madman
Super Moderator
ABSTRACT
Purpose: Anabolic-androgenic steroids (AAS) are used by men for their aesthetic and performance-enhancing effects and are associated with risk for side effects. Our research aims to deepen knowledge and understanding of men´s experiences of using AAS.
Method: This phenomenological study is based on the reflective lifeworld research approach. Lifeworld interviews were conducted with twelve men about their experiences of using AAS.
Results: By using AAS, men strive towards a muscular, strong, and athletic ideal. Self-imposed demands, self-discipline, and performance accelerate male physical development. The perfect male body ideal thus attained is fragile from both an existential and a biological perspective. The perfect self-image can easily be shattered by adversity. A man’s very existence may be jeopardized if the use of AAS is revealed to others or if the body is let down by illness.
Conclusions: Men´s use of AAS is a complex phenomenon. It partly concerns a traditional view of masculinity that is reflected in the community. It requires both broad and deep knowledge and understanding to be able to meet men using AAS in their problems and vulnerability; a meeting that is hampered by their low trust in healthcare, and by the fact that AAS are illegal.
Introduction
Anabolic-androgenic steroids (AAS) are considered to be a health problem because of their adverse effects and their widespread use in many countries (Eklof et al., 2003; Kanayama et al., 2018). AAS are used in supraphysiological doses (Ip et al., 2011; Lood et al., 2012) to attain the anabolic effect (Brower et al., 1994; Petersson et al., 2010) and are hugely effective (Bhasin et al., 1996; Rogerson et al., 2007). Most of the users are males who define themselves as recreational exercisers or bodybuilders (Eklof et al., 2003; Ip et al., 2011; Kanayama et al., 2020). In many parts of the world, men experience dissatisfaction with their bodies (Kelley et al., 2010) which may be a reason for using AAS (Mitchell et al., 2017; Pope et al., 1997). The main motives for using AAS are improvement of body image and appearance or enhancement of performance (Börjesson et al., 2016; Melia et al., 1996; Petersson et al., 2010). Further reported motives are low self-esteem, curiosity, desire for increased braveness, or criminality (Bonnecaze et al., 2020; Ip et al., 2011; Nilsson et al., 2001).
The use of AAS can cause side effects, some are mild while others may be more serious. The risks for side effects increase with higher doses and longer duration (Bolding et al., 2002; Evans, 2004). Typical AAS-induced physical side effects in men include sexual problems most commonly erectile dysfunction and decreased libido, acne, and gynecomastia. An association has been seen with a variety of psychiatric complications (Börjesson et al., 2020; Eklof et al., 2003; Pope & Katz, 1994; Pope et al., 2014). Typical psychiatric side effects include depression, sleep disorders, and mood disturbances (Sjoqvist et al., 2008). AAS use may also increase the risk of cardiovascular complications such as hypertension, disturbances in the cholesterol profile (Chang et al., 2018; Gårevik et al., 2011). Cardiovascular consequences of AAS have received attention due to case reports of sudden or unnatural death (Darke et al., 2014). Swedish legislation forbids the use of AAS, not only the possession and distribution of AAS but also the presence of exogenously AAS in the body.
*This is the first interview study with AAS users that have practiced the reflective lifeworld perspective (Dahlberg et al., 2008) (RLR) with a caring science perspective (Dahlberg, 2011). In this research, we turn to the men themselves and to their lifeworld. The study aims to deepen knowledge and the understanding of men´s experiences of using AAS and explore their lived experiences. Through the RLR approach, we aimed to reach an existential dimension that is missing in previous research. Deeper knowledge is important especially for healthcare professionals since AAS is widespread and may affect an individual´s health.
Results
The results are first presented through the essential structure of meanings, followed by the meaning constituents: the male body ideal as a model; the perfect male identity; individual existence may be jeopardized when demands are too overpowering.
The use of AAS aims to achieve a perfect male body ideal, which traditionally is muscular, strong, athletic, and healthy. Male physical development is accelerated through the use of AAS combined with high self-imposed demands, self-discipline, and performance. A prerequisite for starting to use AAS is having achieved training maturity as well as having self-control and the potential for further physical development. The body is sculpted by a self-centered effort directed towards the desired body ideal. An identity is created and shaped, which over time leads to self-confidence and a positive self-image. An inseparable new self-identity stimulates respect by being impressive, prominent, and dominant. The challenge is to maintain an arduous and disciplined lifestyle. However, both external and internal factors may limit the body as experienced, thus weakening the self-image. The perfect self-image is fragile and can easily be shattered by adversity. The role of the perfect male ideal is maintained in interaction with the environment and kept alive through other people’s confirmation, acceptance, and integrity.
*The male body ideal as a model
*The perfect male identity
*The existence may be jeopardized when demands are too overpowering
Conclusions and clinical implications
Men´s use of AAS is a complex phenomenon. It partly concerns a traditional view of masculinity that is reflected in society. It also involves an individual driving force to achieve a body ideal that has winning characteristics, not only in competitions. This driving force to attract attention and to be the best in the group blinds users to the negative consequences of using AAS, which do not become visible to these men until illness, injury or other dysfunction arises. Bodybuilding seems to be based on low self-esteem and a competitive instinct among men. However, the built-up body is fragile from both an existential and a biological perspective. Self-esteem and self-confidence can quickly be destroyed in the absence of confirmation from others and the side effects of the substances may damage the body in the form of serious physiological disorders.
*Therefore, both broad and deep knowledge and understanding are required to be able to meet these men in their problems and vulnerability, a meeting which is hampered by their low trust in healthcare, and by the fact that the AAS are illegal.
