness centers. Knowledge about health risks of AAS use is limited due to lack of clinical studies. One hundred men, at least 18years old, intending to start a cycle of AAS were recruited. Baseline demographical data and reasons for AAS use were recorded. Subjects provided samples of AAS for analysis with UPLC-QTOF-MS/MS. One hundred and eleven men were seen for a baseline visit. Nineteen percent had competed in bodybuilding competitions. Recent illicit drug use was reported by 56%. Seventy-seven percent of participants had used AAS in the past, and 97% of them had experienced side effects. After exclusion, 100 men comprised the cohort for follow-up. The AAS cycle performed had a median duration of 13weeks (range 2-52), and the average dose of AAS equivalents was 901mg per week (range 250-3.382). Subjects used other performance and image-enhancing drugs (PIEDs) such as growth hormone (21%). In total, 272 AAS samples were analyzed and 47% contained the AAS indicated on the label. The principal reason for AAS use was gain of muscle mass (44%). Forty-eight percent self-reported to being addicted to AAS. The HAARLEM study cohort shows that strength athletes use AAS in a wide variety of cycles and often also use illicit drugs and other potentially harmful PIEDs. The quality of the AAS used is strikingly low. Follow-up of the cohort will provide novel data regarding health risks of AAS use.

A ‘messenger of sex’? Making testosterone matter in motivations for anabolic-androgenic steroid injecting

ABSTRACTAnabolic-androgenic steroids are synthetic derivatives of testosterone. They are thought to be the most commonly used performance and image-enhancing drugs (PIEDs) in Australia. However, the motivations for men’s use of steroids and other PIEDs are poorly understood. Established ways of understanding these motivations highlight men’s performance and/or image-related concerns, in the context of contemporary masculinities and gender norms. Researchers have paid little attention to how the social and political features of testosterone shape and transform steroid use. Instead, testosterone tends to be taken for granted as a ‘messenger of sex’ that acts on the body in predictable and routinised ways. This article takes a different approach. Drawing on feminist science studies and interviews conducted for an Australian research project, we investigate how the cultural and symbolic meanings assigned to testosterone shape the ontological politics of men’s steroid consumption. Approaching testosterone as an emergent social and biopolitical gathering rather than as a stable sex hormone allows us to better understand how men’s PIED consumption is mediated, particularly by pervasive ideas about sexual difference and the biology of gender. In concluding, we consider ways of better engaging men who consume steroids in health initiatives, in keeping with their concerns and perspectives.

Men’s Performance and Image-Enhancing Drug Use as Self-Transformation: Working Out in Makeover Culture

ABSTRACTThis article investigates how men who inject performance and image-enhancing drugs (PIEDs) describe their experiences of embodiment and masculinity, locating that analysis in the context of contemporary ‘makeover culture’ and the imperatives of self-transformation. Drawing on qualitative data from interviews we conducted with 60 men who inject PIEDs in Australia, our analysis suggests there is a pragmatic logic associated with PIED use that challenges much research concerning this population, which tends to pathologise men who use PIEDs as disordered in their relationship to their bodies and cultural norms of masculinity. We unpack how the men interviewed describe everyday practices of doing gender in the context of illicit drug use, the implications in normative understandings of maleness and masculinity, and how PIED consumption practices encouraged particular attention to working on the self. Our findings suggest that drug injecting practices can be understood as forms of self-transformation in makeover culture that have the potential to make new, unexpected possibilities for being in the world, and can inform harm reduction measures, including the de-stigmatisation of drug use more broadly.

Masculinities, practices and meanings: A critical analysis of recent literature on the use of performance- and image-enhancing drugs among men.

The use of performance- and image-enhancing drugs (PIEDs) has been a topic of considerable research interest since the 1980s, with the vast majority of PIED consumers being men. In this article, our departure point is a 2005 article by Helen Keane, in which she critically analyses 'the discursive constitution of male steroid users' as psychologically disordered subjects. We extend Keane's insightful feminist analysis by examining the constitution of masculinity in post-2005 social science research on PIEDs. We ask (1) to what extent do the discursive trends identified by Keane persist in the more recent literature on PIED use among men? (2) how have her insights been taken up in the post-2005 literature, and (3) to what extent does this work attend to the specificity and varied meanings of steroid practices? We argue that men who use PIEDs continue to be pathologised as insecure, inadequate and vulnerable, and marked by 'obsession', 'compensatory behaviours' and crisis. In some of the analysed texts, the male steroid user becomes doubly disordered as both insecure in his masculine body and at risk of drug dependence. Of the articles that engage with Keane's work, only two recognise the value of her insights. The others misinterpret or apply Keane's argument in inconsistent or incoherent ways. Finally, in some of the post-2005 texts, we begin to see attention to the wide variety of practices and meanings encompassed by the term 'PIED use' although much remains to be learned.

