Instant Genius - How body image pressures lead to steroid use

Episode Date: January 31, 2025

Be it a Marvel superhero, a fashion model or a professional athlete, we likely all have an image in our minds of what we wish our bodies looked like. But for some, the pressure of meeting these expectations can lead to the use of anabolic steroids in an attempt to get that Hollywood or magazine cover look. In this episode, we speak to Dr Orlanda Harvey, a senior lecturer in social work based at Bournemouth University. She tells us what steroids do to our bodies, the various motivations recreational users have for using them and the health issues, both for body and mind, that can arise from doing so. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Ambition comes in all shapes and sizes. At First Citizens Bank, we roll with your goals because we're built for what you're building. Fit for your ambition for Citizens Bank. No one goes to Hank's for his spreadsheets. They go for a darn good pizza. Lately, though, the shop's been quiet. So Hank decides to bring back the $1 slice.

He asks co-pilot in Microsoft Excel to look at his sales and costs to help him see if he can afford it. Co-pilot shows Hank where the money's going and which little extras make the dollar slice work. Now, Hanks has a line out the door. Hank makes the pizza. Co-Pilot handles the spreadsheets. Learn more at M365 copilot.com slash work. Kayak gets my flight, hotel, and rental car right, so I can tune out travel advice that's just plain wrong. Bro, Skycoin, way better than points. Never fly during a Scorpio full moon.

Just tell the manager, you'll sit. No, instant room upgrade. Stop taking bad travel advice. Start comparing hundreds of sites with kayak and get your trip right. Bad advice? You're talking to me? Kayak, got that right. This podcast is sponsored by name, audio, and focal. Streaming has made music more accessible than ever,

but true listening is about more than ease. It's about quality. British audio experts name audio, alongside French acoustic specialist focal, combine handcrafted tradition with, cutting-edge innovation and high-end materials, delivering digital precision with analogue warmth, so you can experience exceptional sound at home. Music just as the artist intended. Visit name audio.com to learn more. Hello and welcome to Instant Genius, a bite-sized masterclass in podcast form.

Every Monday and Friday, you'll hear world-leading scientists and experts talking about the most fascinating ideas in science and technology today. I'm Jason Goodyear, commissioning editor at BBC Science Focus. Be it a Marvel superhero, a fashion model or a professional athlete. We likely all have an image in our minds of what we wish our bodies look like. But for some, the pressure of meeting these expectations can lead to the use of anabolic steroids in an attempt to get that Hollywood or magazine cover look. In this episode, we speak to Dr. Orlando Harvey,

a senior lecturer in social work based at Bournemouth University. She tells us what steroids do to our bodies, the various motivations recreational users have for using them, and the health issues, both for the body and the mind, that can arise from doing so. So today we're talking about anabolic steroids. So let's get the first question out of the way. What actually are they?

So anabolic androgenic steroids are part of the human-in-harmes, advancement drugs, if you like. That's what they come as in a big group. And they are part of the image and performance enhancing drugs. So they're one part of those. There are a few others, but the ones that I'm most interested in and have been exploring, if you like, are the anabolic androgenic steroids. And what they're used for is to enhance muscle, if you like. They're called muscle drugs informally. People might also have heard of them as roids. And they really are about enhancing the structure and the function of skeletal muscles. So they're looking to enhance speed and energy levels and strength, perhaps used for muscle definition and increasing strength.

So let's have a look at the kind of legality. So they are available on prescription for certain conditions. Is that right? Yes, they are. They're a form of kind of synthetic testosterone, own, if you like. So they might be used for somebody who is, well, in fact, one of the people that I interviewed had started use because of HIV and recovery. So that kind of thing might be why they're used for muscle wasting diseases, things like that. But used recreationally or illegally for sport, then they are really about that increase in muscle and power and strength. The recreational use is also, though, more aesthetic, so it can be about being body beautiful. So, let's stick with the legality for a minute. So what's their classification according to UK drug law?

