Strength is Never a Weakness: Muscle Dysmorphia

Hi Everyone

I hope you are all keeping well

It has been a busy few months for me with work and doing research. I have done two interviews of recent around steroids and hyperandrogenism. I shared them on my personal profile through social media but not on the blog. So here is the first one.

1. Are Steroids becoming increasingly Popular in Gyms? Roundtable Discussion on Turkish Radio and Television

I hope you enjoy it :)

Let me know what you think by leaving a comment below

Kind regards

Andrew

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications:

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.

I had my own business for providing training plans for teams and athletes.

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.

Contact details below;

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7

This article is a condensed version of a university assignment I submitted (as part of one of my assessments last semester) on Androgenic Anabolic Steroid Usage.

*Disclaimer*

This is not an attempt to bash or throw a dig at someone who uses AAS. This is just a review of a meta analysis, which I am hoping to inform and educate my readers with this blog post.

Just because this is a meta analysis, it does not mean we should take its word for it. We should be critical of how it was made, the potential bias of the researcher(s), and the level of rigor for the methodology (validity and reliability).

Remember I am discussing this in the context of recreational usage of AAS, not in the context of competitive sports (they are two entirely different topics of discussion) and as a competitive athlete and member of UK Anti-Doping I am not in favor of using AAS in a tested sporting environment to gain an unfair and non sportsmanship advantage over one's opponent.

Enjoy reading!

Methodology of Literature Review

A literature search was carried out on Sports Discus, Google Scholar and Science Direct with

using keywords “AAS”, “Anabolic Steroids”, “Muscle Dysmorphia”, “Body Image”, and “Anabolic

Steroids Meta-Analysis”. Through analyzing the literature search, the Meta-Analysis entitled

“The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression

analysis” (2014) was found.

Sagoe, D., Molde, H., Andreassen, C.S., Torsheim, T. and Pallesen, S., 2014.
The global epidemiology of anabolic-androgenic steroid use: a meta-analysis
and meta-regression analysis. Annals of epidemiology, 24(5), pp.383-398.

This reviewed 271 papers and was deemed a suitable reference for

analyzing AAS trends over time. To do this, in Appendix 1 the adapted Data Inclusion and

Exclusion Criteria was imposed upon the 271 Journals, 61 of which met the criteria. These papers

were across the following two defined time periods;

1. 1985 – 1999

2. 2000 – 2015

The reason for the two time periods is to compare usage at the turn of the century and then review a

new generation of “AAS users” - 15 years later which may highlight new trends. In addition, the

introduction of certain external factors has made getting AAS easier in the 21st Century. These

time periods are also cross-referenced geographically as follows:

1. United Kingdom

2. North America

3. Rest of World

This is for comparison within each region as different countries have dissimilar laws on accessibility

for AAS. E.g. in the UK it is easier to obtain AAS than in America (Kokkevi, et al, 2008).

Furthermore, data between each geographical area and can be found in Appendices 2 and 3 which

formulated the Flow – Chart 1.0 and 2.0 below.

How has there been such an increase in AAS usage over the last 15 years compared to

1985-1999? There is no one simple answer as there are plenty of contributing multi factorial issues.

If I was to pick three;

• Internet Access: This has to lead to an increase of buying steroids and the most popular place

for internet users is off black market sites and the dark web (DuRant et al., 1993: 923).

• Influence of Social Media: The encouragement of the steroid user has been negatively

influenced by unrealistic images and beliefs circulated on social media. These have massive cult

followings (Instagram) behind them due to their lavish, appealing and large than life lifestyles,
thus encouraging those with already frail perceptions of their masculinity to follow them.
(Field et al, 2005). Again with reference to symbolic violence.

• Job Roles: Police, army, fire service, private security, construction, etc use steroids for their

physical jobs, but there is an increase in other professions such as doctors, coaches and teachers to

use AAS to look and feel powerful and authoritative when dealing with clients or patients

(Kimmel and Mahalik, 2004; Magnolia Pictures & Magnet Releasing, 2008).

Future Research Recommendations and Summary

In order to raise awareness and to help those suffering with BI, MD or perhaps an addiction to AAS,
the Image and Performance Enhancing Drugs (IPEDs) publish literature reviews and steroid
awareness guides within the UK to educate and inform users or potential users as part of the

Lifeline Project (Lifeline, 2017). Another example of a successful scheme is Drugs in
Sport Clinic and User Support (DISCUS) in Durham (Frank, 2016). It ran for fifteen years educating
the public on how to train, eat correctly, use AAS safely and the potential negative side effects of
using AAS, but its funding was cut. This is an issue when one of the local towns (Middlesbrough)
which was named the UK capital for steroid usage (GazetteLive, 2016).

Across the pond, the Adolescents Training and Learning to Avoid Steroids (ATLAS) study in

America (1996) was created to reduce the increase in steroid usage at school level. At the end of

the program, students reported better understanding of the effects (positive and negative) and

also encouraged better lifestyle (diet and training) habits (Goldberg et al, 1996). Regrettably, a

year after the ATLAS program, the American Paediatrician Association stated “to our knowledge,

no study has identified an adolescent population without the temptation and risks of anabolic steroid

use. Furthermore, no study has been published showing a decrease in the prevalence of anabolic

steroid use over time” (Miller et al 2002). This can be evidenced with the data shown in Flow -

Chart 1.0 and 2.0.

