Social Media, Body Image and Resistance Training: Creating the Perfect 'Me' with Dietary Supplements, Anabolic Steroids and SARM's

Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review

BACKGROUND

Selective androgen receptor modulators (SARMs) are small-molecule compounds that exert agonist and antagonist effects on androgen receptors in a tissue-specific fashion. Because of their performance-enhancing implications, SARMs are increasingly abused by athletes. To date, SARMs have no Food and Drug Administration approved use, and recent case reports associate the use of SARMs with deleterious effects such as drug-induced liver injury, myocarditis, and tendon rupture.

PURPOSE

(1) To provide a comprehensive synthesis of the literature pertaining to SARMs from a sports medicine perspective and (2) to provide a better understanding of the clinical effects, treatment protocols, prevalence, and potential contamination associated with athlete-consumed SARMs.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic review of the English-language literature from PubMed, Cochrane, and Embase databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles relevant to SARM clinical outcomes, elimination profiles, contamination, safety profiles, prevalence, and doping control were included.

RESULTS

A total of 72 articles from 2003 to 2022 were identified for inclusion. The prevalence of SARM use among athletes is estimated to be 1% to 3%. SARM preclinical and clinical studies reported significant increases in lean body mass and side effects-including bone remodeling, testosterone suppression, and kidney, liver, and prostate enlargement. Thirteen case reports described 15 cases of SARM abuse. All described patients were men, with a median age of 32 years (range, 19-52 years), more than half were identified as athletes (8/15), and all ingested SARMs orally for a mean course of 8 weeks. Five patients described in the case reports explicitly denied "illicit drug use," implying patients may believe their use to be legal. Athletes most commonly purchased SARMs online, and most of these compounds have been shown to be contaminated with other substances, contributing to adverse effects. Athletes reported consuming SARMs at much higher doses than clinically studied, which may increase the risk of the reported side effects, such as liver injury, impaired insulin sensitivity, cardiovascular events, and tendon damage.

CONCLUSION

The results of this systematic review serve to educate sports medicine clinicians and researchers on how to better identify, diagnose, and treat athlete SARM abuse. SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body-including prostate enlargement and serum testosterone suppression. Identifying and treating SARM abuse requires taking a thorough substance and supplement use history with open communication, providing literature-supported patient education, negotiating SARM discontinuation, and performing multidisciplinary treatment of adverse events. Athlete SARM abuse is increasingly widespread and unsafe, and public health oversight bodies should advocate for regulation of these gray-market compounds.

Modeling Evasive Response Bias in Randomized Response: Cheater Detection Versus Self-protective No-Saying

Randomized response is an interview technique for sensitive questions designed to eliminate evasive response bias. Since this elimination is only partially successful, two models have been proposed for modeling evasive response bias: the cheater detection model for a design with two sub-samples with different randomization probabilities and the self-protective no sayers model for a design with multiple sensitive questions. This paper shows the correspondence between these models, and introduces models for the new, hybrid "ever/last year" design that account for self-protective no saying and cheating. The model for one set of ever/last year questions has a degree of freedom that can be used for the inclusion of a response bias parameter. Models with multiple degrees of freedom are introduced for extensions of the design with a third randomized response question and a second set of ever/last year questions. The models are illustrated with two surveys on doping use. We conclude with a discussion of the pros and cons of the ever/last year design and its potential for future research.

Youth and Adolescent Athlete Musculoskeletal Health: Dietary and Nutritional Strategies to Optimise Injury Prevention and Support Recovery

Background: Despite the well-documented benefits of exercise and sports participation, young athletes are particularly vulnerable to musculoskeletal injuries. This is especially true during periods of rapid growth, sports specialisation, and high training loads. While injuries are an inevitable aspect of sports participation, the risk can be minimised by promoting the development of strong, resilient tissues through proper nutrition and injury prevention strategies. Moreover, targeted nutrition strategies can accelerate recovery and rehabilitation, allowing for a quicker return to sports participation. Methods: This narrative review synthesises scientific evidence with practical insights to offer comprehensive dietary recommendations aimed at strengthening tissues and supporting the healing process during recovery and rehabilitation. The selection of all sources cited and synthesised in this narrative review were agreed upon by contributing author consensus, experts in sports nutrition (R.A., H.V., B.D.) and exercise and sports medicine (M.H.). Results: Key topics include factors that contribute to injury susceptibility, general dietary recommendations for growth and development, sports nutrition guidelines, and nutrition considerations during injury and rehabilitation. This review also addresses external factors that may lead to suboptimal nutrition, such as food literacy and eating disorders. Conclusions: By highlighting these factors, this article aims to equip coaches, nutritionists, dietitians, athletic trainers, physical therapists, parents/guardians, sporting organisations, and schools with essential knowledge to implement effective nutritional strategies for injury prevention, recovery, and rehabilitation, ultimately enhancing long-term health and athletic performance.

Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis

OBJECTIVE

To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey.

ELIGIBILITY CRITERIA

Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables.

RESULTS

We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=-0.21, 95% CI (-0.31 to -0.12)) and doping use (g=-0.08, 95% CI (-0.14 to -0.03), but not inadvertent doping (g=-0.70, 95% CI (-1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=-0.28, 95% CI -0.31 to -0.24), doping use (z=-0.09, 95% CI -0.13 to to -0.05) and inadvertent doping (z=-0.19, 95% CI -0.32 to -0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI -0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality.

CONCLUSION

This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions.

Health-Related Quality of Life in Rugby Athletes: The Role of Dietary Supplements and Their Consumption

This study investigates dietary supplement use among rugby players and their general health, focusing on prevalence and underlying motivations. Involving 92 athletes, it examines the relationship between supplement usage, motivations, and health outcomes using the 36-item Short Form Health Survey and a 24-item ad hoc questionnaire. Findings reveal a high frequency of supplement usage, motivated by desires to enhance performance, appearance, and mood. Significant differences in health-related quality of life are found between users and non-users, particularly in mental health, social functioning, and emotional stability. Motivations like performance enhancement and body shape manipulation were linked to altered health perceptions, indicating the psychosocial impacts of supplementation. This study emphasizes the need to consider the holistic effects of supplements on athlete well-being, advocating for a balanced approach prioritizing both physical and mental health. It calls for increased awareness among athletes, coaches, and sports professionals about the potential risks and benefits of supplement use and the importance of informed decision-making. Additionally, it highlights the need for further research to understand the mechanisms of supplement use and its impact on athlete health, aiming to enhance sports science and promote overall athlete well-being in competitive environments.

Myopericarditis Following Use of Selective Androgen Receptor Modifier "RAD-140"

We report the case of a 16-year-old boy who had myopericarditis following the first dose of a selective androgen receptor modulator called Testolone ("RAD-140"). These drugs are widely abused by physically active young adults; however, the drugs' side effects, which can be life-threatening, are not well characterized.

Effect of Social Media on Diet, Lifestyle, and Performance of Athletes: A Review of Current Evidence

PURPOSE OF REVIEW

Social media (SM) plays an important role in providing diet and health advice to athletes, but it also carries with it a risk of credibility in the information sought for and received. The objective of this review is to assess the knowledge gap on how SM influences dietary and lifestyle practices in athletes.

RECENT FINDINGS

For this, relevant literature was searched in three leading databases with appropriate keywords, which were subjected to proper scrutiny that led to inclusion of 22 articles (original research papers, reviews, viewpoints, and commentaries). The current era of digitalization has seen an over-reliance on internet and SM for nutrition and lifestyle advice for an athlete. SM has become a powerful tool in athlete's choice of food, nutrition information, healthy living, and performance, with merits and demerits. Their role in choosing dietary supplements and particular food types (e.g., ketogenic diet), body image, self-esteem and eating disorders, and in lifestyle and performance are discussed. SM should be used with caution and should not be used alone as a source of information for nutrition related pieces of advise by athletes. Any food type and supplements trending in SM should be discussed with a sports nutritionist before consumption. SM influencers having a big follower base may not always be disseminating the right knowledge on food and nutrition, thus caution should be exercised. For optimal benefit to the athlete, SM information should be in alignment with recommendations provided by sports nutrition and coaches.

Selective Androgen Receptor Modulators-Transformative Drugs or Heralds of the Next Drug Epidemic?

This Viewpoint examines whether selective androgen receptor modulators have the potential to be transformative drugs or whether they herald the next drug epidemic.

