Bodybuilders Experiences with Anabolic Steroids-

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Please see the attached qualitative research study done in the UK and published in the J of Health Psy. I have removed the methods section and much of the body and have left the summary and implications for your review. Yes, you would have banned me if I did the entire article. However, if you are interested in the entire article just let me know and I can send it. Sit down, grab a coffee and happy reading.
OMB

Journal of Health Psychology

J Health Psychol 2006; 11; 845
Sarah Grogan, Sarah Shepherd, Ruth Evans, Sam Wright and Geoff Hunter
Body Builders
Experiences of Anabolic Steroid Use: In-depth Interviews with Men and Women
845
Abstract
This study was designed to
investigate anabolic steroid users’
experiences of, and motivations
for, use. Five men and six women
users took part in in-depth
interviews. Four themes emerged:
Steroid Use vs Abuse; Side-effects;
Trusted Information Sources; and
Social Pressure. Many users
believed that steroids used in
moderation were safe. Serious
side-effects (liver and kidney
damage, hypertension) were not
significant disincentives.
Information from health
professionals tended to be
mistrusted because it was not
based on first-hand experience of
use. Social support, especially from
within the body building
community, was an important
motivator. It is concluded that
intervention programmes need the
support of the body building
community in order to be effective.
RECENT research suggests that British men
are investing increasing amounts of time and
energy in body maintenance and body building
(Aoki, 1996; Grogan, 1999; Mishkind, Rodin,
Silberstein, & Striegel-Moore, 1986; Shabi, 2001;
Wright, Grogan, & Hunter, 2001). Women’s body
building is a relatively new cultural phenomenon,
and has shown a significant increase in
popularity since the 1980s (St Martin & Gavey,
1996). The use of anabolic steroids and other
drugs such as human growth hormone as an aid
to body building is becoming more and more
prevalent in Britain (Drugs and Sport Information
Service, 1997; Korkia, 1994; Lennehan,
2003). Steroids help to maximize the effects of
weight training in increasing muscle mass, but
carry with them risks of serious side-effects such
as kidney and liver damage and hypertension, as
well as presenting risks of HIV infection and
Hepatitis to those who use injectable steroids
(Institute for the Study of Drug Dependence,
1993; Rich et al., 1999). An understanding of the
first-hand experience of steroid use is necessary
in order to be able to make credible and useful
suggestions for health professionals, including
Community Drugs Teams, who deal with the
side-effects of steroid use and who may wish to
develop interventions for use with steroid users.
Body building is perhaps unique as a sport in
that most competitors in mainstream amateur
body building competitions take steroid drugs in
the lead up to competition (Korkia, 1994; Wright
et al., 2001). Indeed, anabolic steroids are so
much a part of body building culture, that
‘natural body building’ competitions have been
set up specifically for those body builders who
choose not to take steroid drugs (St Martin &
Gavey, 1996). Although there is some debate as
to whether steroids are really necessary to attain
the levels of muscularity required in mainstream
competitions (Pope, Phillips, & Olivardia, 2000),
users are likely to believe that this requires the
use of steroids (Wright, Grogan, & Hunter,
2000). Protein supplements, creatine and
ephedrine are also used by many body builders,
and are heavily marketed in mainstream body
building magazines such as Muscle and Fitness,
in spite of conflicting evidence on effectiveness
and the unknown health risks of long-term,
heavy use (Pope et al., 2000). When in competition
body builders diet and dehydrate themselves
to levels that mean that although they
may look strong they may actually feel weak
because of starvation and dehydration necessary
to present in competition form (Fussell,
1991). Steroid use presents particular tensions
between the appearance of the body (muscular
which implies strength and fitness) and the felt
body (as experienced by body builders themselves
who may feel weak and ill). One of the
most important questions to be addressed here
is how people who choose to use steroids make
sense of the paradoxical relationship between
the apparently healthy, muscled external appearance,
and the often unhealthy internal states of
their bodies. This article examines this interesting
paradox through a reading of accounts
presented by users, to investigate the felt experience
of steroid use.
