Appearance and performance enhancing drug usage and body image across three age cohorts of fitness enthusiast men

Background: Because research findings on men’s body image and compensatory behaviors (e.g., appearance and performance enhancing drug (APED) usage) across the lifecycle in men is contradictory, the purpose of this study was to examine the relationship between age and body image concerns, and to investigate the specific types of APEDs used across the three age cohorts (emerging, established, and middle-aged men). Methods: Using an online survey and a sample of 1020 fitness enthusiast men, we investigated (1) type of APED/supplements used across three periods of life (emerging adulthood, established adulthood, middle age), and (2) any relationship between period in life and body image. Results: emerging adult participants had significantly lower appreciation for body functionality compared to their older counterparts. Established adult men had higher drive for leanness and muscle dysmorphia symptoms compared to the other two groups. The data suggest that men vary in severity of body image dissatisfaction depending on their age. All participants in the current study participated in polypharmacy of APED usage, and the associations between age cohorts and APED consumption were significant. Established adult men endorsed a more muscular body, higher drive for leanness, and they proportionally consume more APEDs compared to their younger (and older) counterparts. Conclusions: At this stage of life, men may start noticing age-related changes to their body, which may lead to preoccupations with their health and functionality, and they may use products to help counteract a declining metabolism and overall shift in physical health. Findings of this study could be beneficial for familiarizing clinicians with focused knowledge of intergenerational dynamics, which allows for better understanding of the diversity of challenges and opportunities facing each age cohort with respect to the aging body.

Body image; Muscle dysmorphia; Appearance and performance enhancing drugs; Fitness enthusiast; Age; Drive for lean-ness; Body appreciation

[1] Hildebrandt, T, Lai, JK, Body image and appearance and per-formance enhancing drug use. In: TF Cash, Smolak, L, (eds.) Body Image: A handbook of science, practice and prevention (pp. 314–320). 2nd edn. Guilford Press: New York. 2011.

[2] Peat CM, Peyerl NL, Ferraro FR, Butler M. Age and body image in Caucasian men. Psychology of Men & Masculinity. 2011; 12: 195–200.

[3] Infurna FJ, Gerstorf D, Lachman ME. Midlife in the 2020s: Op-portunities and challenges. American Psychologist. 2020; 75: 470–485.

[4] Malik M, Grogan S, Cole J, Gough B. Men’s reflections on their body image at different life stages: a thematic analysis of in-terview accounts from middle-aged men. Journal of Health Psy-chology. 2019; 2019; 26: 1222–1232.

[5] Mehta CM, Arnett JJ, Palmer CG, Nelson LJ. Established adult-hood: A new conception of ages 30 to 45. American Psycholo-gist. 2020; 75: 431–444.

[6] Arnett JJ. Emerging adulthood. a theory of development from the late teens through the twenties. The American Psychologist. 2000; 55: 469–480.

[7] Wood D, Crapnell T, Lau L, Bennett A, Lotstein D, Ferris M, Kuo A. Emerging adulthood as a critical stage in the life course. In N Halfon, Forrest CB, Lerner RM, Faustman EM (eds.) Hand-book of life course health development (pp. 123–143). Springer: New York. 2018.

[8] Cash TF, Deagle EA. The nature and extent of body-image dis-turbances in anorexia nervosa and bulimia nervosa: a meta-analysis. International Journal of Eating Disorders. 1997; 22: 107–126.

[9] He J, Sun S, Zickgraf HF, Lin Z, Fan X. Meta-analysis of gender differences in body appreciation. Body Image. 2020; 33: 90–100.

[10] Griffiths S, Hay P, Mitchison D, Mond JM, McLean SA, Rodgers B, et al. Sex differences in the relationships between body dissatisfaction, quality of life and psychological distress. Australian and New Zealand Journal of Public Health. 2016; 40: 518–522.

11] Murray SB, Griffiths S, Mond JM, Kean J, Blashill AJ. Anabolic steroid use and body image psychopathology in men: Delineating between appearance- versus performance-driven motivations. Drug and Alcohol Dependence. 2016; 165: 198–202.

[12] Strübel J, Petrie TA. Appearance and performance enhancing drug usage and psychological well-being in gay and heterosexual men. Psychology & Sexuality. 2019; 10: 132–148.

