Performance And Image Enhancing Drugs Research Articles

“You Could Try This Compound, but it Might Send You nuts”: How Steroid Suppliers Perceive the Underground Market and Their ‘Hybrid’ Role within It

ABSTRACT Introduction The illicit manufacture and use of image and performance enhancing drugs (IPEDs) have increased. The underground market continues to meet consumer demands amidst evolving cultural narratives around most alluring IPEDs. This qualitative study aimed to provide insights into how IPED suppliers perceive demands within the current market and their roles within it. Methods We interviewed four IPED suppliers in Australia regarding distribution challenges and market changes. Interviews were transcribed and analyzed, with immediate reflective notes taken after each interview. Inductive line-by-line analysis facilitated identification and development of themes. Results Cultural narratives were perceived to influence the demand for several drugs (e.g. trenbolone, dihydroboldenone, fluoxymesterone) due to their perceived desirability and elevated status compared to other compounds. Consumers, who appeared to demonstrate knowledge gaps, were sometimes guided in their consumption practices by IPED suppliers, who drifted into a “hybrid” role of coach-supplier. Discussion IPED suppliers highlighted a perceived demand for specific AAS, driven by cultural narratives. Consequently, IPED suppliers assumed a hybrid role whereby they provide advice to the people who purchase IPEDs at point-of-sale. Urgent action is needed to address cultural narratives and provide education and harm reduction to support people who use IPEDs.

Attitudes and doping prevalence among Norwegian youth across exercise activities

BackgroundUse of image and performance enhancing drugs (IPEDs), such as anabolic-androgenic steroids, has in the last decades spread from elite athletes to recreational exercisers seeking a shortcut to a lean and muscular physique. The drugs are associated with multiple potential negative health consequences, some of which may be particularly harmful for adolescents. To better develop adequate and targeted preventive measures, identifying individuals and groups at risk for using IPEDs are important. MethodsBy analyzing quantitative data extracted from Ungdata, a national data collection survey on adolescent health and well-being, this study describe self-reported physical activity and exercise habits, IPED prevalence, and attitudes and intentions towards IPEDs among 88 412 Norwegian adolescents aged 13–19 years. Results72 % participated in weekly sport or physical exercise. Young adolescents mostly exercised in sport clubs while older adolescents preferred training in gyms. Average lifetime IPED prevalence was 2.2 % (0.7 %–4.0 % depending on exercise activity). Respondents reported more favorable attitudes and higher intentions to use IPEDs when it was related to increasing muscle size (18 % and 5.8 %, respectively) and reducing weight (19 %, 8.1 %), compared to improving sport performance (5.6 %, 3.0 %). Large variations in attitudes and intentions were found between exercise groups, with individuals exercising in gyms having more favorable attitudes toward IPEDs than other groups. ConclusionThe study finds a low relative prevalence, but high acceptance for IPED use in certain exercise groups. Education and preventive measures should specifically target groups at risk for future use of these drugs.

Profiling and assessing the risks of image- and performance-enhancing drugs use during the COVID-19 lockdown.