Identifying methods used to manage weight and shape by first year university students: A qualitative analysis

OBJECTIVE

To identify current strategies used by first-year university students to lose weight, maintain weight, or change their body shape.

METHODS

First-year university students (n = 661) completed an open-ended, web-based survey. Cross-sectional data were analyzed qualitatively using a reflexive thematic approach to identify strategies used to lose weight, maintain weight, or alter body shape/composition. Thematic maps were constructed for each weight- and shape-related goal.

RESULTS

Four main types of strategies were used to achieve all three weight or shape-related goals among first-year college students: changes in diet, changes in exercise, self-monitoring, and disordered eating. One behavioral strategy observed across all weight-related goals was prioritizing protein consumption, including protein gained from supplementation. However, there were also differences in strategies by weight- or shape-related goal. For example, only participants aiming to lose or maintain weight reported mindful strategies for monitoring diet. Individuals aiming to alter body composition reported heterogeneity in goal-related intentions, targeting specific body parts through exercise, and extensive supplement use.

CONCLUSIONS

First-year college students use a variety of strategies to manage their weight and shape. Some strategies were observed across goals, whereas others are specific to the weight- or shape-related goal. More research is needed to understand the impacts, both positive and negative, of using the strategies identified in the present study.

The dichotomy between health and drug abuse in bodybuilding

Aim: The aim of the present study was to investigate the expansion and prevalence of anabolic steroid use by examining the divergent effects between health and drug abuse and to create more awareness around the harmful consequences of these drugs when administered at abusive levels. Methods: A focused and concise literature search was conducted, and 101 high-quality articles were included in the review. Results: The findings underscore the adverse health risks of steroid abuse, emphasizing the stark contrast between health and drug abuse. Conclusions: While steroids and other performance-enhancing drugs can yield muscle growth, strength and even fat loss, abusing these substances can lead to adverse health outcomes. Furthermore, within the fitness subculture, particularly in the realm of bodybuilding, steroid abuse fosters an atmosphere of cheating and deception, frequently downplaying or ignoring the negative and sometimes deadly consequences it brings.

Illegal products containing selective androgen receptor modulators purchased online from Italy: health risks for consumers

Background

Selective androgen receptor modulators (SARMs) are small synthetic drug molecules that are still not approved as medicine in Europe or the United States but are sold on illegal websites to improve sport performance, particularly bodybuilding.

Aim

To address the quality issues of illegal SARM products and their increasing diffusion in Italy with their potential health risks for consumers.

Methods

Web-based tools were used to investigate retail websites, trending searches, and information exchange via social media. Thirteen SARM products, purchased on retail websites accessible from Italy, were subject to visual inspection and chemical analysis by mass spectrometry and quantitative nuclear magnetic resonance.

Outcomes

The primary outcome was demonstration of additional health risks due to the illicit presence of other active ingredients, contamination, and misdosage in SARM products sold on the internet. The secondary outcome was to show the increasing trend of interest in Italy for these products.

Results

Most websites reported misleading information; specifically, the statement "for research only" was reported notwithstanding indications on dosage and training phases. The trending search showed that interest toward SARMs increased in Italy in the last years. The use of these products is clearly encouraged by the emerging phenomenon of "broscience" as revealed in socials. Visual inspection evidenced nonconform labeling. Qualitative analysis confirmed the presence of the stated SARM in about 70% of samples. In 23% of samples, the expected SARM was not detected but a different one instead, and in 1 sample, no SARMs were detected. Other undeclared pharmaceutical substances (tamoxifen, clomifene, testosterone, epimethandienone, tadalafil) were measured in 30% of samples. The copresence of >1 active substance was observed in >60% of samples. Quantitative nuclear magnetic resonance data showed nonuniform content ranging from 30% to 90% of the label claim.

Clinical Implications

The use of SARMs, in the presence of unexpected life-threatening reactions in persons using the products to increase sport performance, should be assessed.

Strengths and Limitations

This investigation involved an integrated approach to study SARM products and related sociologic aspects. The main shortcomings are the limited number of samples and retail websites in the clear web investigated.

Conclusion

SARMs sold online as food supplement-like products represent a health hazard due to the presence of unapproved and undeclared active substances. The presence of contaminants clearly indicates the absence of good manufacturing practices in the production, which increases the health risks.