[13] Cafri G, Thompson J, Ricciardelli L, Mccabe M, Smolak L, Yesalis C. Pursuit of the muscular ideal: Physical and psychological consequences and putative risk factors. Clinical Psychology Review. 2005; 25: 215–239.

[14] Parent MC, Moradi B. His biceps become him: A test of objectification theory’s application to drive for muscularity and propensity for steroid use in college men. Journal of Counseling Psychology. 2011; 58: 246–256.

[15] McCabe MP, Ricciardelli LA. Body image dissatisfaction among males across the lifespan: a review of past literature. Journal of Psychosomatic Research. 2004; 56: 675–685.

[16] Baghurst T, Lirgg C. Characteristics of muscle dysmorphia in male football, weight training, and competitive natural and non-natural bodybuilding samples. Body Image. 2009; 6: 221–227.

[17] Hildebrandt T, Schlundt D, Langenbucher J, Chung T. Presence of muscle dysmorphia symptomology among male weightlifters. Comprehensive Psychiatry. 2006; 47: 127–135.

[18] Pope HG, Kanayama G, Hudson JI. Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: a cross-sectional cohort study. Biological Psychiatry. 2012; 71: 254–261.

[19] Babusa B, Túry F. Muscle dysmorphia in Hungarian non-competitive male bodybuilders. Eating and Weight Disorders. 2012; 17: e49–e53.

[20] Murray SB, Rieger E, Hildebrandt T, Karlov L, Russell J, Boon E, et al. A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image. 2012; 9: 193–200.

[21] Yager Z, O’Dea JA. Relationships between body image, nu-tritional supplement use, and attitudes towards doping in sport among adolescent boys: implications for prevention programs. Journal of the International Society of Sports Nutrition. 2014; 11: 13.

[22] Reel J, Beals K, Ransdell L, Hewett Z. The Hidden Faces of Eating Disorders and Body Image. Women in Sport and Physical Activity Journal. 2010; 19: 86-88.

[23] Stapleton P, McIntyre T, Bannatyne A. Body Image Avoidance, Body Dissatisfaction, and Eating Pathology. American Journal of Men’s Health. 2016; 10: 100–109.

[24] De Jesus AY, Ricciardelli LA, Frisén A, Smolak L, Yager Z, Fuller-Tyszkiewicz M, et al. Media internalization and confor-mity to traditional masculine norms in relation to body image concerns among men. Eating Behaviors. 2015; 18: 137–142.

[25] Heath B, Tod DA, Kannis-Dymand L, Lovell GP. The rela-tionship between objectification theory and muscle dysmorphia characteristics in men. Psychology of Men & Masculinity. 2016; 17: 297–308.

[26] Rosenmann A, Kaplan D, Gaunt R, Pinho M, Guy M. Consumer masculinity ideology: Conceptualization and initial findings on men’s emerging body concerns. Psychology of Men & Mas-culinity. 2018; 19: 257–272.

[27] Parent MC, Bradstreet TC. Integrating self-concept into the re-lationship between drive for muscularity, and disordered eating and depression, among men. Psychology of Men & Masculinity. 2017; 18: 1–11.

[28] Turel T, Jameson M, Gitimu P, Rowlands Z, Mincher J, Pohle-Krauza R. Disordered eating: Influence of body image, socio-cultural attitudes, appearance anxiety and depression - a focus on college males and a gender comparison. Cogent Psychology. 2018; 5: 1483062.

[29] Bennett EV, Hurd LC, Pritchard EM, Colton T, Crocker PRE. An examination of older men’s body image: how men 65 years and older perceive, experience, and cope with their aging bodies. Body Image. 2020; 34: 27–37.

[30] Ferraro FR, Muehlenkamp JJ, Paintner A, Wasson K, Hager T, Hoverson F. Aging, Body Image, and Body Shape. The Journal of General Psychology. 2008; 135: 379–392.

[31] Homan KJ, Boyatzis CJ. Body Image in Older Adults: Links with Religion and Gender. Journal of Adult Development. 2009; 16: 230–238.

[32] Liechty T, Ribeiro NF, Sveinson K, Dahlstrom L. “It’s About What I Can Do With My Body”: Body Image and Embodied Ex-periences of Aging Among Older Canadian Men. International Journal of Men’s Health. 2014; 13: 3–21.