Purpose: Anabolic-androgenic steroids (AAS) are used by men for their aesthetic and performance-enhancing effects and are associated with risk for side effects. Our research aims to deepen knowledge and understanding of men´s experiences of using AAS.
Method: This phenomenological study is based on the reflective lifeworld research approach. Lifeworld interviews were conducted with twelve men about their experiences of using AAS.
Results: By using AAS, men strive towards a muscular, strong, and athletic ideal. Self-imposed demands, self-discipline, and performance accelerate male physical development. The perfect male body ideal thus attained is fragile from both an existential and a biological perspective. The perfect self-image can easily be shattered by adversity. A man’s very existence may be jeopardized if the use of AAS is revealed to others or if the body is let down by illness.
Conclusions: Men´s use of AAS is a complex phenomenon. It partly concerns a traditional view of masculinity that is reflected in the community. It requires both broad and deep knowledge and understanding to be able to meet men using AAS in their problems and vulnerability; a meeting that is hampered by their low trust in healthcare, and by the fact that AAS are illegal.
Introduction
Anabolic-androgenic steroids (AAS) are considered to be a health problem because of their adverse effects and their widespread use in many countries (Eklof et al., 2003; Kanayama et al., 2018). AAS are used in supraphysiological doses (Ip et al., 2011; Lood et al., 2012) to attain the anabolic effect (Brower et al., 1994; Petersson et al., 2010) and are hugely effective (Bhasin et al., 1996; Rogerson et al., 2007). Most of the users are males who define themselves as recreational exercisers or bodybuilders (Eklof et al., 2003; Ip et al., 2011; Kanayama et al., 2020). In many parts of the world, men experience dissatisfaction with their bodies (Kelley et al., 2010) which may be a reason for using AAS (Mitchell et al., 2017; Pope et al., 1997). The main motives for using AAS are improvement of body image and appearance or enhancement of performance (Börjesson et al., 2016; Melia et al., 1996; Petersson et al., 2010). Further reported motives are low self-esteem, curiosity, desire for increased braveness, or criminality (Bonnecaze et al., 2020; Ip et al., 2011; Nilsson et al., 2001).
The use of AAS can cause side effects, some are mild while others may be more serious. The risks for side effects increase with higher doses and longer duration (Bolding et al., 2002; Evans, 2004). Typical AAS-induced physical side effects in men include sexual problems most commonly erectile dysfunction and decreased libido, acne, and gynecomastia. An association has been seen with a variety of psychiatric complications (Börjesson et al., 2020; Eklof et al., 2003; Pope & Katz, 1994; Pope et al., 2014). Typical psychiatric side effects include depression, sleep disorders, and mood disturbances (Sjoqvist et al., 2008). AAS use may also increase the risk of cardiovascular complications such as hypertension, disturbances in the cholesterol profile (Chang et al., 2018; Gårevik et al., 2011). Cardiovascular consequences of AAS have received attention due to case reports of sudden or unnatural death (Darke et al., 2014). Swedish legislation forbids the use of AAS, not only the possession and distribution of AAS but also the presence of exogenously AAS in the body.
*This is the first interview study with AAS users that have practiced the reflective lifeworld perspective (Dahlberg et al., 2008) (RLR) with a caring science perspective (Dahlberg, 2011). In this research, we turn to the men themselves and to their lifeworld. The study aims to deepen knowledge and the understanding of men´s experiences of using AAS and explore their lived experiences. Through the RLR approach, we aimed to reach an existential dimension that is missing in previous research. Deeper knowledge is important especially for healthcare professionals since AAS is widespread and may affect an individual´s health.
Results
The results are first presented through the essential structure of meanings, followed by the meaning constituents: the male body ideal as a model; the perfect male identity; individual existence may be jeopardized when demands are too overpowering.
The use of AAS aims to achieve a perfect male body ideal, which traditionally is muscular, strong, athletic, and healthy. Male physical development is accelerated through the use of AAS combined with high self-imposed demands, self-discipline, and performance. A prerequisite for starting to use AAS is having achieved training maturity as well as having self-control and the potential for further physical development. The body is sculpted by a self-centered effort directed towards the desired body ideal. An identity is created and shaped, which over time leads to self-confidence and a positive self-image. An inseparable new self-identity stimulates respect by being impressive, prominent, and dominant. The challenge is to maintain an arduous and disciplined lifestyle. However, both external and internal factors may limit the body as experienced, thus weakening the self-image. The perfect self-image is fragile and can easily be shattered by adversity. The role of the perfect male ideal is maintained in interaction with the environment and kept alive through other people’s confirmation, acceptance, and integrity.
*The male body ideal as a model
*The perfect male identity
*The existence may be jeopardized when demands are too overpowering
Conclusions and clinical implications
Men´s use of AAS is a complex phenomenon. It partly concerns a traditional view of masculinity that is reflected in society. It also involves an individual driving force to achieve a body ideal that has winning characteristics, not only in competitions. This driving force to attract attention and to be the best in the group blinds users to the negative consequences of using AAS, which do not become visible to these men until illness, injury or other dysfunction arises. Bodybuilding seems to be based on low self-esteem and a competitive instinct among men. However, the built-up body is fragile from both an existential and a biological perspective. Self-esteem and self-confidence can quickly be destroyed in the absence of confirmation from others and the side effects of the substances may damage the body in the form of serious physiological disorders.
*Therefore, both broad and deep knowledge and understanding are required to be able to meet these men in their problems and vulnerability, a meeting which is hampered by their low trust in healthcare, and by the fact that the AAS are illegal.
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