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In recent years there have been increasing calls for the use of anabolic androgenic steroids (AAS) and associated drugs to be recognized as a public health issue. In the domain of the competitive athlete and professional bodybuilder, recent decades have seen the diffusion of AAS from the hardcore gyms of the 1980s and 1990s to the mainstream exercise and fitness environments of the twenty-first century. Alongside the apparent increases in the use of these drugs, there is a growing evidence base in relation to harms – physical, psychological and (to some extent) social. But is this form of drug use a public health issue? What criteria should we use to make this judgement? What is the available evidence and has our understanding of the issue improved? By drawing on the authors' research in the United Kingdom and the wider international literature this chapter will explore these issues and attempt to answer the fundamental question – is the use of anabolic steroids a public health issue?

Previous research has found that people who use anabolic androgenic steroids (hereafter ‘steroids’) typically describe these drugs as safe. However, research exploring the inside perspective on steroid risk has focussed on steroids in general, and failed to examine how particular steroids are viewed and experienced. During my online ethnographic research in bodybuilding communities, I found discussion of one particular steroid said to cause significant physical, psychological, social and sexual harm: trenbolone. Trenbolone is a veterinary drug used to increase muscle in beef cattle that has been found to have neurodegenerative and genotoxic effects on animals. It has been used by bodybuilders since the 1980s, and recent research has found it to be one of the most popular steroids used by bodybuilders. If trenbolone is described by bodybuilders as causing significant harm, why do so many bodybuilders use it? This chapter attempts to answer this question through a description of bodybuilder folk models of trenbolone risk. Using a social life of drugs approach it describes: (1) the effects of trenbolone; (2) how these effects are given meaning as either harms or benefits, and then weighed against each other; (3) how the risks of trenbolone are reduced through harm reduction strategies and (4) the role of online communities in negotiations of trenbolone risk. Trenbolone was found to occupy a mythical status in bodybuilding communities, in part because of the conflicted relationship bodybuilders have with the drug. This conflicted relationship illustrates the inherent ambivalence of drugs, which are always both remedy and poison.

This study seeks to gain some understanding about the attitudes of anabolic‐androgenic steroid (AAS) users towards the media and whether their constructs of masculinity are influenced by this. It also aims to explore their attitudes towards health information.

A self‐completion questionnaire containing 35 items of both open and closed questions was designed for the study. All participants were English‐speaking, injecting male steroid users, 16 years or older whose trigger for using was confidence and self‐esteem, and were registered clients at either of the two included UK needle exchange services.

Participants and other AAS users were open about their use to each other, but not to people external to that sub‐culture. They denied media influence, although they thought that most men in the media with muscular bodies used AAS. They associate masculinity with strength and muscle. They seemed knowledgeable about the health implications of AAS, but would not tell a health professional unless asked directly. There appears to be a sub‐culture normalisation regarding AAS use, with the trivialisation of health messages, their minimisation of the possibility of negative effects happening to them, and comparison of oneself to others they regard as inferior in some way.

The paper explores the need for a credible and non‐judgmental source of information for users of AAS.

While steroid use in the sports context has already been extensively studied by academic researchers, its patterns and implications in the prison context have received scant attention. Why do inmates use androgenic–anabolic steroids (AAS)? How does this use relate to sports activities, in particular fitness training, and what does it mean vis-à-vis the body image that is promoted in this environment? Does it even relate to fitness or sport? How do prison authorities regulate or prevent prisoners' AAS use? This empirical study is based on 28 interviews with 19 inmates and nine staff members (guards, managers) of four Belgian prisons. We showed that steroid use is largely connected with fitness activities and that it has an instrumental, goal-oriented dimension. AAS are used for athletic/performance purposes, e.g. increasing muscular strength. They also help gain or maintain a satisfactory body (self-)image, which has implications on the own identity, prestige and power relations within the prison community. In jail, the body is a major type of symbolic capital that is intended to reinforce status and cope with the difficulties and actual conditions of incarceration. We also observed differences in the perceived legitimacy of the various drugs that are used in prison. While guards are more tolerant towards AAS than other drugs, prisoners are less prone to openly confess to using AAS. Admitting to using AAS would damage the inmate's reputation, the legitimacy of his muscled body, and the subsequent goals of individual power and prestige.

This chapter presents an auto-ethnographic journey into the world of women's bodybuilding and the role performance-enhancing drugs play in the pursuit of muscularity in this growing, but hard-to-reach, subculture. The research addresses a paucity in the literature and paves the way for further research to inform public health initiatives for this population. Synthesizing journal entries, field observations and informal conversations recorded over the course of 18 months, this chapter provides insight into the rituals and practices present in bodybuilding culture. This embodied narrative explores the decision-making process surrounding anabolic androgenic steroid use in the context of competitive endeavour, including the impact that cultural norms, peer influence and personal narrative have on their uptake. It also sheds light on the experiences of being a woman in a man's world and the additional stigma women face when attempting to increase their muscularity. It also highlights the personal and professional challenges involved in auto-ethnographic endeavour.

