Introduction
The use of appearance and performance-enhancing drugs and supplements (APEDs) to enhance athletic performance and increase muscularity has become increasingly popular. However, the safety and quality of these products remain a concern. While legal APEDs are widely available, there is limited information on their potential benefits, side effects, and long-term health outcomes. Illicit APEDs, on the other hand, have been associated with more severe health effects. Additionally, the use of over-the-counter APEDs has been linked to the use of illicit APEDs, as well as symptoms of eating disorders and muscle dysmorphia. Understanding the patterns of APED use in different subpopulations is crucial for public health surveillance and identifying potential disparities.
Variations in APEDs Use Across Subpopulations
Pooled data from nine studies conducted in the United States revealed that approximately 3-4 million individuals reported lifetime use of anabolic-androgenic steroids, with a majority of users presumed to be cisgender men. However, disparities in APED use exist among marginalized communities, including higher usage among presumed cisgender sexual minority men and men of color. There is also evidence suggesting that gender minority populations, such as transgender and gender-expansive individuals, are at an increased risk of using illicit APEDs. Transgender boys/men, in particular, face structural barriers that may lead them to use nonprescription steroids due to limited access to gender-affirming care.
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APEDs and Eating Disorders and Muscle Dysmorphia Symptoms
Certain gender minority groups are also at an elevated risk of experiencing symptoms of eating disorders and muscle dysmorphia. Transgender college students, for example, have a higher likelihood of self-reported eating disorders, purging behaviors, and the use of diet pills compared to cisgender heterosexual women. In terms of muscle dysmorphia symptoms, transgender men exhibit similar drive for size as cisgender men but higher appearance anxiety/avoidance. It is worth noting that the relationship between APED use and eating disorders and muscle dysmorphia symptoms has been observed in other populations as well, but further research is needed to better understand these associations among gender minority individuals.
Addressing the Gaps in Knowledge
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Given the limited data on APED use among gender minority communities, this study aims to fill these gaps by examining the lifetime use of APEDs among transgender men, transgender women, and gender-expansive adults. Additionally, the study explores the association between APED use and recent eating disorder symptoms and muscle dysmorphia symptoms. The hypothesis is that there will be a positive association between APED use and the presence of eating disorder symptoms and muscle dysmorphia symptoms across gender minority populations.
By shedding light on APED use among gender minority individuals, this research will not only contribute to existing knowledge but also raise awareness among healthcare providers regarding the potential risks and challenges faced by these communities.
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