The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research

Abstract

BackgroundTo our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use.MethodsWe systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users’ ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines.ResultsA total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users’ immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation.ConclusionsOur findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.

The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review

“…, Sagoe et al . ). Motivators for IPED use were found to be enhanced appearance (Van Hout ), sporting achievement (Sagoe et al .…”

“…), increased strength (Smith & Stewart ), occupational functioning (Van Hout & Brennan ), enhanced self‐confidence (Vassello & Olrich, 2010), body image disturbance (Sagoe et al . ), a healthy appearance (Van Hout ) and sexual attraction (Petrocelli et al . ).…”

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids

“…Baseline levels of use were low, limiting the potential to demonstrate effectiveness with short-term follow-up measures. Additionally, while school years may be associated with onset of AS for a minority of users, initiation has more frequently been reported from 20-30 years of age (Pope et al, 2014a;Sagoe et al, 2014a), an age that interventions have very rarely targeted. As young people move from school into new environments, they are likely to be exposed to different opportunities, social expectations and pressures, which may affect motivation and factors that influence their decisions.…”

“…However, misuse amongst the wider population has been reported since the 1980s (Buckley et al, 1988;Johnson et al, 1989) and evidence suggests that globally the use of AS is increasingly widespread outside of sports environments (Sagoe et al, 2014b;Pope et al, 2014a;McVeigh and Begley, 2016). Participation in sport may not be the primary risk factor for AS use (Harmer, 2010) and outside of sport common motivations include supporting an attractive and healthy physique and enhancing muscle growth and physical strength (Sagoe et al, 2014a;Brennan et al, 2016). Further, use of AS in some individuals has been associated with body image disorders such as muscle dysmorphia and high drive for muscularity (Kanayama et al, 2006;Rohman, 2009).…”

‘Join us on our journey’: exploring the experiences of children and young people with type 1 diabetes and their parents

“…On the other hand, AS use is not exclusive to competitive sport. AS use has been evidenced in fitness as well as amateur-and recreational sports, affecting people as young as 12 years old (Dunn & White, 2011;Kuehn, 2009;Sjöqvist, Garle, & Rane, 2008;Sagoe, Schou Andreassen & Pallesen, 2014). The fundamental rationale behind anti-doping in competitive sports, namely promoting universal sport values, equality and fair play, may not apply to fitness and recreational sport.…”