Image and Performance-Enhancing Drugs (IPEDs) can enhance mental and physical capabilities and impact one's overall health. Initially confined in sport environments, IPEDs use has become increasingly widespread in a high-performing society. The present study was aimed at profiling IPEDs use during the COVID-19 lockdown among an international sample of young adults. A cross-sectional observational study was carried out in eight countries (United Kingdom, Italy, Lithuania, Hungary, Portugal, Spain, Brazil, and Japan) between April and May 2020. The survey questionnaire included validated measurements such as Exercise Addiction Inventory (EAI), Appearance Anxiety Inventory (AAI), and Self-Compassion Scale (SCS) as well as questions about the type of IPEDs, purchasing methods and socio-demographic information. A total of 736 IPEDs users were included in the survey. Their mean age was 33.05 years (±SD = 10.06), and 64.2% were female participants. Overall, 6.8% were found at risk of exercise addiction (EAI >24), 27.6% presented high levels of appearance anxiety, and 24.9% revealed low levels of emotional regulation's self-compassion. Most participants (55.6%) purchased IPEDs through pharmacies/specialized shops, while 41.3% purchased IPEDs on the Internet. Online IPEDs buyers were mainly men who had higher scores on the Exercise Addiction Inventory. One or more IPEDs classifiable as "potentially risky" were used by 66.3% of the sample. Users of "potentially risky IPEDs" were younger and primarily men. They showed higher scores both on the Exercise Addiction Inventory and Appearance Anxiety Inventory. This study profiled users of IPEDs when the most restrictive COVID-19 lockdown policies were implemented in all the participating countries. More targeted post-COVID 19 prevention strategies should be implemented according to the emerged socio-demographic and psychopathological traits and cross-cultural differences emerged. Longitudinal studies will also be needed to determine the long-term effect of the COVID-19 lockdown on IPEDs consumption.

Performance and Image Enhancing Drug Use Among Australian Women: The Role of Interpersonal Relationships in Facilitating Use

Background: Women comprise a minority of performance and image-enhancing drug (PIED) consumers, with use linked to undesirable side effects. Preliminary work suggests that many women have little knowledge of what substances they are using, with males close to them involved in their use. This study aimed to explore women's motivations for PIED use; to examine the negative health experiences related to use; and to understand how interpersonal relationships facilitate their use. Method: Women who had used PIEDs were invited to participate in an online survey ( N = 28) and/or interview ( N = 10). Open-text survey and interview data were analyzed using content and thematic analyses, respectively. Results: There were three key areas (motivations, health experience, role of third parties) within which 12 theme categories were developed from the survey data. There were three overarching themes developed from interviews that expanded on these data: socializing women's use, facilitating women's use, and PIEDs exacerbating existing issues. Conclusion: The findings substantiate the nuanced gender dynamics of women's PIED use, challenging stereotypes and revealing the complexity of their motivations and experiences. While women's reasons for PIED use may share some semblance with men's, there is a less comprehensive understanding of the physical and psychosocial impacts of these drugs. To empower women and destigmatize PIED use, interventions focusing on substance literacy and stigma management are crucial. Future research should explore these interventions’ effectiveness in promoting women's well-being and autonomy.

‘The general concept is a safer use approach’: how image and performance enhancing drug coaches negotiate safety through community care

Background Drug coaches are a novel extension of traditional personal trainers who play a significant role providing support and shaping drug-related behaviours for people who use image and performance enhancing drugs (IPEDs). They constitute a critical domain for everyday risk management, where substance use, and its associated harms are influenced by social exchange. This study investigated how IPED coaches negotiate safety within the community through the provision of their services and the partnerships they form with clients. Method Ten IPED coaches, selected through purposive sampling, engaged in semi-structured interviews (32–57 minutes in length) exploring the way in which they operate in their field of practice. Iterative inductive analysis was applied to the transcripts, enhanced by discussions among researchers and an independent coder. Results The findings are organised under three categories, revealing the nuanced strategies and identities of IPED coaches, emphasising harm reduction and optimising ‘gains’ in IPED use. These coaches play a significant role in harm reduction, wielding their ‘chemical capital’ and lived experience to integrate nuanced harm reduction strategies into their partnerships with clients. Conclusion Embodying a model of peer-driven knowledge exchange and emphasising open and inclusive discourse IPED coaches offer a vehicle toward integrated harm reduction strategies.

Understanding muscularity, physique anxiety, and the experience of body image enhancement among men and women: A mixed‐methods study

AbstractThis study explores the growing trend of pursuing an ideal muscular physique, which escalates the risk of body image issues and engagement in enhancement behaviours. Employing a mixed‐methods approach, we examined the psychosocial dynamics surrounding these ideals and experiences, particularly the use of performance and image‐enhancing drugs (PIEDs). The quantitative arm of the study, involving 131 participants of mixed gender, investigated associations between social physique anxiety (SPA), drive for muscularity, male body attitudes, appearance comparisons, and self‐compassion. Concurrently, qualitative interviews with 16 individuals engaged in PIEDs interrogated the reasons for body image concerns and adaptive coping strategies around increasing body appreciation. The study emphasises the convergence of muscular ideals across genders and advocates for continued research in this domain.