Exploring the prevalence of anabolic steroid use among men and women resistance training practitioners after the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has had a significant impact on individual health and fitness routines globally. Resistance training, in particular, has become increasingly popular among men and women looking to maintain or improve their physical fitness during the pandemic. However, using Anabolic Steroids (AS) for performance enhancement in resistance training has known adverse effects. Thus, this study aimed to explore the prevalence of AS use among men and women resistance training practitioners after the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted among 3,603 resistance training practitioners (1,855 men and 1,748 women) in various geographical locations impacted by COVID-19. The participants were asked to complete self-administered questionnaires, which included questions regarding demographic information, training habits, and current or prior usage of AS. The data were analyzed using SPSS statistical software and the chi-square method, with a significance level of (P < 0.05).

RESULTS

A total of 3603 men and women resistance training practitioners completed the survey. In the study, 53.05% of men and 41.99% of women used anabolic and androgenic steroids. Of those men who used steroids, 29.47% used Testosterone, while 31.20% of women used Winstrol. Additionally, 50.30% of men used steroids via injection, while 49.05% of women used them orally. According to the study, 49.99% of the participants had 6 to 12 months of experience with resistance training, and 64.25% of them underwent three training sessions per week. The analysis using the χ2 test did not reveal any significant difference between men and women in terms of duration of bodybuilding, frequency per week, and engagement in other activities.

CONCLUSION

This study shows that a significant proportion of men and women resistance training practitioners used AS, particularly among young adults with limited training experience. Thus, there is a need for targeted education and awareness campaigns to address the hazards of AS use and promote healthy training habits during the COVID-19 pandemic.

Selective androgen receptor modulator use and related adverse events including drug-induced liver injury: Analysis of suspected cases

PURPOSE

Selective androgen receptor modulators (SARMs) have demonstrated agonist activity on the androgen receptor in various tissues, stimulating muscle mass growth and improving bone reconstruction. Despite being in clinical trials, none has been approved by the Food and Drug Administration (FDA) or European Medicines Agency for pharmacotherapy. Still, SARMs are very popular as performance-enhancing drugs. The FDA has issued warnings about the health risks associated with SARMs, but the long-term exposure and possible adverse events still need to be fully understood. This review aims to evaluate the adverse events associated with using SARMs by humans.

METHODS

PubMed database was searched from September 16, 2022, to October 2, 2023. In total, 20 records were included in the final review. Data from preclinical and clinical studies supported the review.

RESULTS

Since 2020, 20 reports of adverse events, most described as drug-induced liver injury associated with the use of SARM agonists, have been published. The main symptoms mentioned were cholestatic or hepatocellular liver injury and jaundice. Limited data are related to the dosages and purity of SARM supplements.

CONCLUSION

Promoting SARMs as an anabolic agent in combination with other performance-enhancing drugs poses a risk to users not only due to doping controls but also to health safety. The lack of quality control of consumed supplements makes it very difficult to assess the direct impact of SARMs on the liver and their potential hepatotoxic effects. Therefore, more detailed analyses are needed to determine the safety of using SARMs.

Analyzing Social Media Policies on Muscle-Building Drugs and Dietary Supplements

BACKGROUND

Use of legal and illegal muscle-building drugs and dietary supplements has been linked to many adverse health and social outcomes. Research has shown that social media use is associated with the use of these drugs and dietary supplements; however, it remains unknown whether social media companies have specific policies related to the content and advertising of muscle-building drugs and dietary supplements on their platforms. Therefore, this study aimed to assess the content and advertising policies of eight popular social media companies related to muscle-building drugs and dietary supplements.

METHODS

Content and advertising policies for YouTube, TikTok, Instagram, Snapchat, Facebook, Twitter, Twitch, and Reddit were analyzed in November 2022 to determine whether there were any provisions related to legal (e.g., whey protein) and illegal (e.g., anabolic-androgenic steroids) muscle-building drugs and dietary supplements. Policies were classified as either none, restricted, or prohibited.

RESULTS

All eight social media platforms had explicit policies prohibiting user-generated content and advertising of illicit drugs and substances (e.g., anabolic-androgenic steroids). User-generated content and advertising policies related to legal muscle-building dietary supplements across the platforms varied; however, none of the eight social media companies had a specific policy regarding user content.

CONCLUSIONS

Findings underscore the need for stronger social media content and advertising policies related to legal muscle-building dietary supplements.

