Appearance- and Performance-Enhancing Substances Including Anabolic-Androgenic Steroids Among Boys and Men

Body dissatisfaction, particularly with a focus on muscularity, continues to be a pervasive issue among boys and men. It may then come as no surprise that some look to use special drugs and substances to facilitate their pursuit of an increasingly muscular physique. This chapter highlights a myriad of both legal and illegal appearance- and performance-enhancing substances (APESs) which could be sought for such functions, with a particular focus on a class of illicit APES that has received arguably the greatest empirical and clinical attention – anabolic-androgenic steroids (AASs). While AASs may be sought out to boost lean muscularity at a rate virtually impossible through conventional diet or exercise alone, our chapter first presents medical research to underscore the physical and psychological health complications connected with its use. Second, we illustrate the close relationship between problematic male body image and the motivation to use AASs, highlighting in particular its association with muscle dysmorphia, a serious psychiatric condition hallmarked by the pathological extreme pursuit of muscularity. The chapter closes by synthesizing available literature to provide an overview of important (but preliminary) considerations, guidance, and recommendations that may help support clinicians in dealing with the complexities of AAS use.