Masculine enhancement as health or pathology: gender and optimisation discourses in health promotion materials on performance and image-enhancing drugs (PIEDs)

ABSTRACT The consumption of performance and image-enhancing drugs (PIEDs) is commonly pathologised in public health discourse as stemming from an unhealthy relationship to masculinity, and is often framed as intrinsically ‘risky’ and fundamentally at odds with ‘good health’. This article examines Australian health promotion materials on PIEDs to analyse their role in shaping notions of good health, normal gender and appropriate self-improvement. To do so, it draws on the work of Butler, Law and Latour to consider how these materials co-constitute men and their health, often in problematic ways. First, we examine the ways in which PIEDs are constituted via a politics of the ‘natural’, then consider how the health promotion materials on PIEDs participate in the regulation of appropriate, healthy masculinity, and conclude by examining how adolescent masculinity is co-constituted with PIEDs. We observe a key tension between health promotion’s avowed interest in improvement and optimisation and its treatment of PIED consumers as aberrant, vulnerable and insecure subjects whose drive to enhance and optimise is characterised by pathology and addiction. We conclude by arguing that health promotion materials on PIEDs fail to acknowledge the exceedingly normative character of enhancement practices in contemporary society.

Interdisciplinary care for users of anabolic agents in recreational sports in Switzerland – a first clinic has opened in Zurich

The use of anabolic androgenic steroids (AAS) as well as other image- and performance-enhancing drugs (IPEDs) has become one of the most recent global major substance use disorders in the 21st century. These substances are not only used by professional bodybuilders and competitive athletes, but moreover by recreational gym users aiming to achieve personal image and sports-performance goals [1]. The global lifetime prevalence of AAS use is estimated to be as high as 1-5% in the general population and up to 30% among recreational gym users. In Switzerland, it is estimated that there are over 200 000 users that use these substances mostly outside of competitive sports [2].

Across the spectrum of legality: The market activities of influencers specialized in steroids and other performance and image enhancing drugs

BackgroundLike many other goods and services, performance and image enhancing drugs (PIEDs), and particularly androgenic anabolic steroids (AAS), are increasingly discussed and promoted by social media influencers. Little, however, is known about the influencers specialized in PIEDs and which drugs and services they promote and sell. AimsAgainst this background, the study has been intended to identify prominent influencers specialized in PIEDs, examine the market activities they engage in, and assess the latter's legality. MethodsWe first searched the clean internet to identify prominent PIED influencers. Second, we conducted a six-month-long, non-reactive digital ethnography of the social media accounts of 20 influencers and, via a content analysis, identified the market activities they engage in. Third, we assessed the latter's legality, primarily using the EU legislation as a benchmark. FindingsThe selected influencers are all current or former bodybuilders, predominantly male and from the United States. Many of them have developed a considerable number of followers, in three cases exceeding one million. They engage in various market activities that span the whole spectrum of legality, from legal to illegal, with many activities having an uncertain, but often dubious, legal status. ConclusionsThough they may promote harm reduction for some users, PIED influencers also promote the public acceptance of PIED use beyond the bodybuilding community and enhance access to PIEDs for millions of people. Multifaceted policy interventions are required, aiming at preventing influencers from becoming a major source of information on, and route of access to, PIEDs.