Polydrug use and polydrug markets amongst image and performance enhancing drug users: Implications for harm reduction interventions and drug policy

BackgroundOver the past two decades, the use of image and performance enhancing drugs (IPEDs) has increased significantly. Once largely confined to professional athletes, IPED use has transcended the elite sporting arena and is now predominantly found among non-elite, recreational gym users. This paper presents research findings from a qualitative study of IPED use and supply in a ‘hardcore’ bodybuilding gym in the north of England. This article makes an original contribution to the field by providing an in-depth account of the use and supply of IPEDs among this population, demonstrating the intersectionality that exists across IPEDs, diverted medication and both licit and illicit substance use and supply. MethodsThe findings are based on the research team’s privileged access to an independent, ‘hardcore’ body building gym in the north of England. Four fieldworkers undertook overt systematic observations, supplemented by 20 semi-structured interviews. ResultsAmongst this sample of bodybuilders, substance use transcended IPEDs to encompass a much broader cocktail of substances all who used IPEDs concomitantly used diverted medication as a means of negating anticipated side-effects, and over half used illegal psychoactive drugs. Furthermore, virtually all of these substances were available to buy via the gym, through fellow gym members and, at times, staff. ConclusionThis article draws three main conclusions. (1) We are witnessing a convergence of IPED use and supply with diverted medication and ‘traditional’ recreational substances. (2) The extensive poly-substance use reported by interviewees in this sample necessitates a review of existing harm reduction advice for IPED users that takes into consideration the full range of substances currently being used. (3) Punitive drug policy reform that aims to reduce IPED markets needs to consider the potential to displace social supply towards more commercially-driven dealing. Harsher drug laws may also risk criminalising and stigmatising IPED users.

Defining and defending drug-free bodybuilding: A current perspective from organisations and their key figures

The use of performance- and image-enhancing drugs in the past seventy years or so has sparked a number of responses, including heated public debates, the creation of dedicated organisations and drug policies, as well as the emergence of communities of practice and belief in support of or in opposition to the phenomenon. Drug-free, known in the field as ‘natural’, bodybuilding has been developing since the 1970 s as a response to a dominant bodybuilding culture where the use of performance- and image-enhancing drugs has become normalised. Recent years have seen a multiplication of national and international governing bodies, competitions, and participants in drug-free bodybuilding in different parts of the globe. As the field grows, the questions of what constitutes natural bodybuilding and who can authentically represent it become central. Adopting a multi-method, qualitative approach, this article explores the ways organisations and their key figures define and defend their versions of drug-free bodybuilding. The discussion focus is on the policies, meanings and identities embedded in these different versions, and how their production and negotiation makes sense in light of antagonisms between players in the field of natural bodybuilding as well as their relation to drug-enhanced bodybuilding and the wider world of sport. In examining this previously uncharted body culture, the article explores how the use of performance- and image-enhancing drugs provokes responses and processes of contestation and differentiation. In the process, what becomes apparent is the designation and negotiation of drug-free, natural bodies as an ongoing, dynamic, social process.

Performance and image enhancing drug (PIED) producers and suppliers: a retrospective content analysis of PIED-provider cases in Australia from 2010-2016

