Research Paper
Image and performance enhancing drug use among men who have sex with men and women who have sex with women in the UK

https://doi.org/10.1016/j.drugpo.2020.102933Get rights and content

Abstract

Background

The use of image and performance enhancing drugs (IPEDs) among men who have sex with men (MSM) and women who have sex with women (WSW) is rarely studied, with most of this research focused on anabolic androgenic steroid use among MSM. To address this gap, the extent of recent IPED use and the associated factors are explored in a community-recruited sample of MSM and WSW

Methods

Data from the UK LGBT Sex and Lifestyles Survey was used, which recruited through social-media advertising and community organisations (April-June 2018). Participants were asked if they had taken any IPEDs (e.g. anabolic steroids, growth hormone, hCG, Melanotan, non-prescribed diet pills) in the past 12 months. Factors associated with recent (in past 12 months) IPED use among MSM and WSW were investigated using stepwise binary logistic regression.

Results

1,658 MSM and 1,507 WSW were included in the analysis. Among MSM, 3.4% (n = 57) had recently taken IPEDs, 60% of those taking IPEDs had used psychoactive drugs. In the multivariable analysis, IPED use among MSM was associated with psychoactive drug use, Viagra use, higher body dissatisfaction, and lower sexual satisfaction. Among WSW, 4.1% (n = 62) had recently taken IPEDs, and 50% of those taking IPEDs had used psychoactive drugs. In the multivariable analysis, IPED use among WSW was associated with being aged 45 years and over, recent STI diagnosis, recent sexual contact without consent, and higher body dissatisfaction.

Conclusion

IPED use was reported by around 1-in-25 MSM and WSW, and was associated with a number of health and psychological problems. Research to better understand the drivers and impacts of IPED use among MSM and WSW, and how this compares to use among heterosexual people is needed.

Introduction

Image and performance enhancing drugs (IPEDs) are a group of substances that people take to alter their appearance or physical abilities and include anabolic androgenic steroids (AAS), growth hormones, weight loss drugs and skin tanning agents, such as melanotan (Begley, McVeigh, & Hope, 2017). Whilst IPEDs can be consumed both orally and through intramuscular and subcutaneous injection, administration through injection is most common. Evidence indicates an increase in the range and availability of IPEDs, through online promotion and retail, with this probably related to increases in polydrug use and overall use (Sagoe et al., 2015; Salinas, Floodgate, & Ralphs, 2019). In the UK at least, this is corroborated by data indicating an increase in the number of people who are accessing needle and syringe programs that report using IPEDs (McVeigh & Begley, 2017). There are a number public health and health problems associated with the use of IPEDs, particularly AAS, such as cardiovascular conditions and sexual dysfunction (Begley et al., 2017), and injecting IPEDs in particular has been associated with hepatitis C infection (Hope et al., 2016). Polydrug use is common, with the concomitant use of a range of psychoactive substances, particularly cocaine and amphetamines often reported (Hope et al., 2017). A systematic review investigating motivations for injecting IPEDs identified numerous motivations including body image disturbance, a drive for muscularity, increasing strength and enhancing appearance (Brennan, Wells, & Van Hout, 2017).

Research into IPED use has mostly been on samples predominantly composed of heterosexual men (Hope et al., 2016; Rowe, Berger, Yaseen, & Copeland, 2017; Van de Ven et al., 2018), or samples composed mostly of gay and bisexual men recruited from gyms mainly used by this group (Bolding, Sherr, & Elford, 2002; Ip et al., 2017); with the participants often using AAS. In England and Wales, being a man who has sex with men (MSM) was associated with increased odds of HIV and Hepatitis B among men using IPEDs (Hope et al., 2016). In the USA, homosexual men using AAS reported more HIV and STI diagnoses and greater sexual risk taking behavior compared to heterosexual men using AAS (Ip et al., 2017). Therefore, both sexual risk and injecting drug use may compound a person's risk for HIV acquisition among people who use IPEDs. In terms of psychological harms, research from Australia and New Zealand found that among gay and bisexual men, thoughts about using AAS were associated with lower quality of life and greater dissatisfaction with muscularity and height, but this was not observed for actual AAS use (Griffiths, Murray, Dunn, & Blashill, 2017). A small study in the USA investigating AAS use in women, including homosexual women (3/12), found that women who used AAS were more likely to meet the criteria for substance-dependence disorder, be diagnosed with a psychiatric illness, and have a history of sexual abuse compared to women who did not use anabolic androgenic steroids (Ip et al., 2010).

Another group of IPEDs are weight loss drugs or diet pills, and in Massachusetts, USA, adolescent gay men and young lesbian and bisexual women were at greater odds of using diet pills than heterosexual adolescent men and women (Watson, Adjei, Saewyc, Homma, & Goodenow, 2017). The same trend has also been observed in Minnesota adolescents (Watson et al., 2018), and use of dieting supplements has been associated with depressive symptoms in the USA (Vrany, Hawkins, Wu, & Stewart, 2018). However, much of the research into the use of diet pills that considers MSM and women who have sex with women (WSW) focuses specifically on adolescents and is based on samples from the USA.

