Androgen abuse among gay and bisexual men

Exploring Anabolic Androgenic Steroid Use Among Cisgender Gay, Bisexual, and Queer Men

Importance

Anabolic androgenic steroids (AAS) are disproportionately used by sexual minority men, with the physical and mental health implications of AAS use incompletely understood.

Objective

To understand the reasons for use and health care needs of gay, bisexual, and queer cisgender men using AAS.

Design, Setting, and Participants

This qualitative study was conducted from November 2021 to May 2023 using self-administered questionnaires and semistructured interviews that were transcribed and coded using reflexive thematic analysis. Participants were recruited through convenience and snowball sampling from lesbian, gay, bisexual, transgender, and queer clinical centers in New York, New York, as well as through online platforms. All patients self-identified as cisgender and gay, bisexual, or queer.

Exposures

History of nonprescribed AAS use for a minimum of 8 consecutive weeks was required.

Main Outcomes and Measures

The primary outcomes were reasons for and health implications of AAS use and interactions with health care practitioners, as determined through interviews. Interview transcripts were collected and analyzed.

Results

Thematic saturation was reached after interviews with 12 male participants (mean [SD] age, 44 [11] years), with the majority of participants identifying as gay (10 participants [83%]), White non-Hispanic (9 participants [75%]), being in their 30s and 40s (9 participants [75%]), holding a bachelor's degree or higher (11 participants [92%]), and having used steroids for a mean (SD) of 7.5 (7.1) years. One participant (8%) self-identified as Black, and 2 (17%) identified as Hispanic. Seven men (58%) met the criteria for muscle dysmorphia on screening. Nine overarching themes were found, including internal and external motivators for initial use, continued use because of effectiveness or fear of losses, intensive personal research, physical and emotional harms experienced from use, using community-based harm reduction techniques, frustration with interactions with the medical community focused on AAS cessation, and concerns around the illegality of AAS.

Conclusions and Relevance

In this qualitative study, AAS use among cisgender gay, bisexual, and queer men was found to be associated with multifactorial motivators, including a likely AAS use disorder and muscle dysmorphia. Despite all participants experiencing harms from use, men seeking medical help found insufficient support with practitioners insistent on AAS cessation and, thus, developed their own harm reduction techniques. Further research is needed to assess the utility of practitioner education efforts, the safety and efficacy of community-developed harm reduction methods, and the impact of AAS decriminalization on health care outcomes for this patient population.

Sources of knowledge and truth related to anabolic/androgenic steroid use among two-spirit, gay, bisexual, queer, and other men who have sex with men

OBJECTIVES

This study sought to explore how two-spirit, gay, bisexual, and queer cisgender and transgender (2SGBQ+) men engage with information related to non-prescribed anabolic/androgenic steroid (AAS) use, and how discourses of risk surrounding AASs influence their AAS use practices. Two objectives were achieved: (1) Sources of information that 2SGBQ+ men consulted when considering using AASs were identified and (2) the ways in which discourses of risk shaped 2SGBQ+ men's experiences of using AASs were revealed.

METHODS

Participants were recruited for semi-structured interviews online and through word of mouth. A critical poststructural methodology and theories of risk discourse and biopolitics were used to identify themes and interpret data.

RESULTS

Seventeen interviews were conducted with adult 2SGBQ+ cis and trans men. Three themes emerged: (1) Unauthoritative sources of knowledge and truth sought by current and prospective AAS users were inconsistent and difficult to evaluate; (2) Authoritative sources, including health care providers, reacted inconsistently; and (3) 2SGBQ+ men generated and shared lay knowledges as a form of community-led harm reduction.

CONCLUSION

The complexities of seeking and evaluating information highlight the privileged nature of trustworthy, accurate information on the topic. Risk-as a discursive regime-places 2SGBQ+ male AAS users in the position to produce lay knowledge and cultivate their own "truths" on the topic, which can lead to preventable harm. Public health needs to address these biopolitical effects by considering these lay forms of knowledge as an untapped resource and design accessible and judgement-free AAS use harm reduction programs for 2SGBQ+ AAS users.

Why do queer men experience negative body image? A narrative review and testable stigma model

Queer men (i.e., men who are not heterosexual; sexual minority men) are disproportionately affected by negative body image - they experience greater body dissatisfaction are more likely to develop eating disorders than heterosexual men. While existing literature has examined individual-level predictors of negative body image for queer men, less is known about why queer men as a group are disproportionately affected by negative body image. By synthesising existing theoretical frameworks, research, policy, and media reporting, this narrative review moves towards an understanding of systemic-level negative body image for queer men. Through the lens of hegemonic masculinity, we explain how systemic experiences of stigma work to inform unattainable appearance standards for queer men, and how these standards then contribute to pervasive negative body image concerns among this community. Next, we describe how systemic stigma works to exacerbate negative health outcomes for queer men with body image concerns. Finally, we present a synthesized model of the processes outlined in this review, articulate testable predictions for future studies, and describe practical implications that could be widely employed to improve body image for queer men. Our review is the first to propose a comprehensive explanation of systemic negative body image for queer men.

Body image and associated factors among sexual minority men: A systematic review

Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.

"Guys with Big Muscles Have Misplaced Priorities": Masculinities and Muscularities in Young South Korean Men's Body Image

Men's body image is an issue of increasing importance as related illnesses continue to grow in prevalence around the world. However, cross-cultural attention to men's body image experiences has been relatively understudied. Based on data derived from cognitive anthropological methods of cultural domain analysis, I develop the concept of "muscularities" to more effectively examine the expectations inherent in multifarious models of body image men continuously navigate. Related to but distinct from "masculinities"-the recognition of culture-bound hierarchies of ways of doing-being a man-"muscularities" attends to the culturally particular ways in which muscles are conceived and evaluated as indices of socioeconomic status, intelligence, social skills, and professionalism, to name a few. Young South Korean men's experiences of chan'gŭnyuk ("small muscle") and manŭn kŭnyuk ("large muscle") challenge universalist assumptions about the kinds of muscles people value in global perspective, demonstrate the necessity of recognizing multiple muscularities in research, and encourage new directions of inquiry that attend to the consequences of variable embodiments of muscularities.