Help-Seeking Beliefs Among Anabolic Androgenic Steroid Users Experiencing Side Effects: An Interpretive Phenomenological Analysis

in Journal of Clinical Sport Psychology
View More View Less
  • 1 Ulster University
  • 2 Queens University
  • 3 Claudy Health Centre
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $59.00

1 year online subscription

USD  $79.00

Student 2 year online subscription

USD  $113.00

2 year online subscription

USD  $150.00

Recreational athletes comprise the most prevalent population using illegal Anabolic Androgenic Steroids (AAS). Despite regulatory efforts, substances are widely accessible, and most users report the experience of harmful side effects. It remains unclear why few users seek professional medical help. The aim of this study was to determine AAS users’ experience of side effects and help-seeking beliefs using an Interpretative Phenomenological Analysis of six interviews. Participants were from the United Kingdom (n = 5) and United States (n = 1), had all experienced side effects, with some reporting prolonged use of AAS (>10 years) and self-manufacturing the drugs from raw ingredients. Results showed that AAS users discredit medical professionals’ competencies, and practice cognitive dissonance by avoiding challenging situations. A microculture for information-sharing has developed among AAS users who initially self-treat to counteract side effects, leaving them vulnerable to further harm. To conclude, there is an urgent need for educational interventions that outline the risky practice of unregulated AAS use and self-treatments, and the need to seek professional help. Such interventions could be developed through a co-production basis, and be implemented by current/former AAS users alongside the medical community.

Gilmore, Shannon, and Breslin are with the Sport and Exercise Sciences Research Institute, Ulster University, Jordanstown Campus, Newtownabbey, Northern Ireland. Shannon and Breslin are also with the Institute of Mental Health Sciences, Ulster University, Coleraine Campus, Coleraine, Northern Ireland. Leavey is with The Bamford Centre for Mental Health and Wellbeing, Ulster University, Magee Campus, Derry, Northern Ireland. Dempster is with the School of Psychology, Queens University, Belfast, Northern Ireland. Gallagher is with Claudy Health Centre, Claudy, Northern Ireland.

Shannon (s.shannon@ulster.ac.uk) is corresponding author.
  • Advisory Council on the Misuse of Drugs. (2010, September). Consideration of the anabolic steroids. London, UK: Author.

  • Al-Falasi, O., Al-Dahmani, K., Al-Eisaei, K., Al-Ameri, S., Al-Maskari, F., Nagelkerke, N., & Schneider, J. (2008). Knowledge, attitude and practice of anabolic steroids use among gym users in Al-Ain District, United Arab Emirates. The Open Sports Medicine Journal, 2(1), 7581. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aljuboury, N.H. (2019). Misuses and side effects of steroids derivatives. International Journal of Medical Sciences, 2(1), 14.

  • Anawalt, B.D. (2019). Diagnosis and management of anabolic androgenic steroid use. The Journal of Clinical Endocrinology & Metabolism, 104(7), 24902500. PubMed ID: 30753550 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Baggish, A.L., Weiner, R.B., Kanayama, G., Hudson, J.I., Picard, M.H., Hutter, A.M., & Pope, H.G. (2010). Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction. Circulation: Heart Failure, 3(4), 472476. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bell, C. (Director). (2008). Bigger faster stronger [Movie]. USA: Madman Movies.

    • Export Citation
  • Breslin, G., Shannon, S., Haughey, T., Donnelly, P., & Leavey, G. (2017). A systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches and officials. Systematic Reviews, 6(1), 177. PubMed ID: 28859666 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clement, C.L., Marlowe, D.B., Patapis, N.S., Festinger, D.S., & Forman, R.F. (2012). Nonprescription steroids on the Internet. Substance Use & Misuse, 47(3), 329341. PubMed ID: 22080724 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cooper, J. (2007). Cognitive dissonance: 50 years of a classic theory. London, UK: Sage.

  • Cordaro, F.G., Lombardo, S., & Cosentino, M. (2011). Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the Internet. Scandinavian Journal of Medicine & Science in Sports, 21(6), e247e259. PubMed ID: 21210860 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Crawford, P., Brown, B., Kvangarsnes, M., & Gilbert, P. (2014). The design of compassionate care. Journal of Clinical Nursing, 23(23–24), 35893599. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Creado, S., & Reardon, C. (2016). The sports psychiatrist and performance-enhancing drugs. International Review of Psychiatry, 28(6), 564571. PubMed ID: 27310472 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dunn, M., Mazanov, J., & Sitharthan, G. (2009). Predicting future anabolic-androgenic steroid use intentions with current substance use: findings from an Internet-based survey. Clinical Journal of Sport Medicine, 19(3), 222227. PubMed ID: 19423975 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Evans-Brown, M., & McVeigh, J. (2009). Anabolic steroid use in the general population of the United Kingdom. In V. Møller, P. Dimeo, & M. McNamee, (Eds.), Elite sport, doping, and public health (pp. 7597). Odense, Denmark: University of Southern Denmark Press.