[33] Reddy SL. Understanding the body image experiences of older men. International Journal of Humanities and Social Science. 2013; 3: 34–42.

[34] Paxton SJ, Phythian K. Body image, self-esteem, and health sta-tus in middle and later adulthood. Australian Psychologist. 1999; 34: 116–121.

[35] Tiggemann M. Body image across the adult life span: stability and change. Body Image. 2004; 1: 29–41.

[36] Ziebland S, Robertson J, Jay J, Neil A. Body image and weight change in middle age: a qualitative study. International Journal of Obesity and Related Metabolic Disorders. 2002; 26: 1083–1091.

[37] Hildebrandt T, Lai JK, Langenbucher JW, Schneider M, Yehuda R, Pfaff DW. The diagnostic dilemma of pathological appear-ance and performance enhancing drug use. Drug and Alcohol Dependence. 2011; 114: 1–11.

[38] Felton, R. The FDA’s tattered safety net for dietary supplements. Consumer Reports. 2020. Available at: https://www.consumerreports.org/dietary-supplements/fdas-supplement-warning-system-has-deadly-limitations/(Accessed: 9 September 2021).

[39] McCreary DR, Hildebrandt TB, Heinberg LJ, Boroughs M, Thompson JK. A Review of Body Image Influences on Men’s Fitness Goals and Supplement Use. American Journal of Men’S Health. 2007; 1: 307–316.

[40] Bahrke MS, Yesalis CE, Kopstein AN, Stephens JA. Risk factors associated with anabolic-androgenic steroid use among adoles-cents. Sports Medicine. 2000; 29: 397–405.

[41] Hildebrandt T, Langenbucher JW, Carr SJ, Sanjuan P. Model-ing population heterogeneity in appearance- and performance-enhancing dru78; 116: 717–733.

[42] Khorramabady Y. The effect of muscle dysmorphia and social physique anxiety on the use of supplements and drugs. Zahedan Journal of Research in Medical Sciences. 2017 30;19: e13541.

[43] Raudenbush B, Meyer B. Muscular Dissatisfaction and Supple-ment Use among Male Intercollegiate Athletes. Journal of Sport and Exercise Psychology. 2003; 25: 161–170.

[44] Lieberman HR, Marriott BP, Williams C, Judelson DA, Glick-man EL, Geiselman PJ, et al. Patterns of dietary supplement use among college students. Clinical Nutrition. 2015; 34: 976–985.

[45] Mahoney CR, Giles GE, Williams CS, Brunye TT, Taylor HA, Kanarek RB, et al. Relationships between use of dietary supple-ments, caffeine and sensation seeking among college students. Journal of American College Health. 2019; 67: 688–697.

[46] Zahnow R, McVeigh J, Bates G, Hope V, Kean J, Campbell J, et al. Identifying a typology of men who use anabolic androgenic steroids (AAS). The International Journal on Drug Policy. 2018; 55: 105–112.

[47] Karazsia BT, Crowther JH, Galioto R. Undergraduate men’s use of performance-and appearance-enhancing substances: An examination of the gateway hypothesis. Psychology of Men and Masculinity. 2013; 14: 129–137.

[48] Walker DC, Anderson DA, Hildebrandt T. Body checking be-haviors in men. Body Image. 2009; 6: 164–170.

[49] Hildebrandt T, Alfano L, Langenbucher JW. Body image dis-turbance in 1000 male appearance and performance enhancing drug users. Journal of Psychiatric Research. 2010; 44: 841–846.

[50] Ip EJ, Trinh K, Tenerowicz MJ, Pal J, Lindfelt TA, Perry PJ. Characteristics and Behaviors of Older Male Anabolic Steroid Users. Journal of Pharmacy Practice. 2015; 28: 450–456.

[51] Hildebrandt T, Langenbucher JW, Flores A, Harty S, Berlin HA, Berlin H. The influence of age of onset and acute anabolic steroid exposure on cognitive performance, impulsivity, and ag-gression in men. Psychology of Addictive Behaviors. 2014; 28: 1096–1104.