So they are class C drugs in the UK. It's a really grey area around legality. So they're okay for personal use. But in order to use them for personal use, you would have to leave the country, go to a country where they are legal and bring them back in physically. You can't buy them, you can't sell them. So you can't buy them online in this country or purchase them legally and you can't sell them. So the minute you step into those kind of areas where you're purchasing ingredients online in the UK, then you're stepping over the bounds of legality. So do we know how common the recreational use of these drugs is? So this is a really interesting and tricky question. And actually, there's a lot of questions in the literature about how common it actually is.

So if you look at the UK Office for National Statistics, their last study showed that lifetime use for men between 16 and 59 was about 200,000 people. And this has kind of stayed the same. But obviously, that's a survey where they ask you if you use drugs. And obviously, there's a lot of stigma around using anabolic steroids. It's not something people are going to share. So they believe the number is slightly higher than that and has increased, obviously slightly, they came around in the 1980s. So it's been increasing since then. But these official statistics remain stable around the 200,000s. So how are they taken then? Is it mainly via injection? So you can take them orally as well. So there's slightly different reasons for taking them

orally or via injection. The majority of people move on quite quickly from oral to injection if they're going to be using them seriously to achieve their aims. But some people do only use oral steroids throughout the whole time. And the issues there might be around issues for liver and things like that, the injectable steroids, there are issues maybe around infection and injection site injuries because they go straight into the muscle. So it's different from injecting perhaps other drugs that people might use illicitly. So is the different sort of more banged for the book? I know that's a bit of a crass phrase. It's kind of hard to say. I think it's more about what are you trying to achieve from them. So this is where my interest as a sociologist, you're moving more into the medical

side of things where you're looking at exactly what they do within the body. But all of the conversations I've had around the choices people make, it's about what they're using them for. So let's have a look at that, then. So one thing often associated with the use of these steroids is a condition known as body dysmorphic disorder. So what is that? So body dysmorphic disorder is when somebody looks at themselves in the mirror and says, what I see is not what I want to be. In terms of of their reality, what they're seeing is not what they want, but also what they're seeing is not always quite real. Does that make sense? They're not quite big enough. They're not quite good enough in terms of the muscular aesthetic. It's really interesting when we look at motivation to use,

because your main motivation to use is going to be building muscle and building strength. But when you're looking at it from aesthetic reasons, and we're seeing a lot more aesthetic use coming in, that is linked to people's identity. So your identity is a man. So when you talk about body dysmorphia, we've seen it in women for years, you know, the need to look really, really thin and be like the supermodels. I'm thinking of the supermodels in the 1990s and all of those looks. We're now seeing that change. I say now, I'm feeling my age now. From about the 1990s, we've started to see that impact on men. So we had the 80s and Schwarzenegger, and Schwarzenegger, and all of those muscular movie heroes coming through.

So that image started to change of what it was to be a masculine man, if you like. And that's kind of kept going. So if you think now that we've got our Marvel superheroes, and it's not just young men, this is affecting as around what you should look like. James Bond is a really good example. If you look at shirtless pictures of James Bond in the 70s, it's very different to Daniel Craig, a man in his middle ages, with a six-pack. So we're seeing this aesthetic change in muscularity. Where body dysmorphia comes in

is if somebody has a unhealthy relationship to body image. But this is where it gets quite interesting, I think, in that for some people, looking muscular can be very congruent with who they want to be and who they are. So they will use, they will go down the gym, they will do all of those natural things to change their body shape. When do you start taking anabolic steroids and when does it become a problem is one of the questions that academics are discussing a lot because it's maybe it's when it's incongruent with you when you can't stop doing it or you're doing it to the point where the risks are too great or you're trying to be something you're not, you can't be. But for some people they use for periods of time to change their appearance, they become

happier or they will tell you they become happier because of it. And actually the benefits psychologically outweigh the physiological harms? Is there anything we can say that's sort of typical about these people that have this condition? I think it would be around thinking about how they see themselves, so it's their identity, and so there might be reasons why they want to be more masculine. So I looked very much at anabolic steroid users as a group, and rather than people with specifically body dysmorphia, People who use anabolic enderogenic steroids might have body dysmorphia, but they might not. What we do see is those that become dependent on them and might be more likely to have body dysmorphia and issues around identity. There are those who use anabolic steroids who don't have those diagnosable symptoms, if that makes sense.

