Muscle Drugs

Muscle drugs, which often are associated with performance and image enhancing drugs (PIEDs) and ‘doping’, are used to enhance the structure and function of skeletal muscle. These substances are consumed for both cosmetics reasons (e.g. increase muscle definition) as to enhance physical performance (e.g. increase strength).

The use of performance and image enhancing drugs for the purposes of physical enhancement is nothing new. Humans have long sought to improve their physique or performance: from the use of special herbs and mushroom concoctions to the more recent use of anabolic androgenic steroids (or simply steroids) and other muscle enhancing drugs.

The most commonly used muscle drugs are steroids. A 2014 meta-analysis showed that 3.3% of the world’s population (6.4% men/1.6% woman) have used steroids at least once. In particular, subgroups that engage in physical activities for lifestyle purposes or aesthetic reasons often show high consumption levels. For example, people involved in weight training (e.g. fitness, powerlifting and bodybuilding) are commonly use performance and image enhancing drugs to increase muscle size, mass or power. Nonetheless, there are many other subgroups not related to sport or other physical activities that are also no stranger to performance and image enhancing drug consumption or other types as lifestyle drugs. These subgroups will often identify themselves more with other practices (e.g. their occupation) rather than with sport or other forms of physical activity (e.g. someone can still train at a fitness centre or at home).

Aside from steroids, there is a growing interest in human growth hormone (HGH), in particular for anti-ageing purposes, erythropoietin (EPO), and untested substances such as the non-steroidal selective androgen receptor modulators (SARMs). These drugs are often also used in combination with steroids. For instance, illicit HGH use in the weight-training community is often associated with poly-pharmacy involving steroids and other muscle enhancing drugs. In addition to combining muscle drugs with other muscle enhancers (e.g. steroids with HGH), diuretics (e.g. furosemide), weight-loss drugs (e.g. Clenbuterol), anti-oestrogens (e.g. Tamoxifen), and cosmetic or image enhancing drugs (e.g. Melanotan) are often used in addition as well.

While steroids are used for a wide variety of reasons, including ‘pleasurable’ ones, and can be used without harmful consequences in clinical settings, an issue, for example, is that most people use far greater doses than therapeutically indicated, and generally obtain muscle drugs via the black market where the quality of these substances cannot be controlled. Evidence is increasingly suggesting that the use of steroids is associated with a wide range of acute and chronic physical and psychological health consequences, with particular concerns around cardiovascular disease, cognitive deficiencies, and body image disorders. Another issue are the harms related to injecting practises (e.g. steroids and HGH are often injected) including damage to the injection site, local and systematic infections.