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Is There a Relationship Between Body Image and Anabolic-androgenic Steroid Abuse?

Erin Dugan

April 30, 2009



The relationship between body image and anabolic-androgenic steroid abuse, has become an increasingly discussed subject in recent decades. This type of abuse is defined as the illicit use of steroids for the purpose of achieving a certain physical goal, such as a more muscular, larger, or leaner body. The words “anabolic” and “androgenic”, referring to the practice of bodybuilding and increased masculine characteristics respectively, provide a glimpse into the particular results and motivations of using the substances. Although these drugs are legal and allow many people to achieve otherwise unrealistic or impossible physical objectives, the dangers that can result from mistreatment of the drugs often outweigh the benefits. Steroid abuse affects many different geographical areas worldwide and a number of social niches, including families, local communities, and most often the sporting world, upon which media places a large focus. There exist a significant number of factors that have been identified as causes of abuse as well as several strategies that have effectively dealt with the issue in the past. This review paper not only uses scientific literature and studies to provide detailed descriptions of the significances and causes of the use and abuse of anabolic-androgenic steroids, but also simultaneously creates a concrete, comprehendible definition of the practice and explores the subject specifically in regard to body image.

Definition of Steroid Abuse

            Substance abuse is defined as a pattern of substance use leading to significant impairment in functioning (2000, 4th text revision ed.). According to Agulló-Calatayud et al. (2007), abuse of one specific substance, anabolic-androgenic steroids (AAS), has grown continuously in recent years. Anabolic-androgenic steroids are synthetic derivatives of testosterone, which is the natural male hormone responsible for the androgenic, or masculinizing, and anabolic, or tissue-building, effects of male adolescence and adulthood (Yesalis, 1993, p. xxiv). Steroid abuse is not specifically listed or defined in the DSM-IV due to insufficient substantial research data (2000, 4th text revision ed., p. 140) but is viewed by scientists as any illicit use of steroids (Kanayama et al., 2006). The American Psychological Association, however, provides several criteria and symptoms to diagnose substance abuse in Diagnostic and statistical manual of mental disorders (2000, 4th text revision ed). 

Importance of the Problem in Society

The History and Extent of the Issue

Originally taken by athletes mainly for their anabolic, or muscle building, effects (Sato et al., 2008, p. 652), consumption of this class of substance has increased considerably during the last few decades (Agulló-Calatayud et al., 2007, p. 103). A steroid user generally goes through cycles of seteroid use, ranging from being virtually drug-free to taking much more than recommended during a particular sport season or to meet physical goals. (Yesalis, 1993, p. xxv). Abuse of steroids has become a recreational drug in the recent past in addition to a part of the competition of the sports world (Agulló-Calatayud et al., 2007, p. 103). Casual and frequent use of such a strong substance has caused many public health problems in a number of countries throughout the world (Kanayama et al., 2006, p. 697). Such health complications have led to the development of drug-testing methods and laws banning abuse of these powerful drugs.


Abuse and Age Groups

Although anabolic-androgenic steroid abuse is a significant problem for millions of Americans in all age categories, according to Sato et al. (2008), it has become an increasingly large issue for adolescents. This dangerous practice is beginning to affect youth at a younger age than it ever has in past years (Calfee & Fadale, 2006). Although steroid use usually climaxes at the age of 18 (Sato et al., 2008), childhood steroid use is not unusual (Calfee & Fadale, 2006). Appallingly, 15% of NCAA users cited junior high as the first their first personal experience with steroids (Calfee & Fadale, 2006). Publications have consistently found 2% to 3% of students using steroids in the 9 to young teen age group and as many as 9% among middle school participating in gymnasts or weightlifting

According to a study conducted in 1990, AAS was proven to be the most used recreational drug in United States’ schools (Agulló-Calatayud et al., 2007). Males were estimated to be responsible about 4% to 11% of such use, and females only up to 3.3%  (Calfee & Fadale, 2006). Surprisingly, almost one-third of those students were not athletes and were simply abuse steroids for the purpose of improving physical appearance and meeting fitness goals (Calfee & Fadale, 2006). The serious nature of this issue was emphasized again when steroid abuse was compared to crack cocaine and heroin use during a study by Sato et al (2008). In this study, the lifetime rate of steroid use among high school seniors was 2.7% compared to 3.5% for crack cocaine and 1.4% for heroin. In addition, Calfee and Fadale’s study conducted in 2006 2006) found 6.4% use of steroids by male high school seniors. Among surveyed college athletes, 42% reported first using steroids in high school (Calfee & Fadale, 2006). Not surprisingly, abuse continues into college and adulthood. Its use and abuse has “trickled down from the Olympic, professional, and college levels to the high schools and the junior high schools” (Yesalis, 1993, p. 65).