In previous work (Wright et al., 2000, 2001)
we have asked men and women body builders
to complete questionnaires to give us information
about their motivations for steroid use.
We found that 59 out of 135 body builders who
completed questionnaires placed in two body
building magazines (44 per cent of the sample)
had used steroids. We applied Content Analysis
to responses and found that motivations to use
steroids were complex and person-specific
(Wright et al., 2001). Although respondents
gave us full and detailed responses to the questions
we asked, we were not able to look in
depth at motivations for steroid use in the
sample that we studied due to the nature of
the postal questionnaire methodology. We never
met any of the respondents, which meant that
we did not get a full picture of the lived experience
of steroid use. This study is an attempt to
redress that, and is complementary to the quantitative
work that we have published previously.
In this investigation, the results of in-depth
interviews (over a period of six months) with
men and women who have used anabolic steroids
for body building are presented.
Most previous work on anabolic steroid use
has focused on men, as most body builders are
men, and most steroid users are male (Lennehan,
2003; Pope et al., 2000). High levels of muscularity
are generally seen as inappropriate for
women (Choi, 2000), and in interviews with girls
as young as eight, we have found that girls are
as scared of becoming muscular as they are of
becoming fat (Grogan & Wainwright, 1996).
Various authors have documented the struggle
faced by pioneering women body builders as
they entered the competitive body building
world in the 1970s (St Martin & Gavey, 1996).
The first widely publicized women’s body building
event was held in 1979 in Los Angeles
(previously the only choice for women body
builders was the ‘beauty pageant’ added on to
the men’s competitions). In the 1980s, the Ms
Olympia competition started in the USA, and in
the UK, NABBA (National Amateur Body
Building Association) renamed its ‘Miss Bikini
International’ competition ‘Ms Universe’. In
1986, the Ms Universe competition was divided
into ‘Physique’ and ‘Figure’ classes. ‘Physique’
class caters for those who are aiming for a more
muscular physique and less traditionally feminine
presentation (minimal make-up, bare feet),
and the ‘Figure’ for those who want traditionally
feminine presentation (moderate degrees of
muscularity, high shoes, g-strings, make-up). In
the 1990s, Ms Fitness competitions were added,
targeting women who engage in weight training
as part of a general fitness regime. Fitness
competitors engage in an aerobic performance
as well as posing to reveal body shape and tone.
Women’s use of anabolic steroid drugs for body
building has increased recently, in tandem with
the increase in women’s body building competitions
(Korkia, 1994; Wright et al., 2001).
Masculinizing side-effects would be expected to
act as a deterrent for many women. Excess hair
growth on the body and male pattern baldness
are well-established side-effects when women
take steroids (Korkia, 1994). These would be
expected to take women away from traditional
western ideals of femininity (Choi, 2000; Grogan,
2000) so were of particular interest here.
This study aimed to investigate the felt experience
of anabolic steroid use in men and women.
In particular, the ways that these men and
women talked about their reasons for taking
(and for not taking) anabolic steroids were of
interest to facilitate an understanding of how
harm-minimization and prevention interventions
might be targeted effectively.
Conclusions and implications
Obviously any conclusions drawn from these
interviews need to be tentative. Although an
attempt has been made here to access the
experiences of men and women of a variety of
ages, occupations and training histories, this is a
relatively small number of participants and their
experiences may differ from those of other
users. However, the findings of this study do lead
to some suggestions for harm-minimization
strategies in the short term and for prevention
strategies in the longer term.