What is required is a data analysis on a large scale to determine behavioral tendencies of the 21st

century AAS user. The government needs to recognize this matter and its ultimate effect it will have
on the NHS if unchecked. That way, new intervention programmes can be put into immediate effect
at hospitals and drug/alcohol clinics. This should minimize any increase in ujnderground AAS usage,
eventually reducing it over time whilst decreasing MD and related issues. However, this is easier said
than done as getting access to this data requires having trust within the gym and fitness sub-cultures
to open up about the stigma that surrounds MD and AAS usage and acquisition.

Appendices

Appendix 1: Data Collection Inclusion and Exclusion Criteria to formulate argument:

61 studies were included in this review. Inclusion of these studies was due to them meeting the

following;

I) Male and female included in data collection within respective journals.

II) N sample size value shown (showing both male and female breakdown).

III) % breakdown of AAS used by males and females.

IV) Paper had to contain either one or more of the following keywords; High School/School/

Adolescents/Gym/General/Prison/Ex Prisoner/Prisoner/Drug User/Athlete/Athletics/NFL/Sports.

V) Studies must be within 1985 – 2015.

VI) Studies must show survey response rates.

210 Studies were excluded from the data analysis if they did not meet the following;

I) Studies did not show AAS prevalence rates

II) Studies did not show survey response rates

III) Studies did not show any gender breakdown of sample population

IV) Studies did not show sample sizes

Appendix 2.0 Limitations of the Literature and Data

Within any study or methodology there are some limitations to the data collection which are

identified as follows: regarding questionnaires, it is to be assumed people can lie and that they are

limited to what they can answer (Beiske, 2002) due to the questions that are set. Each studies’

questions will be different to some degree bar a few standardised statements requiring answers.

The can be duplicated if subjects are used more than once, however this is unknown as

participants’ are left out in accordance with the Data Protection Act (Act, 1998). There is

more research being done in the 21^st Century on AAS than in previous years.

This can be shown in the papers

This is due to the popularity of AAS being used and studied at an academic level. Regrettably

this places bias and an unfavorable slant to presenting any case. The data gathered is from

multiple populations so one cannot assume that all AAS users are all athletes, teenagers, males or

females etc. The main purpose was to identify the difference in usage over time. Considering

some of the studies, a few had very poor replies to their questionnaires whereas others were

excellent. These ranged from a 2.7% response to up to 100%.

This no doubt effects the reliability of the study. Adding to that, some studies had very small

sample sizes thus also presenting potentially unrealistic or misleading data (Beiske, 2002). A

significant majority of the studies analysed did not meet the criteria. If they did, the data may

have changed significantly (in favour of an increase usage of AAS). Finally, as previously

mentioned, different countries have different laws on steroid availability and accessibility

(Anabolics.com Advanced Science of Muscle Building, 2017 and Sted-Ed Steroid Education,

2017) which may also affect recruitment numbers for data collection.

To see the breakdown of the papers and the stats they are at the bottom of the page. There is a

big break in the text as the tables extend across the page. Do allow the table to be fully seen

we have had to knock them way down so no adverts down the side will interfere with

them. Apologies for this presentation error bu eblogger does not support formatting tables.

Once both my final Master projects are completed I will write them up on this as it goes
more into detail into AAS culture, gym culture, negatives of social media.

Appendix 3 Table 2.0 Data of all AAS and Non AAS users across 21 Studies over a 15 year period.

1985 - 1999 Timeline of AAS Studies
Geographical area of Investigation	Studies	AAS Usage % (Combined)	Male AAS Usage %	Female AAS Usage %	Sample (N) Size (Combined)	Sample Size Male	Sample Size Female	Sample Size of AAS Users (Combined)	Sample Size of Males who use AAS	Sample Size of Females who use AAS	Study Response Rate %
United Kingdom	4	3.50	3.90	1.80	3576	2870	706	125	112	13	59.50
North America	11	2.80	3.50	2.00	34321	15529	15792	973	650	323	75.20
Rest of World	6	5.88	5.28	1.20	17188	9285	8503	487	386	101	81.50
Combined	21	2.88	4.15	1.77	55085	27684	25001	1585	1148	437	72.00

Appendix 4 Table 3.0 Data of all AAS and Non AAS users across 40 Studies over a 15 year period.

2000 - 2015 Timeline of AAS Studies
Geographical area of Investigation	Studies	AAS Usage % (Combined)	Male AAS Usage %	Female AAS Usage %	Sample (N) Size (Combined)	Sample Size Male	Sample Size Female	Sample Size of AAS Users (Combined)	Sample Size of Males who use AAS	Sample Size of Females who use AAS	Study Response Rate %
United Kingdom	4	41	41.06	0.00....	1408	1383	25	578	576	2	54.40
North America	8	4.04	4.12	3.97	39910	17,308	22,602	1612	713	899	85.40
Rest of World	28	4.79	5.60	3.73	101233	57996	43237	4859	3248	1611	80.62
Combined	40	4.94	5.91	3.81	142,551	76687	65864	7049	4537	2512	73.47