[52] Mooney R, Simonato P, Ruparelia R, Roman-Urrestarazu A, Martinotti G, Corazza O. The use of supplements and perfor-mance and image enhancing drugs in fitness settings: a ex-ploratory cross-sectional investigation in the United Kingdom. Human Psychopharmacology: Clinical and Experimental. 2017; 32: e2619.

[53] Ivanov N, Vuong J, Gray PB. A Content Analysis of Testos-terone Websites: Sex, Muscle, and Male Age-Related Thematic Differences. American Journal of Men’S Health. 2018; 12: 388–397.

[54] Coquet R, Roussel P, Ohl F. Understanding the Paths to Appearance- and Performance-Enhancing Drug Use in Body-building. Frontiers in Psychology. 2018; 9: 1431.

[55] Macho J, Mudrak J, Slepicka P. Enhancing the self: amateur bodybuilders making sense of experiences with appearance and performance-enhancing drugs. Frontiers in Psychology. 2021; 12: 2244.

[56] Bojsen-Møller J, Christiansen AV. Use of performance- and image-enhancing substances among recreational athletes: a quantitative analysis of inquiries submitted to the Danish anti-doping authorities. Scandinavian Journal of Medicine & Science in Sports. 2010; 20: 861–867.

[57] Attlee A, Haider A, Hassan A, Alzamil N, Hashim M, Obaid RS. Dietary Supplement Intake and Associated Factors among Gym Users in a University Community. Journal of Dietary Sup-plements. 2018; 15: 88–97.

[58] Kanayama G, Gruber AJ, Pope HG, Borowiecki JJ, Hudson JI. Over-the-counter drug use in gymnasiums: an underrecognized substance abuse problem? Psychotherapy and Psychosomatics. 2001; 70: 137–140.

[59] Kartakoullis NL, Phellas C, Pouloukas S, Petrou M, Loizou C. The Use of Anabolic Steroids and other Prohibited Substances by Gym Enthusiasts in Cyprus. International Review for the So-ciology of Sport. 2008; 43: 271–287.

[60] Kinsey, AC, Pomeroy, WR, Martin, CE. Sexual behaviour in the human male. Indiana University Press: Bloomington, IN. 1948.

[61] Dehlin JP, Galliher RV, Bradshaw WS, Hyde DC, Crowell KA. Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology. 2015; 62: 95–105.

[62] Strubel J, Petrie TA. The clothes make the man: the relation of sociocultural factors and sexual orientation to appearance and product involvement. Journal of Retailing and Consumer Ser-vices. 2016; 33: 1–7.

[63] Alleva JM, Tylka TL, Kroon Van Diest AM. The Functionality Appreciation Scale (FAS): Development and psychometric eval-uation in U.S. community women and men. Body Image. 2017; 23: 28–44.

[64] Smolak L, Murnen SK. Drive for leanness: assessment and rela-tionship to gender, gender role and objectification. Body Image. 2008; 5: 251–260.

[65] Plonsky L, Oswald FL. How Big is “Big”? Interpreting Effect Sizes in L2 Research. Language Learning. 2014; 64: 878–912.

[66] Aron A, Aron EN, Coups EJ. Statistics for psychology. 5th edn. Pearson Prentice Hall: NJ. 2009.

[67] Hildebrandt T, Langenbucher J, Schlundt DG. Muscularity con-cerns among men: development of attitudinal and perceptual measures. Body Image. 2004; 1: 169–181.

[68] Hildebrandt T, Harty S, Langenbucher JW. Fitness supplements as a gateway substance for anabolic-androgenic steroid use. Psy-chology of Addictive Behaviors. 2012; 26: 955–962.

[69] McCreary DR. Body image and muscularity. In: Cash, TF, L. Smolak, L, (eds.) Body image: A handbook of science, practice and prevention (pp. 198–205). 2nd edn. Guilford Press: New York, NY. 2011.

[70] Baker L, Gringart E. Body image and self-esteem in older adult-hood. Ageing and Society. 2009; 29: 977–995.

[71] Clarke LH, Korotchenko A. Aging and the Body: a Review. Canadian Journal on Aging/La Revue Canadienne Du Vieillisse-ment. 2011; 30: 495–510.

[72] Ha E, Zemel MB. Functional properties of whey, whey compo-nents, and essential amino acids: mechanisms underlying health benefits for active people. The Journal of nutritional biochem-istry. 2003; 14: 251–258.