Surveys on androgen abuse: a review of recent research

PURPOSE OF REVIEW

To summarize recent survey research on androgen abuse [i.e., anabolic-androgenic steroids (AAS)], including prevalence among international samples, risk factors for use, associated impairments of use, and treatment and interventions for abusers.

RECENT FINDINGS

Recent research has documented the prevalence of androgens abuse remains most common among boys and men compared to girls and women, which was stable across nations. However, fewer studies have focused on population-based samples and instead focused on convenience or high-risk samples (i.e., gym goers). Androgen abusers commonly report a history of violent victimization, including adverse childhood experiences. Research continues to document many adverse biological, psychological, and social effects related to androgen abuse, including more than 50% of abusers reporting at least one side effect. Mental health problems and polysubstance use continues to be highly prevalent among androgen abusers. Despite these adverse effects from use, there remains little survey research on treatment and interventions for androgen abusers, representing an important area of future investigation.

SUMMARY

Androgen abuse remains relatively common, particularly among boys and men, with adverse health effects regularly occurring. Healthcare professionals and systems can adapt their treatment approaches to focus on reducing harms associated with androgen abuse.

Association between the use of muscle-building supplements and DNA damage in resistance training practitioners

OBJECTIVES

Little is known about the relationship between the supplements used for sport and safety, especially regarding the induction of genotoxicity. Therefore, more knowledge about a DNA damage possibly caused using sport supplements is necessary. The aim of this study was to investigate the potential association between the use of muscle-building supplements and DNA damage in resistance training practitioners.

METHODS

Muscle-building supplements were classified into three categories based on evidence of efficacy and safety: Strong Evidence to Support Efficacy and Apparently Safe (SESEAS); Limited or Mixed Evidence to Support Efficacy (LMESE), and Little to No Evidence to Support Efficacy and/or Safety (LNESES). DNA damage was evaluated by the comet assay (DNA damage index and frequency) and buccal micronucleus by the cytome assay (micronuclei and nuclear buds). In the sequence, the adjusted analysis of covariance was performed. This study included 307 individuals ages 37.99 ± 13.95 y (52.1% men), of which 157 consumed supplements.

RESULTS

The results of the comet assay revealed that participants who used supplements had higher DNA damage indexes (P = 0.018) and damage frequency (P = 0.045) than those who reported using no supplements. Moreover, the comet assay also indicated that the participants who used supplements classified into the SESEAS category presented the highest DNA damage index (P = 0.025) and frequency (P = 0.044) compared with those who used no supplements. However, we found no significant difference in the micronuclei and nuclear buds in the evaluated groups (P > 0.05).

CONCLUSION

Supplement use is not associated with permanent damage, suggesting that SESEAS supplements are safe for consumption.

Cutaneous Manifestations of Anabolic-Androgenic Steroid Use in Bodybuilders and the Dermatologist's Role in Patient Care

Young adults have been increasingly facing pressure to achieve an appealing athletic physique, often influenced by social media influencers on platforms like Instagram. This viewpoint highlights the association between image-centric social media, dissatisfied body image, the use of anabolic-androgenic steroids (AAS) to achieve desired results, and the overlooked dermatological side effects of AAS, including acne and acne fulminans. We underscore the importance of recognizing acne fulminans as an indicator of possible AAS abuse and encourage dermatologists to actively identify and address AAS use to improve their patients' well-being.

Androgen Receptor and Cardiovascular Disease: A Potential Risk for the Abuse of Supplements Containing Selective Androgen Receptor Modulators

The androgen receptor (AR) is a member of the family of ligand-activated transcription factors. Selective androgen receptor modulators (SARMs) exert their biological function through complex interactions with the AR. It has been speculated that overexertion of AR signaling cascades as a result of SARM abuse can be a risk factor for the development of various cardiovascular diseases. The present literature review explores the implications of the interaction between SARMs and the AR on cardiovascular health by focusing on the AR structure, function, and mechanisms of action, as well as the current clinical literature on various SARMs. It is shown that SARMs may increase the risk of cardiovascular diseases through implications on the renin-angiotensin system, smooth muscle cells, sympathetic nervous system, lipid profile, inflammation, platelet activity, and various other factors. More research on this topic is necessary as SARM abuse is becoming increasingly common. There is a noticeable lack of clinical trials and literature on the relationship between SARMs, cardiovascular diseases, and the AR. Future in vivo and in vitro studies within this field are vital to understand the mechanisms that underpin these complex interactions and risk factors.