Yeah, so how likely is somebody that starts using steroids to become dependent? Can we say that? Yes, yes, it's a good question. There's some great work by Kanyama and colleagues and people like that in America who have found a means of dependency, and they reckon about 30% of people who start using can end up becoming dependent. What's really interesting about the dependency, though, is it's, so when you use something like heroin, you're likely to become dependent on the drug. With something like anabolic steroids, the dependency can be more complex because some of it might be around how you see the effect.

So not just the increase in muscle, but it impacts libido and things like that. So we think about masculinity and libido. So if you stop using them, your sex drive might go down. You might become more depressed, but that depression could come from not looking as good as you should think you should inside, not getting the admiration that maybe you expect to have. So it's a very complicated relationship with why people might then continue to use, rather than just saying I'm addicted to this drug because of the, you know, the drug makes me addicted. It's much more complicated than that, much more psychological effects play a big part in it.

So how about the physical effects that they can have on someone's health? So the physical effects come in kind of short, medium and long-term effects depending on how people use what they're using and the combination. So a lot of people who use anabolic androgeric steroids actually pride themselves on their ethnofirm. pharmaceutical knowledge. They will have plans for how they manage their use. They will have plans for drugs to mitigate the side effects. Not everybody, and that's one of the risk groups, is those people that don't understand the risks and harms and side effects. So short-term risks might be things like acne might become a problem. Their chest areas will grow. They might have changes down in terms of those medium term things like fertility can be impacted, sexual functioning,

liver damage. Heart problems with the heart is quite an issue as well around cardio toxicity. There have been reports of heart attacks as a result. Quite often from long use, these are long term use. These are people in their 50s who've been using for a long time. We have things like testicular atrophy as well. So there's a whole range of liver, kidney functions that using steroids can impact and can be very harmful. The biggest, risks are to adolescence. So people who are young men, particularly who are still growing. So then there's potential neurological issues. There's also, you know, you're using things that are going to change how your muscle develops whilst you're developing. So we have real issues around that.

But there are also interesting harms that might come from the psychological effects. So depending on the drugs that you're choosing to use the types of anabolic steroid, some have more side effects around potential aggression increase, things like that as well. So there's an awful lot of risks that the people who choose to use are putting on themselves. However, talking to these people, or if you go into the forums where they're talking about managing risk and harm, quite often the benefits outweigh these risks. They'll tell you a lot of these risks are managed. And the trouble is doctors and health professionals will find it very hard to agree with that because of the doses that they're using, they use these superphysiological doses, which would be

unethical to actually test in medical clinical trials. So there's an issue there around a lot of users will be relying on the expertise of other anabolic steroid users who've been using that for a lot longer. So it's quite an interesting area around understanding the real harms that they're putting themselves under because the medical trials cannot match what they're doing. You mentioned there sort of different patterns of use. So can we break those down into different sort of typical categories? Or is it just more or how long's a piece of string sort of thing? It does depend on the individual. I mean, what they call six to 12 weeks cycles that were very, very common in the 90s, 2000s and up until recently. And actually lots of users will do those,

particularly those who are bodybuilders and things like that, they will be doing these cycles. So they'll come on, they'll increase their use, they'll be following it through a meticulous pattern of what drugs they're taking. When, within my research, one of the gentleman showed me is Excel spreadsheet of how he was managing this. And then they will decide to do post-cycle therapy. So they'll come off. They know they're going to have withdrawal symptoms and things that impact. So it could be depression. It could be to do with libido. it could be to do with anxiety and other things from stopping using them. So they will then use different drugs to manage these.