Traditionally policymakers have paid little attention to the consumption of steroids and other performance and image enhancing drugs (PIEDs) in Australia. Yet, in recent times PIEDs have come to occupy an increasing amount of discursive space and, indeed, regulatory action. This newfound interest may be attributed to several broader developments, not least the perception of the involvement of organized crime in distributing PIEDs to the professional sports world and other sectors of this illicit market. This paper seeks to explore the empirical reality of the claim that the production and supply of PIEDs in Australia is the prerogative of organized crime groups. A retrospective content analysis of Australian PIED provider cases was conducted between 2010 and 2016. To widen our search, both media articles describing court cases, obtained from the Factiva database, and public online court records, using the Australasian Legal Information Institute (AustLII) database, were searched. Search terms included “steroid*”, “doping” and “testosterone” in combination with the terms “traffic*”, “production”, “supply*” and “import*”. In total, 477 PIED provider cases were identified yet most cases were duplicates, irrelevant or lacked sufficient detail, resulting in a final dataset of 144 cases. A coding schedule was developed based on existing PIED supply literature. Our data shows that most PIED provider cases took place in Queensland (41.7%), followed by New South Wales (25%) and Victoria (13.2%). Regarding the type of providers, the largest group consisted of people active in the gym industry (22%), followed by the healthcare sector (17%), the ‘other’ category (12%) and the security sphere (8%). Of the 144 steroid-provider cases, only 12% of the cases indicated the potential involvement of organized crime groups, with half of those being linked to outlaw motorcycle gangs. In contrast to the claims of authorities, our data suggests that organized crime groups currently play a proportionally small role in the illicit production and supply of steroids and other performance and image enhancing drugs in Australia. Indeed, various actors are involved of which only a small fraction are part of or involved with organized crime groups. Many suppliers are particularly active in the gym industry and healthcare sector. The relative presence of such suppliers has important policy implications, not least with regard to the role of criminal law in addressing the provision of PIEDs.

Making a difference? Applying Vitellone’s Social Science of the Syringe to performance and image enhancing drug injecting

Vitellone’s Social Science of the Syringe investigates epistemologies of injecting drug use. She argues for a methodology that can be simultaneously sensitive to biopolitical power regimes; the trajectories of social stratification; and the resistance, creativity and dignity of human agency. She proposes a methodological focus on the syringe-in-use as an active participant in these dynamics. Harm reduction policy and service provision frameworks have paid little attention to the phenomena of performance and image enhancing drug (PIEDs) injection. One way of assessing the merit of Vitellone’s proposal is to use it to investigate these phenomena. I argue that Vitellone’s method can be used to articulate a range of significant differences between people who inject PIEDs and other people who inject drugs, and that these differences can inform harm reduction initiatives. When compared to the heroin syringe, the PIED syringe participates in different socio-economic and material contexts, gendered identities, and biopolitical governance regimes. These differences materialise in different rates of syringe sharing and blood-borne virus transmission; and different experiences of needle exchange services. I offer a thought experiment demonstrating how a different syringe might alter the structural dynamics, biopolitical governance, and the agentic choices of people who inject PIEDs. Judging by the productive effects of diffracting Vitellone’s analysis through an empirical concern with PIED injecting, I concur with Vitellone’s proposition that ‘something objective may be gained from an empirical investigation of the syringe-in-use’ (p. 33).

“Blood letting”—Self-phlebotomy in injecting anabolic-androgenic steroids within performance and image enhancing drug (PIED) culture

BackgroundNew evidence with regard to a previously undocumented practice – self phlebotomy, known as ‘bloodletting’ – incontemporary injecting performance and image enhancing drug (PIED) culture is the subject of this paper. While self phlebotomy has been evidenced in psychiatric patients previously, it was performed here in people who inject AAS as a self directed health care procedure. MethodsData was collected from five publicly accessible internet discussion forums and coded using NVivo software. For the purposes of this study, posts in relation to bloodletting were extracted from the final set of records for analysis ResultsMotivation to perform bloodletting or to ‘self – bleed’ was largely grounded in experiencing symptoms of high blood pressure or a high red blood cell count (RBC).Instructions on how to perform bloodletting were found within discussion threads. ConclusionThis study is intended to provide the first snapshot of online communal activity around practice of self-phlebotomy or bloodletting amongst people who inject AAS. Further research in this area is warranted, and will be of benefit to healthcare workers, treatment providers and policy makers particularly as this relates to evidence informed and targeted harm reduction policies and effective public health interventions.

Natural bodybuilding: An account of its emergence and development as competition sport

Natural, i.e. drug-free, bodybuilding has been rapidly developing in different parts of the world as a distinct body culture with its own practices, discourses, organisations, key figures and focal points. A central aspect of this has been natural bodybuilding’s emergence and development as a competition sport. The present article traces its tentative articulation in the late 1970s, its formation as part of a broader natural movement in bodybuilding in the 1990s, and its consolidation and global expansion from the 2000s to the present day. In sketching this trajectory, natural bodybuilding is situated in the context of the bodybuilding industry and its historical transformations, as well as of the broader phenomenon of performance- and image-enhancing drugs and the reactions the latter has provoked in sport and wider society. The aim of the article is to offer an initial overview of a previously uncharted competition sport and in the process contribute to an exploration of bodybuilding as a varied and evolving phenomenon.