The Prevalence and Awareness of Dietary Supplement Use Among Saudi Women Visiting Fitness Centers in Riyadh, Saudi Arabia

Background Dietary supplements are used for a variety of reasons, some of which are for medical conditions, to compensate for dietary insufficiency, to improve physical performance, and to boost immunity. Generally, individuals who visit sports facilities seek different benefits; it could be for health and well-being, to achieve the desired body shape, for enjoyment purposes, or as a way to socialize. To help achieve some of these goals, dietary supplements can be taken. Aims This study is designed to assess the prevalence and awareness of dietary supplement use among Saudi women who frequent fitness centers in Riyadh, Saudi Arabia. Methods A cross-sectional study was conducted in November 2021 among Saudi women who visited gyms in Riyadh, Saudi Arabia. The sample consisted of 355 participants, all of whom were women from Saudi Arabia. The statistical analysis was done using IBM Statistical Package for Social Sciences (SPSS), Version 21.0 (Armonk, NY: IBM Corp.). Necessary statistical tests such as the chi-square, the t-test, and other appropriate tests were used. A p-value of less than 0.05 has been adopted for statistical significance. Results The majority of the 355 female participants consumed dietary supplements (68.7%). The most commonly used supplements were vitamins (82.8%), amino acids and proteins (30.3%), minerals (22.1%), and fatty acids (3.3%). In the study group, 53.3% of those who were using or used supplements had previous knowledge; 13.1% were up-to-date; and 33.6% weren't. No relationship was found between supplement use and educational level, weight, body mass index (BMI), or marital status. Conclusion Dietary supplement use is common among women who visited gyms in Saudi Arabia. Vitamins were the most commonly used supplements, which suggests that users were more concerned about general health and diet deficiencies than anything else. The participants use dietary supplements cautiously; the majority consume dietary supplements under a doctor's prescription and after reading the leaflets.

Evidence of use and users of image- and performance-enhancing drugs in sports in Switzerland: a scoping literature review and implications for Swiss drug policy

BACKGROUND

"Image- and performance-enhancing drugs" are widely used in sports worldwide to improve body image and performance goals. In view of the growing research interest and use of these substances, and the paucity of data on the situation in Switzerland, we conducted a scoping literature review on evidence of the use and users of these substances in Switzerland.

METHODS

A scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement. We searched PubMed/Medline, Embase and Google Scholar for articles published before August 2022. Primary outcomes were evidence of the use and users of image- and performance enhancing drugs in Switzerland. We used a narrative synthesis approach for data analysis.

RESULTS

Overall, 18 studies were reviewed, which in total comprised 11,401 survey participants, 140 interviews and 1368 toxicologically analysed substances. Articles were mostly peer-reviewed (83%) and mostly included evidence from professional athletes (43%). The mean publication year was 2011. In most articles both outcomes (78%) were evaluated simultaneously. We demonstrate that image- and performance-enhancing drugs appear to be prevalent among athletes and non-athletes in Switzerland. A wide variety of substances exist, and the type of substances used varied by age, motivation, sex and sports discipline. The main motivations for using these substances were, among others, image- and performance enhancement. The main route of acquisition of these substances was the Internet. Furthermore, we demonstrated that substantial proportions of these substances, as well as supplements, may be counterfeit. Information on image- and performance-enhancing drug use was acquired from different sources.

CONCLUSIONS

Although evidence of image- and performance-enhancing drug use and its users in Switzerland is scarce and there are major gaps, we demonstrate that these substances are also prevalent among athletes and non-athletes in Switzerland. Furthermore, high proportions of substances acquired from unregulated drug markets are counterfeit, which puts users in a situation of unpredictable risk when consuming them. Overall, the use of these substances may pose a substantial risk to individual and public health in this possibly growing and often insufficiently informed and medically neglected user community in Switzerland. There is a great need for future research, as well as prevention, harm-reduction and treatment programmes for this hard-to-reach user community. Doping policies in Switzerland should be critically reviewed as simple medical care and evidence-based treatment for non-athlete image- and performance-enhancing drug users is excessively criminalized under the current legislature, leaving possibly over 200,000 image- and performance-enhancing drug users in Switzerland with inadequate medical care.