This chapter introduces the sociologically informed concept of cultural manspreading, which is used to critically examine how gender and power operate in relation to doping and image and performance enhancing drug (IPED) use. Though not exclusively, the chapter centres on the online doping context and how men and women in different forums navigate their doping lifestyles and identities. By focusing on the online doping context, the chapter brackets not only the focus on sport and fitness that has dominated much research, but also the physical dimension that have been at the heart of manspreading in public discourse. Thereby the concept is theorized for wider interpretations, including analysis of men dominating spatial, social and sexual aspects/domains of doping subcultures to the detriment of women or subordinate men. Though doping subcultures are steeped in a masculinity that prioritizes muscular masculinities and construct men as experts and sources of knowledge about doping, the chapter also illustrates how both men and women sometimes play into and challenge such patterns and gender dynamics. Indeed, at times, women's presence in different doping spaces can be a challenge to the default male position. Further, by introducing women-only doping forums the chapter argues that women can begin to debate and share their experiences uninterrupted, developing their own store of knowledge, and setting the female body and experience as default. This supports the idea of a gradual formation of a sis-science doping culture.

With digital spaces an increasing feature of our everyday lives, and the internet now a primary means of sourcing IPEDs and information regarding their use, this chapter seeks to understand how digital fitness forum communities shape the dissemination of culturally embedded harm reduction advice. Findings are drawn from two netnographic studies of fitness forums, which identify several key areas in which community norms and structures served to inform harm reduction behaviours. This included embedded forum reputation systems and the ways in which these shaped IPED access, including through elevating ‘expert’ users and encouraging informed discussion regarding product quality, to the emergence of steroid testing services from forums as a community harm reduction tool. Second, forums were observed to often encourage users to conduct research and inform themselves regarding safe use, though limitations to this norm were also documented in relation to poor-quality medical advice, highlighting the issues with IPED users' reliance on anecdotal advice in the contexts of prohibition. Finally, the role of digital fitness forums as ‘digital backstage’ is considered, examining both how this can be harmful to IPED users from excluded or ‘otherised’ groups, but simultaneously offers cultural participants the opportunity for airing vulnerabilities in a space where their masculine identity is not threatened in doing so, thus facilitating harm reduction among cultural ‘insiders’.

The aim of this review was to amalgamate the extant literature that has investigated the experiences of healthcare professionals with PIED consumers and the experiences of PIED consumers with healthcare professionals, with a specific focus on medical practitioners. A systematic search was undertaken to identify studies that explored the experiences and perspectives of healthcare providers working with clients who use PIEDs, as well as to identify studies that explored the experiences and perspectives of PIED consumers with healthcare providers. Ten studies were included, of which four explored the experiences of healthcare providers with PIED consumers, and six explored the experiences of PIED consumers with healthcare providers. A sizeable proportion of healthcare providers come into contact with PIED consumers, with these interactions mostly related to consumers asking for information, though a small but significant proportion indicate they have been asked to prescribe doping agents. Of the six studies which focused on the consumer experience, five focused on PIED consumers; these studies found that while large proportions reporting accessing a medical practitioner, larger proportions did not, with the doctor's lack of knowledge cited as one reason. More research is needed to investigate how they come into contact with this group of consumers, their level of knowledge and any training that they may need. Given the harms associated with PIED use, and the lack of disclosure of use to healthcare providers, more research is needed to understand the barriers and facilitators for consumers to accessing health care.

This chapter focuses on what we know about the intersections of gender, doping and sport and addresses the history, complexities and nuances of how gender impacts perceptions of and research on doping in sport. After establishing briefly what the physiology, psychology, media studies and sociology literature demonstrates with respect to the intersection of doping and gender, this chapter addresses how and why gender was neglected in the creation of anti-doping policies. The lack of thought toward gender in the creation of the current anti-doping system, combined with the conflation of drug testing and sex testing issues by the International Olympic Committee's medical commission in the 1960s, has led to persistent gender stereotypes associated with anti-doping rule violations. As a result, unintended overlap between sex testing and drug testing continues, with implications for the eligibility of intersex and transgender athletes.

This chapter introduces the main aims and ambition with the anthology, which is to bring together research from diverse perspectives on doping and Image and Performance Enhancing Drug (IPED) use. The chapter highlights existing but often backgrounded links between sport and fitness doping research and present a re-reading of the cultural history of doping through which simplistic divisions, such as that between sport and fitness, are deconstructed. Further, by unbinding the hegemonic divide between sports doping and fitness doping, new insights (and themes) concerning anti-doping, health and risk, new emerging doping spaces and the gendering of this field of research are brought to the fore. These themes are then used as point of departure when introducing the different chapters and scholars that contribute to the volume at hand.