“Raw juicing” – an online study of the home manufacture of anabolic androgenic steroids (AAS) for injection in contemporary performance and image enhancement (PIED) culture

BackgroundNew evidence with regard to an under documented practice – the home manufacture of anabolic androgenic steroids (AAS) for injection, known as ‘homebrewing’ – in contemporary injecting performance and image enhancing drug (PIED) culture is the subject of this paper. MethodsData was collected from five publicly accessible internet discussion forums and coded using NVivo software. For the purposes of this study, threads in relation to homebrewing (n=14) were extracted from the final set of records for ethnographic content analysis. ResultsMotivation to perform homebrewing was largely grounded in the circumnavigation of unreliable online sourcing routes for AAS products, financial losses and potential harms associated with contaminated and counterfeit injectables. Instructions on how to perform homebrewing were found within discussion threads. Identified areas of concern included potential for sterility and dosing issues, injecting harms, isolation from health services. ConclusionThis study provides a snapshot of online communal activity around practice of homebrewing AAS amongst individuals who inject AAS. Further research in this area is warranted, and will be of benefit to healthcare workers, treatment providers and policy makers particularly as this relates to evidence informed and targeted harm reduction policies and effective public health interventions.

Body Image and Eating Disorders are Common among Professional and Amateur Athletes Using Performance and Image Enhancing Drugs: A Cross-Sectional Study

ABSTRACTThe use of performance and image enhancing drugs (PIEDs) is not uncommon in athletes and appears to be associated with several psychopathological disorders of unclear prevalence. In this multicenter, cross-sectional study, we aimed to evaluate the prevalence of body image disorders (BIDs) and eating disorders (EDs) in PIED-using athletes vs. PIED nonusers. We enrolled 84 consecutive professional and amateur athletes training in sport centers in Italy, who underwent semi-structured interviews (SCID-I, SCID-II) and completed the Body Image Concern Inventory (BICI) and the Sick, Control, One, Fat, Food Eating Disorder Screening Test (SCOFF). PIEDs were searched for in participants’ blood, urine, and hair. Of these, 18 (21.4%) used PIEDs, the most common being anabolic androgenic steroids, amphetamine-like substances, coffee and caffeine derivatives, synthetic cathinones, and ephedrine. PIED users and nonusers did not differ in socio-demographic characteristics, but differed in clinical and psychopathological features, with PIED users being characterized by higher physical activity levels, higher daily coffee and psychotropic medication use (e.g., benzodiazepines), more SCID diagnoses of psychiatric disorders, especially substance use disorder, body dysmorphic disorder (BDD), EDs, and general anxiety disorder, higher BICI scores (indicating higher risk of BDD), and higher SCOFF scores (suggesting higher risks for BIDs and EDs).

Information sought, information shared: exploring performance and image enhancing drug user-facilitated harm reduction information in online forums

BackgroundThere is good evidence to suggest that performance and image enhancing drug (PIED) use is increasing in Australia and that there is an increase in those using PIEDs who have never used another illicit substance. Peers have always been an important source of information in this group, though the rise of the Internet, and the increased use of Internet forums amongst substance consumers to share harm reduction information, means that PIED users may have access to a large array of views and opinions. The aim of this study was to explore the type of information that PIED users seek and share on these forums.MethodsAn online search was conducted to identify online forums that discussed PIED use. Three discussion forums were included in this study: aussiegymjunkies.com, bodybuildingforums.com.au, and brotherhoodofpain.com. The primary source of data for this study was the ‘threads’ from the online forums. Threads were thematically analysed for overall content, leading to the identification of themes.ResultsOne hundred thirty-four threads and 1716 individual posts from 450 unique avatars were included in this analysis. Two themes were identified: (1) personal experiences and advice and (2) referral to services and referral to the scientific literature.ConclusionsInternet forums are an accessible way for members of the PIED community to seek and share information to reduce the harms associated with PIED use. Forum members show concern for both their own and others’ use and, where they lack information, will recommend seeking information from medical professionals. Anecdotal evidence is given high credence though the findings from the scientific literature are used to support opinions. The engagement of health professionals within forums could prove a useful strategy for engaging with this population to provide harm reduction interventions, particularly as forum members are clearly seeking further reliable information, and peers may act as a conduit between users and the health and medical profession.