    • Search Google Scholar
    • Export Citation
  • Festinger, L. (1962). A theory of cognitive dissonance (Vol. 2). Palo Alto, CA: Stanford University Press.

  • Filipe, A., Renedo, A., & Marston, C. (2017). The co-production of what? Knowledge, values, and social relations in health care. PLoS Biology, 15(5), e2001403. PubMed ID: 28467412 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Goldman, A.L., Pope, H.G., Jr., & Bhasin, S. (2018). The health threat posed by the hidden epidemic of anabolic steroid use and body image disorders among young men. The Journal of Clinical Endocrinology & Metabolism, 104(4), 10691074. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grogan, S., Shepherd, S., Evans, R., Wright, S., & Hunter, G. (2006). Experiences of anabolic steroid use in-depth interviews with men and women body builders. Journal of health psychology, 11(6), 845856. PubMed ID: 17035257 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hawkins, J., Madden, K., Fletcher, A., Midgley, L., Grant, A., Cox, G., & White, J. (2017). Development of a framework for the co-production and prototyping of public health interventions. BMC Public Health, 17(1), 689. PubMed ID: 28870192 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Interagency drug misuse database. (2009). Centre for Public Health, Liverpool John Moores University.

  • Iriarte, J.A., & Andrade, T.M. (2002). Body-building, steroid use, and risk perception among young body-builders from a low-income neighborhood in the city of Salvador, Bahia State, Brazil. Cadernos de saúde pública, 18(5), 13791387.

    • Search Google Scholar
    • Export Citation
  • Kanayama, G., & Pope, H.G., Jr. (2018). History and epidemiology of anabolic androgens in athletes and non-athletes. Molecular and Cellular Endocrinology, 464, 413. PubMed ID: 28245998 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Karazsia, B.T., Crowther, J.H., & Galioto, R. (2013). Undergraduate men’s use of performance-and appearance-enhancing substances: An examination of the gateway hypothesis. Psychology of Men & Masculinity, 14(2), 129137. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kimergård, A. (2015). A qualitative study of anabolic steroid use amongst gym users in the United Kingdom: motives, beliefs and experiences. Journal of Substance Use, 20(4), 288294. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Larkin, M., & Thompson, A. (2012). Interpretative phenomenological analysis. In D. Harper & A.R. Thompson (Eds.), Qualitative research methods in mental health and psychotherapy: A guide for students and practitioners (pp. 99116). New Jersey: Wiley-Blackwell.

    • Search Google Scholar
    • Export Citation
  • Larkin, M., Watts, S., & Clifton, E. (2006). Giving voice and making sense in interpretative phenomenological analysis. Qualitative Research in Psychology, 3(2), 102120.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lenehan, P. (2003). Anabolic steroids and other performance enhancing drugs. London, UK: Taylor and Francis.

  • Lord, C.G., Ross, L., & Lepper, M.R. (1979). Biased assimilation and attitude polarization: The effects of prior theories on subsequently considered evidence. Journal of Personality and Social Psychology, 37(11), 20982109. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mansfield, A.K., Addis, M.E., & Mahalik, J.R. (2003). “Why Won’t He Go to the Doctor?”: The psychology of men’s help seeking. International Journal of Men’s Health, 2(2), 93109. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McGuane, T., Shannon, S., Sharp, L.A., Dempster, M., & Breslin, G. (2019). ‘You Wanna Ride Then You Waste’: The psychological impact of wasting in national hunt jockeys. The Sport Psychologist, 33(2), 129136. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Newby-Clark, I.R., McGregor, I., & Zanna, M.P. (2002). Thinking and caring about cognitive inconsistency: when and for whom does attitudinal ambivalence feel uncomfortable?. Journal of Personality and Social Psychology, 82(2), 157166. PubMed ID: 11831406 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Oliver, K., Kothari, A., & Mays, N. (2019). The dark side of coproduction: Do the costs outweigh the benefits for health research?. Health Research Policy and Systems, 17(1), 33. PubMed ID: 30922339 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Palumbo, R. (2016). Contextualizing co-production of health care: A systematic literature review. International Journal of Public Sector Management, 29(1), 7290. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Parkinson, A.B., & Evans, N.A. (2006). Anabolic androgenic steroids: A survey of 500 users. Medicine and Science in Sports and Exercise, 38(4), 644651. PubMed ID: 16679978 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pawłowska, B., Zaręba, Z., & Potembska, E. (2016). Use of psychoactive substances, body image and characteristics of personality traits in bodybuilders. Current Problems of Psychiatry, 17(1), 916. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perry, H., & Hughes, G.W. (1992). A case of affective disorder associated with the misuse of ‘anabolic steroids’. British Journal of Sport Medicine, 26(4), 219220. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Petrocelli, M., Oberweis, T., & Petrocelli, J. (2008). Getting huge, getting ripped: A qualitative exploration of recreational steroid use. Journal of Drug Issues, 38(4), 11871205. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pietkiewicz, I., & Smith, J.A. (2012). Praktyczny przewodnik interpretacyjnej analizy fenomenologicznej w badaniach jakościowych w psychologii. Czasopismo Psychologiczne, 18(2), 361369.

