The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men

Anna L. Goldman; Harrison G. Pope, Jr.; Shalender Bhasin


J Clin Endocrinol Metab. 2019;104(4):1069-1074. 

In This Article

Historical Evolution of the Dual Epidemics of AAS use and Body Image Disorders

Prior to the 1980s, illicit AAS use in the United States was limited largely to elite competitive athletes.[4,6] In the early 1980s, however, with the availability of books on how to obtain and use these substances, AAS use spilled over into the nonathletic community. The growth of AAS use by nonathletes appears to have paralleled an increasing prevalence of concerns about body image among young men—a trend fueled in part by a growing emphasis on a lean and muscular male body appearance in modern societies.[6,8] Men with body image concerns appear to be increasingly susceptible to developing "muscle dysmorphia," recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, as a form of body dysmorphic disorder characterized by a pathological preoccupation with muscularity.[8–12] Individuals with muscle dysmorphia typically spend long hours weightlifting in the gym, and often develop compulsive behaviors such as constantly checking their appearance in the mirror, covering their body with clothes to disguise their perceived "smallness," or refusing to be seen in public situations where their bodies would be visible.[9–11] First described in the 1990s, and now the subject of a growing literature, muscle dysmorphia often significantly compromises social and occupational functioning, is associated with an elevated prevalence of mood and anxiety disorders, and is well established to be a risk factor for AAS use and probably the use of other appearance- and performance-enhancing drugs such as SARMs.[4,9–11]