Trends in PIEDs use among male clients of needle–syringe programs in Queensland, Australia; 2007–2015

Abstract Background Increased utilisation of needle–syringe programs (NSP) by men who inject performance and image-enhancing drugs (PIEDs) has been reported. While fewer in number, people who inject PIEDs possess distinct service and knowledge needs compared to other NSP clients. Methods Using standardised data from 26 NSP outlets through the Queensland NSP Minimum Data Set (QNSPMDS), trends in occasions of services among males intending to inject PIEDs were assessed using multilevel mixed-effects negative binomial regression, adjusting for month, year, and age, and clustering by site. Results Compared to 2007, PIEDs-related occasions of service increased from 2008 until 2013 (3% and 13% of all occasions of service involving males in 2007 and 2015, respectively). While accounting for the fewest occasions of service, the Northern region experienced the greatest rate of occasion of service increase (2015 IRR 7.46, 95%CI: 6.11, 9.12). Similarly higher rates were seen among males aged Conclusion NSP settings provide an opportunity to engage with this unique population, providing important education on injection-related injuries and diseases, including blood-borne viruses, and greater linkage to primary care.

The use of supplements and performance and image enhancing drugs in fitness settings: A exploratory cross-sectional investigation in the United Kingdom.

The strive for perfection is prevalent in the fitness industry. This study aimed to explore the use of products to enhance performance alongside exposure to exercise addiction, appearance anxiety and self-esteem in fitness settings. An online survey was prepared and piloted before wider dissemination in fitness clubs via snowballing and selected mailing lists. A list of commonly used products, including Performance and Image Enhancing Drugs (PIEDs) was provided. Exercise addiction (Exercise Addiction Inventory; EAI), anxiety levels (Appearance Anxiety Inventory; AAI) and their self-esteem (Rosenberg's Self-Esteem Scale; RSE) were also measured. 377 questionnaires were completed. A significant number of participants declared the use products either to lose weight (16%) or to reach their fitness goals (41%). The Internet played a major role in both the supply of information and the provision of the enhancement products (33.7%) and side effects were reported (10.5%). Only a limited number of participants sought a medical opinion about taking products (5.1%). EAI scores were high (m=20.02 ± 4.1), AAI (m=15.98 ± 4.8) showed an intermediate level of anxiety, while self-esteem was low (RSE m=12.59 ± 2.2). This pilot study identified the emergence of a new drug trend in fitness settings and showed a potential relationship to exercise addiction, anxiety disorders and low self-esteem. The Internet played a crucial role in disseminating often untested products, including PIEDs without medical supervision and unwanted side-effects were reported. More studies in the field are required in order to safeguard public health and inform policy making.

Acneiform lesions in a female performance and image-enhancing drug user: the first African case report

The literature on performance and image-enhancing drug (PIED) use and their harms is dominated by studies of largely North American, European and Australian males. We present the first case of a non-athlete PIED user from Africa. We describe a 27-yearold South African female of African ancestry who presented with a 9-month history of acne involving mainly the trunk and face. After her initial denial, she confessed a 6-month illicit anabolic-androgenic steroid use. She was also using whey protein supplements. Her motive for PIED use was physique enhancement and endurance. Acne is an underestimated adverse effect of PIED use and health providers need to be aware of this. Polypharmacy and stacking may also exacerbate the risks of experiencing acne and other harms. Health providers must be empathic and open-minded with PIED-using patients to facilitate healthcare provision. This pioneering African case report adds to previous publications from other parts of the world. Keywords: Anabolic-androgenic steroids; acne; doping; performance and image-enhancing drugs; South Africa

The risk environment of anabolic–androgenic steroid users in the UK: Examining motivations, practices and accounts of use