    • Search Google Scholar
    • Export Citation
  • Pope, H.G., Jr., Kanayama, G., Athey, A., Ryan, E., Hudson, J.I., & Baggish, A. (2014). The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: Current best estimates. The American Journal on Addictions, 23(4), 371377. PubMed ID: 24112239 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reardon, C.L., & Factor, R.M. (2010). Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Medicine, 40(11), 961980. PubMed ID: 20942511 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ryan, R.M., & Deci, E.L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Publications.

    • Search Google Scholar
    • Export Citation
  • Sagoe, D., Andreassen, C.S., & Pallesen, S. (2014). The aetiology and trajectory of anabolic-androgenic steroid use initiation: A systematic review and synthesis of qualitative research. Substance Abuse Treatment, Prevention, and Policy, 9(1), 27. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sagoe, D., McVeigh, J., Bjørnebekk, A., Essilfie, M.S., Andreassen, C.S., & Pallesen, S. (2015). Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. Substance Abuse Treatment, Prevention, and Policy, 10(1), 12. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sagoe, D., Molde, H., Andreassen, C.S., Torsheim, T., & Pallesen, S. (2014). The global epidemiology of anabolic-androgenic steroid use: A meta-analysis and meta-regression analysis. Annals of Epidemiology, 24(5), 383398. PubMed ID: 24582699 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shepperd, J.A., Carroll, P., Grace, J., & Terry, M. (2002). Exploring the causes of comparative optimism. Psychologica Belgica, 42(1/2), 6598.

    • Search Google Scholar
    • Export Citation
  • Smith, J.A. (2004). Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology, 1(1), 3954. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Smith, J.A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory method and research. London, UK: Sage.

  • Smith, J.A., & Osbourne, M. (2003). Interpretative phenomenological analysis. Qualitative psychology: A practical guide to methods. London, UK: Sage.

    • Search Google Scholar
    • Export Citation
  • Tajfel, H. (1982). Social psychology of intergroup relations. Annual Review of Psychology, 33(1), 139.

  • Tamminen, K.A., & Bennett, E.V. (2017). No emotion is an island: An overview of theoretical perspectives and narrative research on emotions in sport and physical activity. Qualitative Research in Sport, Exercise and Health, 9(2), 183199. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tracy, S.J. (2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry, 16(10), 837851. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • van Harreveld, F., van der Pligt, J., & Yael, N. (2009). The agony of ambivalence and ways to resolve it: Introducing the MAID model. Personality and Social Psychology Review, 13(1), 4561. PubMed ID: 19144904 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Walker, D.M., & Eli Joubert, H. (2011). Attitudes of injecting male anabolic androgenic steroid users to media influence, health messages and gender constructs. Drugs and Alcohol Today, 11(2), 5670. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yu, J.G., Bonnerud, P., Eriksson, A., Stål, P.S., Tegner, Y., & Malm, C. (2014). Effects of long term supplementation of anabolic androgen steroids on human skeletal muscle. PLoS ONE, 9(9), e105330. PubMed ID: 25207812 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yu, J., Hildebrandt, T., & Lanzieri, N. (2015). Healthcare professionals’ stigmatization of men with anabolic androgenic steroid use and eating disorders. Body Image, 15, 4953.

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 248 248 25
Full Text Views 14 14 2
PDF Downloads 6 6 2