Systematic Review of Safety of Selective Androgen Receptor Modulators in Healthy Adults: Implications for Recreational Users

Selective Androgen Receptor Modulators (SARMs) are not FDA approved, and obtaining SARMs for personal use is illegal. Nevertheless, SARM use is increasingly popular amongst recreational athletes. Recent case reports of drug-induced liver injury (DILI) and tendon rupture raise serious concerns for the safety of recreational SARM users. On 10 November 2022 PubMed, Scopus, Web of Science, and ClinicalTrials.gov were searched for studies that reported safety data of SARMs. A multi-tiered screening approach was utilized, and any study or case report of generally healthy individuals exposed to any SARM was included. Thirty-three studies were included in the review with 15 case reports or case series and 18 clinical trials (total patients N = 2136 patients, exposed to SARM N = 1447). There were case reports of drug-induced liver injury (DILI) (N = 15), Achilles tendon rupture (N = 1), rhabdomyolysis (N = 1), and mild reversible liver enzyme elevation (N = 1). Elevated alanine aminotransferase (ALT) was commonly reported in clinical trials in patients exposed to SARM (mean 7.1% across trials). Two individuals exposed to GSK2881078 in a clinical trial were reported to have rhabdomyolysis. Recreational SARM use should be strongly discouraged, and the risks of DILI, rhabdomyolysis, and tendon rupture should be emphasized. However, despite warnings, if a patient refuses to discontinue SARM use, ALT monitoring or dose reduction may improve early detection and prevention of DILI.

Social media may cause emergent SARMs abuse by athletes: a content quality analysis of the most popular YouTube videos

OBJECTIVES

Selective Androgen Receptor Modulators (SARMs) social media interest is at an all-time high. The aim of this study is to analyze the: (1) quality; (2) educational content; and (3) reliability of the most relevant YouTube videos on SARMs to explain growing SARMs abuse by recreational and professional athletes.

METHODS

'SARMs' was queried (28 November 2021) through the YouTube video library. The top 100 videos filtered by relevance were categorized by source, type of content, educational quality by Global Quality Score (GQS), reliability by Journal of American Medicine Association (JAMA) criteria, YouTube tags, attitude toward SARMs use, and whether the video provided specific support on how to use SARMs. For all outcome variables, descriptive statistics and comparison among source types and category types were performed.

RESULTS

Mean JAMA score was 1.6 ± 0.7 out of 4. Mean GQS score was 2.5 ± 1.1 out of 5. Patient videos were of lower educational quality than athletic trainer videos (GQS: 2.11 ± 0.95 vs. 2.95 ± 1.00, p < 0.01), and videos categorized as user experience were of lower educational quality than videos categorized as general SARMs information (GQS: 1.92 ± 0.90 vs. 2.72 ± 1.07, p < 0.05). User experience and dosing recommendation videos were statistically significantly more positive in attitude than both general SARMs information and SARMS vs. other PEDs.

CONCLUSION

Quality, content, and reliability of SARMs YouTube videos was low. Social media likely causes SARMs abuse through disseminating biased SARMs misinformation. These results serve to educate public health oversight bodies, healthcare providers, and sports team members to better identify signs of SARMs abuse, and promote discussion to discourage SARMs abuse.

Personality and willingness towards performance enhancement and body modification: A cross-sectional survey of a nationally representative sample of Norwegians

We conducted an exploratory investigation of the relationship between personality and willingness towards performance enhancement and body modification in Norway. The study is based on Norwegian Monitor data from a cross-sectional survey of a nationally representative sample of 4,233 (females: 49.9%) persons aged 15 to 96 (45.92 ± 18.02) years. Data were collected using a questionnaire containing demographic questions and measures of physical appearance satisfaction, physical activity level, personality (five-factor model), and willingness towards performance enhancement (e.g., substances that improve creative thinking) and body modification (e.g., use of muscle-building substances). Data were analyzed using descriptive statistics and multiple regression analyses. We found that 62.2% and 50.1% of our sample were either willing to use or contemplating using substances that reduce memory failure and enhance physical fitness respectively. Our sample was most willing or contemplating tattooing (30.0%) and generally skeptical of the other body modification methods with willingness to use or contemplating using substances to enhance muscularity least accepted (3.9%). Higher fantasy/openness and lower agreeableness were associated with higher willingness towards both performance enhancement and body modification. Additionally, higher extraversion and lower control/conscientiousness predicted higher willingness towards body modification. Our findings corroborate previous indications that performance enhancement and body modification are now mainstream. They also underline the importance of personality traits in willingness towards these practices.