Overall, knowledge about the extent of IPED use among adult MSM and particularly adult WSW is currently limited. MSM and WSW experience of body image pressures that may be very different to those of heterosexual people because of their sexuality, for example the use of gay dating apps has been associated with weight stigma, objectification and social comparison among MSM (Filice, Raffoul, Meyer, & Neiterman, 2019). Furthermore, MSM may face additional pressures not experienced by heterosexual men such as a community focus on sex, status, and competition, which has found to predict mental health among gay and bisexual men in addition to more traditional community stressors (e.g. stigma and discrimination) (Pachankis et al., 2020). MSM also have an increased risk of blood borne viruses through sexual transmission (Martin et al., 2013), and this risk might be increased further through IPED use, particular where these are injected (Begley et al., 2017). The use of IPED among women is under researched compared to men, with sexuality rarely considered; we are not aware of any studies that have looked at the extent of IPED use among WSW. Studies indicate that the use of psychoactive drugs is more common among MSM and WSW than among heterosexual people (Booker, Rieger, & Unger, 2017; Office of National Statistics, 2014), thus the proportion of MSM and WSW using IPEDs may also differ to that among the general population. A better understanding of the extent of IPED use among MSM and WSW, and the associated demographic characteristics, wellbeing and psychosocial issues, is therefore needed to inform appropriate responses.

Internationally, very little research has examined the socio-demographic, psychosocial and sexual factors associated with the use of IPEDs among MSM and WSW, with the few studies undertaken typically having either small sample sizes or recruiting from a limited setting (such as a gyms), and mainly focused on MSM. We use data from a large national community survey to examine the extent of IPED use among MSM and WSW in the UK and to investigate the factors associations with their use.

Section snippets

Methods

Data were collected using an online cross-sectional survey of LGBT people living in the UK. Ethical approval was obtained from Liverpool John Moores University Ethics Committee (approval reference: 18/PHI/011). The methods of the LGBT Sex and Lifestyles Survey have been published elsewhere (Hibbert, Brett, Porcellato, & Hope, 2019; Hibbert, Porcellato, Brett, & Hope, 2019), but briefly, a national convenience sample of MSM, WSW and trans people was obtained between April-June 2018 by using

Results

Of the 4690 surveys started, 3676 participants completed the survey (completion rate 78%). There were 1663 (45%) participants who identified as MSM, and 1513 (41%) who identified as WSW (the other 500 participants did not report having sex with someone of the same gender). Participants who completed the survey were more likely to be female (48% vs. 38%, p < 0.001), in a relationship (64% vs. 57%, p < 0.01), and university educated (58% vs. 49%, p < 0.01), but did not differ on any other

Discussion

Overall, we found that IPED use in the last year was reported by around 1-in-25 MSM and WSW, and the lifetime use of IPEDs will almost certainly be higher. We found that recent IPED use was associated with a number of psychological and health problems, such as psychoactive drug use and STI diagnoses. Unsurprisingly, body dissatisfaction was associated with the use of IPEDs among both MSM and WSW. Although this differs to research among gay and bisexual men using AAS in Australia and New Zealand

Funding

This project was funded through a postgraduate Liverpool John Moores University Scholarship.

Declarations of Interest

None.

Acknowledgements

The researchers would like to thank everyone who participated in the survey, as well as CliniQ, COAST, GALOP, the Gay Men's Health Collective and LGB&T Partnership for their contribution to the design and recruitment of the survey.

References (34)

  • Bourne, A., Reid, D., Hickson, F., Torres Rueda, S., & Weatherburn, P. (2014). The Chemsex study: Drug use in sexual...
  • R. Brennan et al.

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

    Health & Social Care in the Community

    (2017)
  • E. Diener et al.

    The Satisfaction With Life Scale

    Journal of Personality Assessment

    (1985)
  • J. Germain et al.

    One size does not fit all: Tackling the issue of weight loss drug use

  • G.M. Herek et al.

    Correlates of internalized homophobia in a community sample of lesbians and gay men

    Journal of the Gay and Lesbian Medical Association

    (1998)
  • M.P. Hibbert et al.

    Psychosocial and sexual characteristics associated with sexualised drug use and chemsex among men who have sex with men (MSM) in the UK

    Sexually Transmitted Infections

    (2019)
  • V.D. Hope et al.

    Risk of HIV and Hepatitis B and C Over Time Among Men Who Inject Image and Performance Enhancing Drugs in England and Wales: Results From Cross-Sectional Prevalence Surveys, 1992-2013

    Jaids-Journal of Acquired Immune Deficiency Syndromes

    (2016)
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