A review of the analytical techniques for the detection of anabolic–androgenic steroids within biological matrices

AbstractAnabolic–androgenic steroids (AASs) and other image and performance enhancing drugs (IPEDs) are controlled by governments and sport institutions such as the World Anti‐doping Agency (WADA). Although elite athletes and professional bodybuilders are the most visible AAS abusers, the introduction of the internet has increased the accessibility of AASs, with use being observed among recreational gym goers at increasing prevalence. Despite reported increase in use, routine analysis for these substances is uncommon, with many forensic laboratories opting to outsource AAS analysis. This review collates information regarding the extraction and analysis of AASs from various biological matrices with the considered purpose of providing a reference for the development of AAS methods to allow for routine detection by forensic laboratories.This article is categorized under: Toxicology > in Sport Toxicology > Analytical

Social media influencers, YouTube & performance and image enhancing drugs: A narrative-typology

BackgroundThe health and fitness industry has witnessed a rise of influencers on social media promoting a myriad of brands and products, including some promoting anabolic steroids and other performance and image enhancing drugs (PIEDs). It is currently unclear, however, what type of information and advice social media influencers distribute. AimThis study aims to examine the narratives of social media influencers who discuss PIEDs. MethodThe study identified 20 influencers specialized in PIEDs and then made a content analysis of the videos they posted on YouTube. FindingsWhile we find several similarities in influencers’ narratives, we also categorize them in three distinct categories: (1) narratives primarily relying on scientific literature and discussing ‘usual’ bodybuilders’ products and doses; (2) narratives primarily relying on the influencers’ personal experience and discussing ‘usual’ bodybuilders products and doses; and (3) narratives primarily relying on the influencers’ personal experience and discussing experimental products and ‘unusual’ doses. RecommendationsThe narrative-typology should be used as a means of identifying high-risk videos on social media platforms like YouTube. Policy-makers should do more to challenge high-risk and potentially harmful discussions. Conversely, reliable discussions ought to be made more visible to ensure they are not overshadowed by flashier and riskier narratives.

Investigating the methods and characteristics of the trafficking of performance and image enhancing drugs in Australia.

Using case law, the aims of this study were to document the methods for trafficking of performance and image-enhancing drugs (PIED) into Australia, and the characteristics of individuals and groups involved. Data was collected from judges' sentencing comments. Searches were conducted using the Australasian Legal Information Institute database across all states in Australia, for the period of January 2010 to December 2021. After removing duplicates and cases which did not meet the inclusion criteria, 31 cases were included in the analysis. Across the 31 cases, 37 individuals were named as being involved in the supply and/or trafficking of PIEDs, with three cases involving an unknown number of individuals. One case named four actors involved in the supply and/or trafficking of PIEDs, three cases involved three actors, four cases involved two actors and 17 cases involved one actor. In 20 of the 31 cases, individuals operated alone. Over half (19 of the 37) of the individuals were health professionals. The majority (n = 17) of cases involved prescription as the method of acquisition, while seven cases involved the importation of PIEDs. The small number of cases identified, with the majority involving only a single actor, and half of the cases involving those in the medical profession. The findings suggest that discrete occurrences of trafficking involves individuals or small groups that do not appear to be linked to large-scale networks or networks involving the supply and trafficking of other illicit substances.

Is the use of performance and image enhancing drugs (PIEDs) in women an issue of concern? The findings from a stakeholder consultation

ObjectivesThere is limited research into the use of performance and image enhancing drugs among women who participate in sport, despite evidence that women do use these substances and experience related harms. The aim of this project is to capture stakeholder perspectives on the current research, policy, and practice landscape in Australia regarding women's performance and image enhancing drug use in regulated and unregulated sport settings. DesignQualitative interviews. MethodsThirty-two semi-structured interviews were conducted online with stakeholders from Australia between September and December 2021. Interviews ranged between 15 and 90 min in duration. Data were imported into the NVivo (Version 12) platform and analysed using thematic analysis. ResultsThirty-two participants (20 females and 12 males) who held a variety of roles (e.g., coach/strength coaches, gym owners, anti-doping agents, athletes) were interviewed. Fourteen participants reported performance and image enhancing drug use. There were four overarching themes generated from the data: ‘participation in untested sports’; ‘environmental factors driving use’; ‘individual rationalisation’; and, ‘the dark side of performance and image enhancing drug use’. ConclusionsPerformance and image enhancing drug use was identified as an issue of concern for women competing in non-elite strength and power-based sports. Of particular concern is the influence of unqualified advice from third parties (i.e., coaches and partners) regarding performance and image enhancing drug use. The environments in which performance and image enhancing drug use occurs can impact individual decisions of women and eventuate in significant and long-lasting physical and psychological harms.

