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Chapter 8 - Exercise and the Use of Image- and Performance-Enhancing Drugs within the Gym Environment

from Section 1 - From Exercise to Addiction: An Introduction to the Phenomenon

Published online by Cambridge University Press:  30 March 2023

By
Jim McVeigh ,
Martin Chandler  and
Gemma Anne Yarwood
Edited by
Ornella Corazza  and
Artemisa Rocha Dores
Ornella Corazza
Affiliation:
University of Hertfordshire and University of Trento, Italy
Artemisa Rocha Dores
Affiliation:
Polytechnic Institute of Porto and University of Porto, Portugal
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Summary

Among the image- and performance-enhancing drugs (IPEDs), anabolic-androgenic steroids (AAS) are now a global public health issue. Once confined to sporting arenas and competitive bodybuilding, they have now reached an increasingly image-conscious general population. In addition to the well-documented evidence of physical harm caused by AAS, there is emerging evidence that in sustained high doses they affect the structure and functioning of the brain. For some of the newer drugs the potential long-term impact is unknown. The risks to health are compounded by polypharmacy, high levels of injecting, and variable product content and contamination resulting from the illicit market. Responses to the issue (i.e., the level and implementation of regulations, education and preventive activities, and treatment and harm reduction) vary. However, there are few data to inform the development of effective interventions, and there is a clear need to develop the evidence base, which requires effective engagement with drug-using populations.

Keywords

anabolic-androgenic steroidsdopingenhancementharm reductionimage- and performance-enhancing drugs
Type
Chapter
Information
The Body in the Mind
Exercise Addiction, Body Image and the Use of Enhancement Drugs
 , pp. 121 - 136
Publisher: Cambridge University Press
Print publication year: 2023