BackgroundThe numbers using illicit anabolic–androgenic steroids are a cause of concern for those seeking to reduce health harms. Using the ‘risk environment’ as a conceptual framework to better comprehend how steroid users’ practices and perspectives impact on health risks, this paper examines steroid user motivations, patterns of use, and the ways in which these practices are accounted for. MethodsAs part of a wider mixed-method study into performance and image enhancing drug (PIED) use and supply in one mid-sized city in South West England, qualitative interviews were undertaken with 22 steroid users. Participants were recruited from a local safer injecting service, rather than bodybuilding gyms, in order to access a wider cross-section of steroid users. A limitation of this approach is potential sample bias towards those showing more health optimising behaviours. ResultsThe research findings highlight that patterns of steroid use varied according to motivation for use, experience and knowledge gained. Most reported having had little or no knowledge on steroids prior to use, with first use being based on information gained from fellow users or suppliers—sometimes inaccurate or incomplete. In accounting for their practices, many users differentiated themselves from other groups of steroid users—for example, older users expressed concern over patterns of use of younger and (what they saw as) inexperienced steroid users. Implicit in these accounts were intimations that the ‘other’ group engaged in riskier behaviour than they did. ConclusionExamining social contexts of use and user beliefs and motivations is vital to understanding how ‘risk’ behaviours are experienced so that this, in turn, informs harm reduction strategies. This paper examines the ways in which use of steroids is socially situated and the implications of this for policy and practice.

Post-cycle therapy for performance and image enhancing drug users: A qualitative investigation

Anabolic-androgenic steroids (AAS) are synthetic forms of the hormone testosterone and their non-medical use is related to increased muscle size, muscle mass, and strength. A primary concern regarding exogenous AAS use is its potential to suppress endogenous (natural) testosterone production. In response, some users seek out substances to use post-cycle to mitigate problems associated with the resumption of endogenous testosterone production. This study sought to understand issues related to post-cycle therapy (PCT) among a sample of performance and image enhancing drugs (PIED) users in Australia. Semi-structured interviews were conducted with 26 participants (n=24 male) who reported the use of a range of performance and image enhancing drugs (PIEDs), including AAS, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin, and peptides. Interviews were conducted in person or by telephone, recorded, and transcribed. Data were analysed following a process of thematic analysis. Three themes emerged: (1) access to PCT; (2) maintenance of gains, maintenance of health; and (3) PCT and links to mental health. Steroids were seen as easier to access than PCT; as such, participants tended to continue to use steroids rather than taper down their use, leading to health concerns. Participants wanted access to PCT for several reasons, including minimising any loss of muscle or strength gained through their PIED cycle; because they were concerned that they were no longer naturally producing hormones; or because they were concerned about their mental health, particularly when coming ‘off cycle’, and the need for PCT to help adjust. This study contributes to the existing literature suggesting that PCT may act as a harm reduction measure, allowing PIED users to safely reduce or cease steroid use or to address any negative effects from use, particularly those related to mental health.

Social suppliers: Exploring the cultural contours of the performance and image enhancing drug (PIED) market among bodybuilders in the Netherlands and Belgium

BackgroundThis paper explores the understudied phenomenon of performance and image enhancing drug (PIED) markets by examining the structure and formation of the market for PIEDs among bodybuilders in the Netherlands and Belgium. This article specifically seeks to account for individual reasons and motivations for dealing PIEDs within these bodybuilding subcultures. Understanding illicit PIED markets is important for policy decisions as knowledge on the production and distribution of these substances may assist in designing law enforcement efforts, harm reduction initiatives and treatment options. MethodsThis 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 64 PIED dealing cases initiated by criminal justice agencies in the Netherlands and Belgium. FindingsThe data indicates that PIED dealing groups and individuals are often driven by motivations stemming from their social and cultural embeddedness in the bodybuilding subculture. Specifically, these PIED dealers are ‘over-socialized’ into the structure and culture of bodybuilding and follow the cultural scripts that come with their group affiliation and organization. As a result of the cultural context in which these transactions occur, PIED dealing networks among bodybuilders in the Netherlands and Belgium are more likely to consist of friends or ‘friends of friends’ tied together by threads of collective meaning found within the bodybuilding subculture. ConclusionWe argue that efforts seeking to explain the structure, formation and motivations of illicit PIED dealing must learn to appreciate how culture mediates structural forces and thereby influences individual and collective action. Policy makers, health care professionals and other relevant parties should consider a plurality of factors (social, economic and cultural) when designing and evaluating PIED-related interventions such as law enforcement efforts, harm reduction initiatives and treatment options.