Gendered perspectives on women’s anabolic–androgenic steroid (AAS) usage practices

BackgroundThe masculinizing effects from anabolic–androgenic steroid (AAS) appear to be different between men and women, leading to calls for more gender-specific information regarding women and AAS use. This study sought to gather perspectives from both men and women on the unique challenges surrounding women’s use of AAS, irrespective of their personal use. Secondly, the study interrogated how women’s AAS practices differ from those of men specifically.MethodsThe data presented in this paper come from a subsample of participants who participated in a larger study investigating women and performance and image enhancing drug (PIED) use in Australia. Participants were included in the current analysis if they were: (i) males or females who competed with or coached female strength athletes using AAS and (ii) female and male strength athletes who used AAS. The final sample comprised 21 participants of which there was a proportion of males (n = 7) and females (n = 7) using AAS.ResultsWomen’s choices in AAS selection were predominantly around oral compounds (e.g. Oxandrolone) as well as other PIEDs (e.g. Clenbuterol). Some women report the use of injectable AAS represents a change in the profile of the typical female user as it reportedly comes alongside drastic physical and psychological changes.ConclusionsThe unique challenges facing women who use AAS are largely isolation and stigma, with little evidence-based practice or education being available to them online or through peer-groups. Future work may consider piloting harm reduction strategies that may be co-designed with this group.

The Liver King Lie: Misrepresentation, justification, and public health implications.

It is well-established that performance and image enhancing drugs (PIEDs) are effective in increasing muscle mass and strength. PIEDs are unique in that, while harm may result from use, there is little evidence of widespread individual or social harm comparable with other illicit substances. However, given the rapid growth of the online health and fitness industry, the digital consumption of hardcore fitness content represents a space ripe for indirect harms. A poignant example of this trend among the digital health and fitness community is the contestation around 'fake natty' users, who falsely claim to not use PIEDs. The non-disclosure of use has the potential to give individuals who are not enhanced the false impression that they too can achieve a bodily ideal which is similar, potentially resulting in psychological distress and risky behaviours. In this commentary, we discuss this harmful phenomenon using the case study of the fitness influencer Brian Johnson, more commonly known as Liver King. Employing a psycho-criminological lens, we use Social Identity Theories to understand the 'Primal' identity, before unpacking Johnson's disavowal of his PIED consumption through Sykes and Matza's (1957) techniques of neutralization. We conclude with an overview of the harms surrounding fake natural influencers and cognitive dissonance, before attempting to map a path towards emic harm reduction in collaboration with the digital fitness community.

Impact of harm reduction practice on the use of non-prescribed performance and image-enhancing drugs (PIEDs): The PUSH! Audit

The PUSH! Audit was a cross-sectional study performed from May 2019 to May 2021. With each audit submitted, general practitioners (GPs) were asked about the impact of their engagement with their patients. In all, 144 audit responses were collected, with 81.6% ofaudits showing a change in behaviour. The changes noted were better monitoring (71.3%), treatment of adverse effects (64.4%), modified use (44.4%) and stopped use (12.2%). This study asking GPs about outcomes with each of theirpatients using non-prescribed PIEDs has shown significant changes in behaviour. There has been no previous work done to evaluate the potential impact of such engagement. The findings of this exploratory study of the PUSH! Audit suggest harm reduction for people who use non-prescribed PIEDs when engaged with GPclinics.

#Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram.