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References

Evans-Brown, M, McVeigh, J, Perkins, C, Bellis, M. Human Enhancement Drugs: The Emerging Challenges to Public Health. North West Public Health Observatory, 2012.Google Scholar
Van de Ven, K, Mulrooney, K, McVeigh, J. An introduction to human enhancement drugs. In: van de Ven, K, Mulrooney, K, McVeigh, J, eds. Human Enhancement Drugs. Routledge, 2020: 1–10.Google Scholar
Elliott, C. Better Than Well: American Medicine Meets the American Dream. W. W. Norton & Company, 2004.Google ScholarPubMed
McVeigh, J, Begley, E. Anabolic steroids in the UK: an increasing issue for public health. Drugs Educ Prev Pol 2017; 24: 278–85.CrossRefGoogle Scholar
Sagoe, D, Molde, H, Andreassen, CS, Torsheim, T, Pallesen, S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann Epidemiol 2014; 24: 383–98.CrossRefGoogle ScholarPubMed
Kanayama, G, Kaufman, MJ, Pope, HG. Public health impact of androgens. Curr Opin Endocrinol Diabetes Obes 2018; 25: 218–23.Google Scholar
McVeigh, J, Evans-Brown, M, Bellis, MA. Human enhancement drugs and the pursuit of perfection. Adicciones 2012; 24: 185–90.Google ScholarPubMed
Llewellyn, W. Anabolics, 11th ed. Molecular Nutrition, 2017.Google Scholar
Taylor, WN. Macho Medicine. McFarland and Company, 1991.Google Scholar
De Kruif, P. The Male Hormone. Brace and Company, 1945.Google Scholar
Koch, FC. The chemistry and biology of male sex hormones. Bull N Y Acad Med 1938; 14: 655–80.Google Scholar
Kicman, AT. Pharmacology of anabolic steroids. Br J Pharmacol 2008; 154: 502–21.CrossRefGoogle ScholarPubMed
Havnes, IA, Jorstad, ML, Innerdal, I, Bjornebekk, A. Anabolic-androgenic steroid use among women – a qualitative study on experiences of masculinizing, gonadal and sexual effects. Int J Drug Policy 2021; 95: 102876.CrossRefGoogle ScholarPubMed
Friedl, KE, Yesalis, CE. Self-treatment of gynecomastia in bodybuilders who use anabolic steroids. Phys Sportsmed 1989; 17: 67–79.CrossRefGoogle ScholarPubMed
Kicman, AT. Pharmacology of anabolic steroids. Br J Pharmacol 2008; 154: 502–21.CrossRefGoogle ScholarPubMed
Hope, VD, McVeigh, J, Marongiu, A et al. Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open 2013; 3: e003207.Google Scholar
Evans-Brown, M, McVeigh, J. Anabolic steroid use in the general population of the United Kingdom. In: Moller, V, McNamee, M, Dimeo, P, eds. Elite Sport, Doping and Public Health. University Press of Southern Denmark, 2010: 75–97.Google Scholar
Begley, E, McVeigh, J, Hope, V et al. Image and Performance Enhancing Drugs 2016 National Survey Results. Public Health Institute, Liverpool John Moores University, 2017.Google Scholar
Korkia, P, Stimson, GV. Anabolic Steroid Use in Great Britain: An Exploratory Investigation. Final Report to the Departments of Health for England, Scotland and Wales. Centre for Research on Drugs and Health Behaviour, 1993.Google Scholar
Lenehan, P, Bellis, MA, McVeigh, J. A study of anabolic steroid use in the North West of England. J Perform Enhanc Drugs 1996; 1: 57–70.Google Scholar
Evans-Brown, M, McVeigh, J. Injecting human growth hormone as a performance-enhancing drug—perspectives from the United Kingdom. J Subst Use 2009; 14: 267–88.Google Scholar
Teichman, SL, Neale, A, Lawrence, B et al. Prolonged stimulation of growth hormone (GH) and insulin-like growth factor I secretion by CJC-1295, a long-acting analog of GH-releasing hormone, in healthy adults. J Clin Endocrinol Metab 2006; 91: 799–805.CrossRefGoogle ScholarPubMed
Matheny, RW Jr, Nindl, BC, Adamo, ML. Minireview: Mechano-growth factor: a putative product of IGF-I gene expression involved in tissue repair and regeneration. Endocrinology 2010; 151: 865–75.CrossRefGoogle ScholarPubMed
Kimergard, A, McVeigh, J, Knutsson, S, Breindahl, T, Stensballe, A. Online marketing of synthetic peptide hormones: poor manufacturing, user safety, and challenges to public health. Drug Test Anal 2014; 6: 396–8.CrossRefGoogle ScholarPubMed