It emerged that serious side-effects were deemphasized
relative to short-term gains. Health
professionals working with steroid users need to
recognize that health risks that might scare
other groups cannot be assumed to represent a
significant disincentive to body builders who
may feel that gains in muscularity are worth the
long-term risk. Like other drug users such as
smokers, and ecstasy users (Conner & Norman,
1996), these interviews (coupled with evidence
from Wright et al., 2001) suggest that steroid
users are likely to focus on the short-term gains
of drug use rather than long-term risks. Participants
minimized the importance of side-effects
relative to the positive effects on body image,
and positioned critics (including health
professionals) as unknowledgeable. Their main
sources of information were ‘steroid bibles’
(magazines and books from within the steroidusing
community as to ‘safe’ doses and combinations
of steroids), websites aimed at steroid
users and word-of-mouth recommendations
from other users at the gym. These may not be
reliable sources of health information. Other
authors have also suggested that steroid users
mistrust medical warnings about side-effects.
Ardito, Goldstein, Bahrke and Sattler (1994)
found that one belief which distinguished
steroid users from non-users within their small
sample of sportsmen, was that 90 per cent of
non-users believed medical information had
established that steroids were harmful, whereas
70 per cent of users believed not enough
research had been conducted to support this.
Monaghan (1999) has also suggested that
steroid users have an ambiguous relationship
with medicine; disavowing medical pronouncements
on the use of steroids, while accepting
medicine as a potential source of information at
some points in their careers. As we have
suggested previously (Wright et al., 2001) there
is an obvious need for reliable, non-judgemental
and credible sources of information, which will
directly tackle steroid users’ mistrust of medical
information, and their belief that only ignorant
people criticize steroid use. If medical
professionals could establish a credible identity
with steroid users, then the high dosages of
steroids recommended by other users and/or
‘steroid bibles’ could be challenged.
The other clear message from the accounts
provided here was the power of the body building
culture in promoting the importance of
muscularity, of body building as a sport, and of
the use of steroids to promote greater size and
to ensure success in competition. Any harmminimization
or prevention programme needs
to recognize the strong sub-cultural roots of
steroid use. Social support from within (and
outside) the body building culture was cited as
an important incentive for continued use, as was
the perceived indifference of family and friends.
While the body building culture supports
steroid use and while many body builders feel
unable to enter competition without using
steroids, it is unlikely that steroid use will stop.
Work in the USA has shown that peer education
programmes can be effective in reducing intentions
to use steroids, and in preventing use
(e.g. Goldberg et al., 2000). Health professionals
in the UK might be well advised to involve
natural body builders with positive, high-profile
images within the body building community in
presenting health promotion messages. Carefully
targeted role models from within the
body building community are less likely to be
dismissed by users as lacking in relevant
knowledge and experience than are health
professionals from outside the community.
Most previous work has not considered that
fact that British women are increasingly using
steroids for body building. The women interviewed
here were very concerned not to look
‘masculine’, and the masculinizing effects of
steroids (increased hair growth on the face and
body, deepening of the voice) were significant
disincentives to steroid use. No women reported
concerns about liver of kidney damage or
concerns about contracting HIV/AIDS through
infected needles. This may relate to pressures
from wider society to maintain an obviously
‘feminine’ appearance (to contradict the
masculinity implied by the muscles), and also to
pressures from within the body building
community for women competitors (including
those competing in the Physique class) to look
‘feminine’. Choi (2000) and St Martin and
Gavey (1996) argue that women body builders
are placed in the paradoxical position of being
expected deliberately to cultivate muscle bulk
while maintaining a stereotypically ‘feminine’
appearance. Judges tend to emphasize conventional
femininity as a crucial component for
winning. This presents a particular conflict for
those who take steroids, because they exert a
masculinizing effect on the body. Women used
steroids in small amounts, and only at times
leading up to competition, to keep these negative
effects to a minimum. Stressing the likelihood
of masculinizing effects, and effects on
fertility may be as useful in dissuading women
from use as focusing on objectively more serious
side-effects such as liver and kidney damage in
prevention strategies aimed at women.
Clearly, attempts to minimize the harmful
effects of steroids and to prevent use need to be
based in an understanding of the body building
sub-culture, and the social pressures on users
from within the body building community.
Support from within the body building
community is necessary to enable the development
of realistic and credible health promotion
strategies for use with this group, and for the
development of viable prevention programmes.