This article sets out to investigate the marketing of image and performance enhancing drugs (IPEDs) on the social media platforms Facebook and Instagram. Drawing upon a 'connective' ethnographic exploration of IPED use and supply, the paper first outlines a supplier typology on these platforms, before shedding light on the marketing strategies employed by sellers in order to overcome the inherent distrust of online sales and build a trustworthy brand. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered.

Do you get what you see? The illicit doping market in Denmark - an analysis of performance and image enhancing drugs seized by the police over a one-year period.

This study examines doping products seized by the police in three regional police districts in Denmark from December 2019 to December 2020. The products, often referred to as performance and image-enhancing drugs (PIEDs), are described in relation to the country of origin, manufacturing company and the active pharmaceutical ingredient (API) stated on the packaging vs. the one identified by subsequent chemical analysis. The study also includes a description of the degree of professionalism by which the products appear according to EU requirements. A total of 764 products were seized during the study period. The products originate from 37 countries, mainly located in Asia (37%), Europe (23%), and North America (13%). 193 different manufacturing companies could be identified from the product packaging. The most frequent compound class was the androgenic anabolic steroids, found in 60% of the products. In 25-34% of the products, either no or an incorrect active pharmaceutical ingredient, relative to the one stated on the product, was found. However, only 7-10% contain either no API or a compound from a different compound class than the one stated. Most products had a professional appearance fulfilling most EU requirements for packaging information. The study shows that many different companies supply PIEDs to the Danish market and that counterfeit and substandard products are widespread. Many products do, however, appear professional to the user giving an impression of a high-quality product. Although many products are substandard, they most often contain an API from the same compound class as the one labeled.

Exploring the experiences of general practitioners working with patients who use performance and image enhancing drugs

ObjectiveMedical practitioners such as general practitioners (GPs) may have an underutilized role when it comes to addressing the associated harms among people who use performance and image enhancing drugs (PIEDs) such as anabolic androgenic steroids (AAS). However, consumers report not accessing this group due to the perception they lack knowledge, and medical practitioners often report having a negative view of this group. The aim of this study was to investigate the experiences of Australian GPs with patients who use PIEDs such as AAS MethodA purposive sample of participants was recruited via research contacts and strategic announcements through GP groups and medical boards. Participants were also recruited through snowball sampling. Interviews were conducted online. A semi-structured interview schedule was utilised. The data were analysed thematically using an inductive approach. FindingsSix participants were recruited. Three themes emerged; these were: (1) Knowledge, support and training, challenges: “Better prepared than what I am”; (2) Ethical conflicts: “The difficulty lies in the conflict”; and (3) Poly drug use: “It's a bit intersectoral”. ConclusionsGPs feel inadequately prepared to provide services to this unique cohort of substance consumers and suggest there are specific challenges which intersect with ethics and legality, which make this an even more complex cohort. PIED consumers which access GPs may also be engaging in polysubstance use, although the temporal order of this relationship is still unclear.

Men, bodywork, health and the potentiality of performance and image-enhancing drugs

ABSTRACT In a qualitative study on masculinity, embodiment and sexuality, we interviewed men who were recreational gym-goers about their bodywork practices in Melbourne, Australia. We also asked whether the men had used performance and image-enhancing drugs (PIEDs) as an adjunct to their bodywork practices. While none had used PIEDs, all were considering, or had considered, using them. We found that participants held varying opinions on PIED use and those who used them. The literature on PIEDs noted men’s concerns with body appearance and health and focused largely on individual problematic use, but non-users were not mentioned. A second issue in the literature focused on social influences on PIED use, but again with no mention of non-users. Discussion on risk reduction as a public health response did not mention non-users either. This paper, therefore, reports on non-users’ thoughts on, regular exposure to, and considerations of PIEDs and other men who use them. We propose that PIEDs might more usefully be understood as an everyday, if contradictory, consideration within most men’s bodywork and health practices. We argue that PIEDs constitute a discursive practice exposing a potentiality that engages non-users also and this requires new health promotion approaches.