Holt, RIG, Sonksen, PH. Growth hormone, IGF-I and insulin and their abuse in sport. Br J Pharmacol 2008; 154: 542–56.CrossRefGoogle ScholarPubMed
Brennan, R, Wells, JG, Van Hout, MC. An unhealthy glow? A review of melanotan use and associated clinical outcomes. Perform Enhanc Health 2014; 3: 78–92.Google Scholar
Evans-Brown, M, Dawson, R, Chandler, M, McVeigh, J. Use of melanotan I and II in the general population. BMJ 2009; 338: b566.CrossRefGoogle ScholarPubMed
Duchaine, D. Underground Steroid Handbook II. HLR Technical Books, 1989.Google Scholar
Phillips, WN. Anabolic Reference Guide. Mile High Publishing, 1991.Google Scholar
Sagoe, D, McVeigh, J, Bjornebekk, A et al. Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. Subst Abuse Treat Prev Policy 2015; 10: 12.Google Scholar
Kanayama, G, Hudson, JI, DeLuca, J et al. Prolonged hypogonadism in males following withdrawal from anabolic–androgenic steroids: an under‐recognized problem. Addiction 2015; 110: 823–31.Google Scholar
Ainsworth, NP, Vargo, EJ, Petroczi, A. Being in control? A thematic content analysis of 14 in-depth interviews with 2,4-dinitrophenol users. Int J Drug Policy 2018; 52: 106–14.Google Scholar
Spiller, HA, James, KJ, Scholzen, S, Borys, DJ. A descriptive study of adverse events from clenbuterol misuse and abuse for weight loss and bodybuilding. Subst Abuse 2013; 34: 306–12.Google ScholarPubMed
McVeigh, J, Germain, J, Van Hout, MC. 2,4-Dinitrophenol, the inferno drug: a netnographic study of user experiences in the quest for leanness. J Subst Use 2017; 22: 131–8.Google Scholar
Milano, G, Chiappini, S, Mattioli, F, Martelli, A, Schifano, F. β-2 Agonists as misusing drugs? Assessment of both clenbuterol- and salbutamol-related European Medicines Agency Pharmacovigilance Database Reports. Basic Clin Pharmacol Toxicol 2018; 123: 182–7.CrossRefGoogle ScholarPubMed
Ip, EJ, Yadao, MA, Shah, BM et al. Polypharmacy, infectious diseases, sexual behavior, and psychophysical health among anabolic steroid-using homosexual and heterosexual gym patrons in San Francisco’s Castro District. Subst Use Misuse 2017; 52: 959–68.Google Scholar
Pope, HG Jr, Kanayama, G, Athey, A et al. The lifetime prevalence of anabolic–androgenic steroid use and dependence in Americans: current best estimates. Am J Addict 2014; 23: 371–7.Google Scholar
Sagoe, D, Pallesen, S. Androgen abuse epidemiology. Curr Opin Endocrinol Diabetes Obes 2018; 25: 185–94.Google Scholar
Home Office. Drugs Misuse: Findings from the 2018/19 Crime Survey for England and Wales. Office for National Statistics, 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832533/drug-misuse-2019-hosb2119.pdfGoogle Scholar
Advisory Council on the Misuse of Drugs. Consideration of the Anabolic Steroids. Advisory Council on the Misuse of Drugs, 2010. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/119132/anabolic-steroids.pdfGoogle Scholar
McVeigh, J, Beynon, C, Bellis, MA. New challenges for agency based syringe exchange schemes: analysis of 11 years of data (1991–2001) in Merseyside and Cheshire, United Kingdom. Int J Drug Policy 2003; 14: 399–405.Google Scholar
Kimergard, A, McVeigh, J. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. Harm Reduct J 2014; 11: 19.Google Scholar
Christiansen, AV, Vinther, AS, Liokaftos, D. Outline of a typology of men’s use of anabolic androgenic steroids in fitness and strength training environments. Drugs Educ Prev Pol 2016; 24: 295–305.CrossRefGoogle Scholar
Christiansen, AV. Gym Culture, Identity and Performance-Enhancing Drugs: Tracing a Typology of Steroid Use. Routledge, 2020.CrossRefGoogle Scholar
Zahnow, R, McVeigh, J, Bates, G et al. Identifying a typology of men who use anabolic androgenic steroids (AAS). Int J Drug Policy 2018; 55: 105–12.Google Scholar
Ip, EJ, Barnett, MJ, Tenerowicz, MJ et al. Women and anabolic steroids: an analysis of a dozen users. Clin J Sport Med 2010; 20: 475–81.Google Scholar
Evans-Brown, M, Kimergard, A, McVeigh, J. Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derived from the illicit market. Drug Test Anal 2009; 1: 323–6.Google Scholar