It's all about self-medicating to manage the side effects. And that's deemed to be a safer way of using, if you can call it that. It's around harm minimisation. However, what we're seeing now is an increase in people doing their cycle, but then instead of coming off completely, they're going into a low level use of just the testosterone, just to keep themselves, perhaps feeling less anxious, to keep up how they feel about themselves. So the people who are then using continuous low doses of testosterone, that's a different type of use, and that can have more harms

associated with it. What's also interesting about use is that people will be using in their 20s and 30s. They might stop using when they want to have a family or children, but we're seeing an increase in men in their 40s and 50s as their libidos change, as they feel less virile, starting to use not the big high levels or the supra doses that they used when they were younger, but this low level. They're using it as a form of testosterone replacement therapy, if you like. And there's a lot of conversations about, you know, how men feel that people don't take seriously what happens to their body changing in their 40s and 50s. People who use steroids in their 40s and younger years rather than going to a doctor, will self-medipake because they know this helps them.

You thought this was your run club era. Turns out it was more of a thinking about run club era. The good news? Someone's marathon training is about to start. Sell your workout gear on Deepop. Just snap a few photos and we'll take care of the rest. They get their race day fit and you get a payout for trying. Someone on Deepop wants what you've got. Start selling now. Deepop, where taste recognizes taste. A Lego set is a gift that always clicks. And clicks.

Mom, look, it's so beautiful. And clicks. For every nature lover, choose a Lego set. A gift that always clicks. This podcast is sponsored by name, audio, and focal. With over 100 years of combined expertise, Name and Focal have been bringing music to listeners just as the artist intended. Since day one, this mantra has shaped every innovation in high-fi design, technology and acoustic engineering, balancing craftsmanship and tradition

with pioneering thinking. Name Audio pushes cutting-edge technology to ensure digital precision whilst sustaining Pratt, pace, rhythm and timing. The elusive quality that makes music feel alive and gives it emotional texture. Today, in partnership with French acoustic specialist focal, name audio creates systems that deliver exceptional sound, and unforgettable listening experiences at home. Try it for yourself at a focal powered by name boutique. Visit focal powered by name.com for more information. Ryan Reynolds here from IntMobil. I don't know if you knew this, but anyone can get the same premium wireless for $15 a month plan that I've been enjoying.

It's not just for celebrities, so do like I did and have one of your assistance assistants assistants switch you to Mint Mobile today. I'm told it's super easy to do at mintmobile.com slash switch. Up front payment of $45 for three month plan equivalent to $15 per month required. Intro rate first three months only, then full price plan options available. Taxes and fees extra. See full terms at mintmobile.com. So presumably, as with any sort of illicit drug, you don't always know what you're getting when you buy something like this. So is that a problem with steroid users? It's a huge problem, particularly because since it's the amount of drugs they use and how they use,

what's happening a lot in the UK is they've now started to purchase the drugs online, but not necessarily the anabolic steroid. what they're doing is getting the components they're making their own. So we're seeing counterfeit labs coming up. And there's kind of two different ways of looking at this. There are those who understand the ethnopharmacology and understand what they're doing and will make their own. If they make their own, you would hope they know what they're getting, but then you have to test everything you're getting in from overseas to make sure they are the products you're getting.

You will also have them making them up in labs just to sell on the black market, if you like. And then you absolutely have no idea what you're getting. And actually, that's one of the things that when you talk to people who use anabolic storage, they want is they want this a way of being able to understand and find out that what they're using is safe and that it's not counterfeit. And there is an awful lot of the network of buying from people you trust, buying from people you know are selling stuff that is legitimate, that is not adulterated, is not counterfeit. because actually the risks that come from using counterfeit anabolic steroids are really hard to understand a measure because you don't know what's being put in them.

So it sounds like really maybe initiating treatment in the first place is quite a hurdle. Yes, I think it might be. So people who use anabolic steroids do seek support, do seek that. That's where I first came across them in work that I was doing in a needle exchange. So they came to get needles and get advice. So some will do that. A lot of them will go and seek help from online forums in terms of how to use safely from people who know. They'll also read academic papers and journals. This is when I went out to interview the group that I interviewed, I don't think there was, there was only one of my 23 people that I interviewed who didn't use academic literature that could get hold of to understand what they were doing, what the risks were, what the harms were and how to mitigate that. if they find a safe person to ask for help from.