Individual Effects

             There are physical effects and emotional or psychological effects of steroid abuse. The physical side effects range from acne and breast development in men and masculinization in women such as an enlarged clitoris and a deeper voice to heart attacks and liver cancer (United States Department of Health and Human Services, 2007, p. 4). Some of these physical effects may be reversed while others are permanent. The traits that may be reversed in males are reduced sperm count and testicular atrophy. Irreversible effects include baldness and gynecomastia, or breast development. Women may experience irreversible body hair growth, deepened voice, and reduced breast size and body fat through continuous use. Adolescents may experience stunted growth due to increased hormone activity (United States Department of Health and Human Services, 2007). According to Sjoqvist et al. (2008), there was a 12.9% mortality rate for a group of AAS using power lifters with a mean age at death of 43 compared to 3.1% for the control group.

            Anabolic-androgenic Steroid Abuse can have serious psychological effects that can last years after discontinued use. These effects include an increase in aggression, psychiatric morbidity, depression, and even suicide (Kanayama et al., 2003). Brower et al (1989) suggest that steroid users are very vulnerable to major depressive episodes in the three months after discontinuing use. Although additional studies are needed to assess the psychological effects of steroids, it is possible for this depression to result in suicide. McCabe and Ricciardelli (2001) suggest that a relationship between AAS use and unhealthy body image exists, but further research is required. In a 2008 study conducted by Sjoqvist, steroid users had more psychiatric effects than nonusers. About 25% of the users reported major mood changes, including anxiety, depression, hostility, and paranoia.

Causes of the Problem

            There are a range of different causes of AAS abuse, but pinpointing one particular cause can be very difficult. Reasons can and often depend upon many societal and personal factors and differ greatly from one person to another. Some studies have been conducted regarding the causation of steroid abuse, but many resulting ideas are either associations or are not statistically significant.

Internal Causes

            Many internal factors have been analyzed as causes of substance abuse. Lemme (2006) states that an individual’s ideal self can serve as motivation. If the ideal self is unrealistic, however, then the motivation may end up increasing efforts for a forgotten aim (Todd, 1987). According to Kanayama et al., (2006), AAS use is not strongly associated with low self-esteem in general. Having this characteristic, however, does provide further insecurities and consequently can be a reason for substance abuse.

Social Causes

            Modern society’s tendency to places an incredible amount of importance on physical appearance, success, and other social norms.  Both sexes are presented with an ideal physical appearance that is marketed and promoted through use of the media (Denham, 2006). Even very young children are targeted through unrealistic cartoon bodies and toys such as Barbie and action figures like GI Joe. This ideal image creates unhealthy body images for both males and females. Specifically, males with body dysmorphic disorder may take steroids in an attempt to boost self-confidence (Kanayama et al., 2003). While women see themselves as overweight and unattractive despite actual lean and muscular bodies, men with muscle dysmorphia see themselves as small and weak when they are large and muscular (United States Department of Health and Human Services, 2007). Kanayama et al. (2006) states that 71.4% of possible future AAS users said that they felt too small. Men with this condition will avoid situations in which their body may be seen and will miss important events to work out (Kanayama et al., 2006). Because males use exercise rather than diet to regulate their weight and shape and attempt to reach their goal of a more muscular body (McCabe & Ricciardelli, 2001), steroids are seen as a perfect tool to “sit back and grow muscles” (DuRant et al., 1995, p 27). AAS to appear as a logical choice seems to be a common choice for boys those boys wanting to increase muscle size and who have less of a concern with overall weight.

            Combined with body image, pressure to fit in places extreme stress on adolescents (Denham, 2006) and homosexual men (Halkitis et al., 2008). In order to fit in to society, a boy may take steroids to achieve the admiration of his peers (Denham, 2006). In a similar manner, homosexual males face a desire for acceptance while also dealing with skewed body images (Halkitis et al., 2008). In order to be accepted some homosexual men strive for a very masculine looking body.

