The Man, the Myth

Grappling with male body image and anabolic steroid misuse.

by Shalender Bhasin, MD

Men’s health is typically associated with conditions related to urological and sexual function. But increasingly, problems with body image are among the top concerns we address in the clinic. Body image disorders are a serious public health issue, especially when linked to misuse of anabolic androgenic steroids, a synthetic hormone resembling testosterone that promotes muscle growth. Steroid use has risen in the past decade and has significant health consequences.

Let’s examine some facts and myths about male body image disorders and steroid use:

The “ideal” male body type marketed to men today is unrealistic and unhealthy.

Past male icons had lean, athletic bodies that average men could reasonably attain through diet and exercise. Today’s action stars and other entertainers transform their musculature to cartoonish proportions. For young men bombarded with these images in popular culture and social media, the pressure to conform to this body type can contribute to body dysmorphia and self-harming behaviors, including overexercising and steroid use. 

Men use anabolic steroids to gain a competitive edge in sports.

Up to 70% of steroid users are non-athletes taking them solely to enhance their physical appearance. Motivating factors for taking anabolic steroids might include boosting confidence, increasing muscle mass and decreasing body fat, improving energy, and attracting a sexual partner. Worryingly, estimates suggest 4 to 8 million steroid users in the U.S. are middle and high school students. 

Steroid use can take years off men’s lives.

Studies have linked steroid use to premature death, particularly those caused by cardiovascular events. Indeed, anabolic steroid use is one of many contributing factors to men’s overall life expectancy decreasing in recent years. 

Anabolic steroid use is a gateway to using other drugs, including opioids.

Steroid use is associated with a host of side effects, including depression and other psychiatric and mood effects. Some steroid users attempt to counteract these symptoms by taking opioids, which themselves create a cascade of other life and health impacts.  

Men should stop taking testosterone altogether.

There are many medically relevant reasons why some men with low testosterone might take testosterone therapy, which is different from steroids. It’s important to talk with a doctor about the benefits and risks of testosterone therapy.

We have come a long way in reducing the shame and secrecy around men’s sexual and physical health, but it can still be uncomfortable to discuss these topics. Please know there is no concern too embarrassing to talk about with your doctor—we are always here to help.

Shalender Bhasin, MD, director of the Boston Claude D. Pepper Older Americans Independence Center; director of the Men’s Health, Aging and Metabolism Research Unit, Division of Endocrinology, Diabetes and Hypertension; and co-director of the Center for Transgender Health