So there's a discussion around coaches who specialize in supporting people who use anabolic steroids, or they might find a drug and substance use service where there's a specialist in there who's particularly interested in this. I was lucky enough to work in one of those for a very short period of time. And there's a network of those across UK, but they are few and far between. but a lot of them won't necessarily seek help to stop using. They're going to seek help to use safely rather than necessarily stop because they're used, the motivations for use are quite often linked to who they are,

who they want to become. And if they see themselves being able to become that person, why would they stop using? Yeah, that sounds like a really complicated issue. Say somebody does want to come off steroids, you know, How do we go about helping them with that? Understanding their reasons for using. So in terms of, yes, there's withdrawal if you stop using. If they stop when they come off cycle and they stop using,

some of it will depend on what withdrawal and their reasons for using. If they've become dependent on use and it's linked to their identity or anything else, their reasons for what they're getting back from using, then you're actually looking at some of the more psychological type support therapies, cognitive behavioral therapies mainly, or things where people can go and talk about their underlying motivations for use. What is it about me that makes me feel I need to be this big muscular person, particularly male? You know, what is it that's speeding into my identity as to who I am? Why do I get depressed when I'm not taking these drugs and I'm not looking like this person

and what can I do to perhaps change that? So some of the best support will also be around understanding how to maintain the body they want without using anabolic steroids and all of that kind of thing. And it could be their lived experience or there's childhood issues around having been bullied at school, having had an unhealthy male role models around them potentially. You know, so the reasons for use are really important to understand. If they're just using for bodybuilding, let's say they've decided to get into this, they get into bodybuilding, they're using it for those reasons. They get to a time in their life when they think, don't want to do this anymore, actually stopping use is not as hard because they've not become

dependent. So it's really the support that they need is going to be around their motivations for using. So say someone listening is struggling with us or knows somebody that is, you know, what should they do? How do they get in touch with these services? So thinking about what kind of support somebody else could give, how they offer the services they offer. So this doesn't sound as helpful as perhaps I should be saying, but I think the NHS has a really good website around understanding what anabolic steroid use is and there are also other websites that really help with that. I mean, I would be looking at sending them if they wanted to seeking support from specialist services and that's having a look at is there any in my area and there might not be.

So it might be that you're going to have to go to potentially, and this isn't great because it's whether you can afford it or not, but there are counsellors who work in this. There are people who are specialists. I'm thinking of Dave Crosslands, I think, is somebody who's well known for working with people and helping them in this area. There are other specialists out there who do this. There are clinics. There's a really good one in Edinburgh as well that looks into this. So I think it's going to be doing that bit of research that perhaps is a little bit harder than you would if you were looking at just normal substance misuse.

So it is going to be doing that research. It's going to be finding out, is there anything in my area? what can I do to find out and get some help in this field for this person. But we also about perhaps, though, looking at some of those support around counselling or something like that, because actually if you're not addicted to the substance but what the effects of the substance are, then some of that psychosocial counselling could be really important too. The first thing I would do, though, is make sure that that person is getting good advice. So one of the experiences of a lot of the people that I've spoken to is that they'll go to a

GP and the GP will just say stop using. It's bad for you. It's a very preventative approach. And I really understand that because the doses they're using, a medical professional is going to say, this is not good for you. However, nobody's going to do that. So it's about really finding some good advice around harm minimisation to start with. How do we lower what you're using? How do we do that? And then finding somebody who can perhaps then help them through stopping use in the long term. Thank you for listening to this episode of Instant Genius, brought to you from the team behind BBC Science Fakers. That was Dr. Orlanda Harvey, a senior lecturer in social work based at Bournemouth University. If you liked what you just heard, then please do consider subscribing to Instant Genius

on your preferred podcast platform. The current issue of BBC Science Focus magazine is out now. Pick up a copy wherever you buy your favourite magazines or download us on your app store of choice. You can also find us on Apple News or online at sciencefocus.com. This podcast is sponsored by Name, Audio and Focal. The texture and emotional depth of music can be lost through digital sources or poor signal.

Name Audio believes you can have digital, precision with analogue warmth. Alongside French acoustic specialist vocal, Name creates high-end audio systems combining innovation with craftsmanship so you can listen to music, just as the artist intended. Discover more at name audio.com.