Effective Strategies

Support and Therapy

            According to DSM-IV (2000, 4th text revision ed.), treatment of substance abuse relies upon social support and acceptance. Acceptance can tremendously help struggles with body image or inadequacy because of failure. By supporting the abuser, an individual allows him to accept himself. Pharmacological and cognitive behavior therapies can be used to treat body-image disorders (Kanayama et al., 2006). Because these disorders are a major cause of AAS abuse, focusing on these aspects may prove to be very beneficial in reducing and preventing the misuse of steroids.


            Educating not only potential users but physicians and friends as well is the most effective strategy to preventing the AAS abuse problem (Sjoqvist et al., 2008). Prevention programs should be implemented on both national and local levels (Yesalis, 1993). These programs should not only address the problems of steroid abuse, but the role American society, as well as world views, have played in creating the problem. The problems with the media’s unrealistic ideals and the pressure to have a perfect body from peers and family members should be targeted as well. Education should be approached in a specific manner. A well-rounded breakdown of the pros and cons of using steroids is necessary in order for it to be effective. Teaching drug refusal is another key component to preventing abuse (Calfee & Fadale, 2006). The education of physicians will provide a safe and reliable source for adolescents to discuss AAS with. Also, peer or near-peer teaching had a more positive outcome than if a non-peer was used (Goldberg et al., 1991). Overall a multifaceted approach to educate individuals of any age, especially youths, about steroids, their effects (both good and bad) and the available alternatives is the best approach. Model examples are (United States Department of Health and Human Services, 2007) the Adolescents Training and Learning to Avoid Steroids (ATLAS) and the Athletes Targeting Healthy Exercise and Nutrition Alternatives (ATHENA).


            The connection between the growing use of steroids and the increasing emphasis from society and the media on body image seems quite clear despite concrete research data. Pressure starting from a young age to achieve unrealistic goals, whether related to sports, body image, work, or other areas of life, has created a setting for abuse problems to continue to grow. Further research is needed on a larger scale to confirm causation and association. As research continues the causes and treatments will continue to become clearer, providing further insight into the effects of steroid abuse and its connection and consequences on body image and psychological well-being.












American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, D.C.

Calfee, R., & Fadale, P. (2006). Popular ergogenic drugs and supplements in young athletes. Pediatrics, 117, 578-589.

Denham, B.E. (2006). Effects of mass communication on attitudes toward anabolic steroids: an analysis of high school seniors. Journal of Drug Issues, 36, 809-830.

DuRant, R.H., Escobedo, L.G., & Heath, G.W. (1995). Anabolic-steroid use, strength training, and multiple drug use among adolescents in the United States. Pediatrics, 96, 23-28.

Goldberg, L., Bents, R., Bosworth, E.,  Trevisan, L., & Elliot, D.L. (1991). Anabolic steroid education and adolescents: do scare tactics work? Pediatrics, 87, 283-286.

Halkitis, P.N., Moeller, R.W., & DeRaleau, L.B. (2008). Steroid use in gay, bisexual, and nonidentified men-who-have-sex-with-men: relations to masculinity, physical and mental health. Psychology of Men and Masculinity, 9, 106-115.

Kanayama, G., Barry, S., Hudson, J.I., & Pope, H.G. (2006). Body image and attitudes toward male roles in anabolic-androgenic steroid users. Am J Psychiatry, 163, 697-703.

Kanayama, G., Cohane, G.H., Weiss, R.D., & Pope, H.G. (2003). Past anabolic-androgenic steroid use among men admitted for substance abuse treatment: an underrecognized problem? J Clin Psychiatry, 64, 156-160.

Lemme, B. (2006). Development in Adulthood (4th ed.). Boston: Allyn & Bacon.

McCabe, M.P., & Ricciardelli, L.A. (2001). Body image and body change techniques among young adolescent boys. European Eating Disorders Review, 9, 335-347.

Sato, S.M., Schulz, K.M., Sisk, C.L., & Wood, R.I. (2008). Adolescents and androgens, receptors and rewards. Hormones and Behavior, 53, 647-658.

Sjoqvist, F., Garle, M., & Rane, R. (2008). Use of doping agents, particularly anabolic steroids, in sports and society. The Lancet, 371, 1872-1883.

Todd, T. (1987). Anabolic steroids: the gremlins of sport. Journal of Sport History, 14, 87-107.

United States Department of Health and Human Services (2006). Anabolic Steroid Abuse. Retrieved March 15, 2009, from

Yesalis, C.E. (Ed.). (1993). Anabolic Steroids in Sport and Exercise. Champaign, IL: Human Kinetics Publishers.



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