Impact of Fitness Influencers on the Level of Physical Activity Performed by Instagram Users in the United States of America: Analytical Cross-Sectional Study

BACKGROUND

Physical activity positively influences the general population's health. Social media networks may promote changes in physical activity habits. This study aimed to analyze the relation between being encouraged to perform physical activity by fitness influencers on Instagram and the level of physical activity performed.

METHODS

An analytical cross-sectional study was performed in 890 United States residents with an Instagram account. The sample was made up of 79.2% females and of 75.4% millennials (born between 1981-1996). Physical activity was measured with the International Physical Activity Questionnaire. Sociodemographic characteristics were registered.

RESULTS

The percentage of females (p = 0.001), millennials (p < 0.001), students (p < 0.001), participants with normal BMI (p = 0.001), and participants performing more than 150 min per week of moderate physical activity (p = 0.014) was significantly higher in the group that felt encouraged to perform physical activity by the information posted by fitness influencers. This group spent a median of 2 h per week on Instagram checking for nutrition or exercise (p < 0.001).

CONCLUSIONS

United States residents who felt encouraged to perform physical activity by fitness influencers on Instagram achieved more the World Health Organization recommendations for substantial health benefit for moderate physical activity. They were predominantly females and millennials with normal weight and spent more time on Instagram checking for nutrition or exercise.

The three-step persuasion model on YouTube: A grounded theory study on persuasion in the protein supplements industry

Persuasion can be defined as an active attempt by a person to change the behavior and attitudes of others. The purposive attempt to influence one's behavior can originate from different areas, and people who are able to do so are often referred to as influencers. Social media platforms such as Instagram or YouTube have become crucial platforms for influencers who generate their income by recommending products and services to their followers, including cosmetics, multimedia articles or clothing. Studies indicate that influencers actively try to persuade the viewer to adopt specific desirable behavior by strategically altering their displayed behavior on social media. Such strategies have mainly been explored in the context of beauty products, where lack of expertise and misinformation might have few negative consequences. Less is known about strategies used in a health-sensitive context, such as nutritional supplements. This research addresses this gap and aims to understand persuasive techniques used by health professionals on YouTube to promote the use of protein supplements. This study is based on an interpretive paradigm using interpretive grounded theory to analyze 60 YouTube videos. We developed a three-step model of persuasion for YouTube videos consisting of the steps: reaching the message, staying on the message, and performing the action that the persuader desires. Our analysis resulted in five core themes that contributed to the persuasiveness of the analyzed YouTube videos. These themes included: Quality, curiosity, engagement, concretization, and genuineness. We conclude the paper with reflections on our model's theoretical and practical implications.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

[Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users]

Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users Abstract. The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users' trust in physicians and drives them into the arms of so-called "gurus." The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.

Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users

The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users' trust in physicians and drives them into the arms of so-called "gurus." The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.

Characteristics of Gym-Goers Performance-Enhancing Substance Use

The use of prohibited performance-enhancing substances (PES) in fitness and gym settings is a public health concern as knowledge concerning its short-term and long-term adverse health consequences is emerging. Understanding the underlying psychosocial mechanisms of PES use and the characteristics of the gym-goers who use PES could help identify those who are most vulnerable to PES use. The aim of this study was to investigate the profile (e.g., sociodemographic factors, exercise profile, gym modalities, peers, and social influence) and psychosocial determinants (e.g., attitudes, subjective norms, beliefs, and intentions) of PES users in gym and fitness contexts. In total, 453 gym-goers (mean age = 35.64 years; SD = 13.08) completed an online survey. Neural networks showed a global profile of PES users characterized by a desire to increase muscle mass, shape their body, and improve physical condition; being advised by friends, training colleagues and coaches or on the Internet; less formal education, and more positive beliefs for PES use. These results may support public health and clinical interventions to prevent abusive use of PES and improve the health and well-being of gym-goers.