Pope, HG, Wood, RI, Rogol, A et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev 2014; 35: 341–75.Google Scholar
Heffernan, TM, Battersby, L, Bishop, P, O’Neill, TS. Everyday memory deficits associated with anabolic-androgenic steroid use in regular gymnasium users. Open Psychiatry J 2015; 9: 1–6.Google Scholar
Bjornebekk, A, Walhovd, KB, Jorstad, ML et al. Structural brain imaging of long-term anabolic-androgenic steroid users and nonusing weightlifters. Biol Psychiatry 2017; 82: 294–302.CrossRefGoogle ScholarPubMed
Hauger, LE, Westlye, LT, Fjell, AM, Walhovd, KB, Bjornebekk, A. Structural brain characteristics of anabolic-androgenic steroid dependence in men. Addiction 2019; 114: 1405–15.CrossRefGoogle ScholarPubMed
Bjornebekk, A, Westlye, LT, Walhovd, KB et al. Cognitive performance and structural brain correlates in long-term anabolic-androgenic steroid exposed and nonexposed weightlifters. Neuropsychology 2019; 33: 547–59.CrossRefGoogle ScholarPubMed
Ip, EJ, Barnett, MJ, Tenerowicz, MJ, Perry, PJ. Weightlifting’s risky new trend: a case series of 41 insulin users. Curr Sports Med Rep 2012; 11: 176–9.Google Scholar
Cutting, WC, Mehrtens, HG, Tainter, ML. Actions and uses of dinitrophenol: promising metabolic applications. JAMA 1933; 101: 193–5.Google Scholar
Dufayet, L, Gorgiard, C, Vayssette, F et al. Death of an apprentice bodybuilder following 2,4-dinitrophenol and clenbuterol intake. Int J Legal Med 2020; 134: 1003–6.Google Scholar
Grundlingh, J, Dargan, PI, El-Zanfaly, M, Wood, DM. 2,4-Dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death. J Med Toxicol 2011; 7: 205–12.Google Scholar
Hope, V, Iversen, J. Infections and risk among people who use image and performance enhancing drugs. In: van de Ven, K, Mulrooney, K, McVeigh, J, eds. Human Enhancement Drugs. Routledge, 2020: 85–100.Google Scholar
Hope, VD, McVeigh, J, Smith, J et al. Low levels of hepatitis C diagnosis and testing uptake among people who inject image and performance enhancing drugs in England and Wales, 2012–15. Drug Alcohol Depend 2017; 179: 83–6.CrossRefGoogle ScholarPubMed
Iversen, J, Hope, VD, McVeigh, J. Access to needle and syringe programs by people who inject image and performance enhancing drugs. Int J Drug Policy 2016; 31: 199–200.CrossRefGoogle ScholarPubMed
Coomber, R, Salinas, M. The supply of Image and Performance Enhancing Drugs (IPED) to local non-elite users in England: resilient traditional and newly emergent methods. In: van de Ven, K, Mulrooney, K, McVeigh, J, eds. Human Enhancement Drugs. Routledge, 2020: 230–46.Google Scholar
Salinas, M, Floodgate, W, Ralphs, R. Polydrug use and polydrug markets amongst image and performance enhancing drug users: implications for harm reduction interventions and drug policy. Int J Drug Policy 2019; 67: 43–51.Google Scholar
Forrest, A. London man convicted over role in £40m international steroid smuggling gang. The Independent, 2019. www.independent.co.uk/news/uk/crime/steroid-smuggling-gang-gurjaipal-dhillon-london-guilty-a8946356.htmlGoogle Scholar
Coomber, R, Moyle, L, Belackov, V et al. The burgeoning recognition and accommodation of the social supply of drugs in international criminal justice systems: an eleven-nation comparative overview. Int J Drug Policy 2018; 58: 93–103.Google Scholar
Turnock, LA. Inside a steroid ‘brewing’ and supply operation in South-West England: an ‘ethnographic narrative case study’. Perform Enhanc Health 2019; 7: 100152.Google Scholar
Hall, A, Antonopoulos, GA. The (online) supply of illicit lifestyle medicines: a criminological study. In: van de Ven, K, Mulrooney, K, McVeigh, J, eds. Human Enhancement Drugs. Routledge, 2020: 173–87.Google Scholar
Corazza, O, Parrott, AC, Demetrovics, Z. Novel psychoactive substances: shedding new lights on the ever-changing drug scenario and the associated health risks. Hum Psychopharmacol 2017; 32: e2616.Google Scholar
