"Past 12-month use of anabolic steroids in 12th grade are similar for males and females, at 1.3% and 0.9%, respectively. Use of other substances for body building and performance is substantially higher for males. In 2022 past 12-month use of androstenedione was 2.8% for males and 1.1% for females, while prevalence of creatine was 18.6% for males and 5.2% for females."
"The desire to achieve a thin physique has stemmed from women’s ideal bodies traditionally being considered ‘thin’ [1]. More recently, the ideal body type for women is changing and social influences (e.g. media) have been promoting athletic female beauty ideals alongside defined and muscular body shapes for women [2, 3].
"Peers and social networks are an important component of the performance and image enhancing drug (PIED) community.
"Stimulants are a class of performance-enhancing substances some bodybuilders use to increase focus, alertness, and energy during their workouts. Some of the most commonly used stimulants in bodybuilding include amphetamines, caffeine, ephedrine, and clenbuterol. These substances are believed to enhance mental and physical performance, reduce fatigue, and improve endurance [25]. While stimulants can provide short-term benefits, their misuse can have serious health consequences.
"Diuretics are drugs that increase the rate of urine production by the kidneys, resulting in a loss of water and electrolytes from the body. In bodybuilding, diuretics are sometimes used to help reduce water retention in the body and promote a more defined and muscular appearance on stage. The use of diuretics in this manner is sometimes referred to as "cutting water weight" [21]. However, the misuse of diuretics can have serious health consequences.
"Insulin is a hormone that plays a crucial role in regulating blood sugar levels. The pancreas produces it, and its primary function is to help cells in the body absorb glucose from the bloodstream, which is then used for energy. In bodybuilding, insulin is often used as a performance-enhancing substance due to its anabolic effects. Insulin stimulates the uptake of amino acids and glucose into muscle cells, promoting muscle growth and repair [16]. However, the misuse of insulin can have serious health consequences.
"Human growth hormone (HGH) is a hormone naturally produced by the pituitary gland and plays a crucial role in stimulating growth, cell reproduction, and regeneration in humans. It is important in childhood for normal growth and development, and in adulthood, it helps to maintain muscle mass and bone density and regulate metabolism. HGH also significantly affects the immune system, cognitive function, and mood [14].
"Anabolic steroids are a class of synthetic substances that mimic the effects of the male hormone testosterone in the body. Bodybuilders and other athletes use these substances to increase muscle mass, strength, and endurance as well as to shorten recovery times after workouts. Anabolic steroids are also used medically to treat delayed puberty, muscle wasting, and osteoporosis [10]. Anabolic steroids are associated with numerous health risks, both short-term and long-term.
"Bodybuilding has a long history of performance-enhancing substance use. The early forms of PES in bodybuilding were simple remedies such as caffeine, alcohol, and opiates. However, the emergence of anabolic-androgenic steroids in the mid-20th century revolutionized the sport and transformed it into what we see today [5]. In the early days of bodybuilding, natural training methods and diet were the only ways to achieve a well-sculpted body.
"We did not find evidence that THN [Take-Home Naloxone] training was associated with risk compensation behavior in this cohort of people who inject drugs. Rather, there was no significant change in frequency of injecting any drugs, injecting opioids, or using benzodiazepines after accessing THN.