Stensballe, A, McVeigh, J, Breindahl, T, Kimergard, A. Synthetic growth hormone releasers detected in seized drugs: new trends in the use of drugs for performance enhancement. Addiction 2015; 110: 368–9.CrossRefGoogle ScholarPubMed
Evans-Brown, M, Kimergård, A, McVeigh, J, Chandler, M, Brandt, SD. Is the breast cancer drug tamoxifen being sold as a bodybuilding dietary supplement? BMJ 2014; 348: g1476.CrossRefGoogle ScholarPubMed
Abbate, V, Kicman, AT, Evans-Brown, M et al. Anabolic steroids detected in bodybuilding dietary supplements – a significant risk to public health. Drug Test Anal 2015; 7: 609–18.Google Scholar
Thomas, A, Kohler, M, Mester, J et al. Identification of the growth-hormone-releasing peptide-2 (GHRP-2) in a nutritional supplement. Drug Test Anal 2010; 2: 144–8.Google Scholar
Kimergard, A, McVeigh, J. Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK. BMJ Open 2014; 4: e005275.Google Scholar
Van de Ven, K. ‘Blurred lines’: anti-doping, national policies, and the performance and image enhancing drug (PIED) market in Belgium and The Netherlands. Perform Enhanc Health 2016; 4: 94–102.CrossRefGoogle Scholar
Havnes, IA, Jorstad, ML, McVeigh, J, Van Hout, MC, Bjornebekk, A. The anabolic androgenic steroid treatment gap: a national study of substance use disorder treatment. Subst Abuse 2020; 14: 1178221820904150.Google Scholar
European Commission. Study on Doping Prevention: A Map of Legal, Regulatory and Prevention Practice Provisions in EU 28. Publications Office of the European Union, 2014. https://ec.europa.eu/assets/eac/sport/news/2014/docs/doping-prevention-report_en.pdfGoogle Scholar
Kleinman, CC, Petit, CE. Legal aspects of anabolic steroid use and abuse. In: Yesalis, CE, ed. Anabolic Steroids in Sport and Exercise, 2nd ed. Human Kinetics Publishers, 2000: 333–59.Google Scholar
Mulrooney, KJD, van de Ven, K, McVeigh, J, Collins, R. Commentary: Steroid madness – has the dark side of anabolic-androgenic steroids (AAS) been over-stated? Perform Enhanc Health 2019; 6: 98–102.Google Scholar
Bates, G, Begley, E, Tod, D et al. A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids. J Health Psychol 2019; 24: 1595–612.CrossRefGoogle ScholarPubMed
Christiansen, AV. Doping in fitness and strength training environments – politics, motives and masculinities. In: Moller, V, McNamee, M, Dimeo, P, eds. Elite Sport, Doping and Public Health. University Press of Southern Denmark, 2010: 99–118.Google Scholar
Havnes, IA, Jorstad, ML, Wisloff, C. Anabolic-androgenic steroid users receiving health-related information: health problems, motivations to quit and treatment desires. Subst Abuse Treat Prev Policy 2019; 14: 20.Google Scholar
Backhouse, SH, Griffiths, C, McKenna, J. Tackling doping in sport: a call to take action on the dopogenic environment. Br J Sports Med 2018; 52: 1485–6.Google Scholar
Bates, G, Tod, D, Leavey, C, McVeigh, J. An evidence-based socioecological framework to understand men’s use of anabolic androgenic steroids and inform interventions in this area. Drugs Educ Prev Pol 2018; 26: 484–92.Google Scholar
Bates, G, Van Hout, MC, Teck, JTW, McVeigh, J. Treatments for people who use anabolic androgenic steroids: a scoping review. Harm Reduct J 2019; 16: 75.CrossRefGoogle ScholarPubMed
Harvey, OA, Keem, S, Parriosh, M, van Teijlingen, E. Support for people who use anabolic androgenic steroids: a systematic scoping review into what they want and what they access. BMC Public Health 2019; 19: 1024.Google Scholar
National Institute for Health and Care Excellence (NICE). Needle and Syringe Programmes. Public health guideline [PH52]. National Institute for Health and Care Excellence, 2014. www.nice.org.uk/guidance/ph52Google Scholar
Harvey, O, Keen, S, Parrish, M, van Teijlingen, E, Trenoweth, S. Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs. Drugs Educ Prev Pol 2019; 27: 377–86.Google Scholar
McVeigh, J, Salinas, M, Ralphs, R. A sentinel population: the public health benefits of monitoring enhanced body builders. Int J Drug Policy, 2021; 95: 102890.Google Scholar

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