Table 2.
Characteristics of qualitative studies presenting data on AAS use initiation
| First author, year, reference | Initiation age(s) | History prior to use | Source(s) | Motive(s)/drive(s) for use |
|---|---|---|---|---|
| Annitto 1980 [19] |
16 years |
Weightlifting |
Illicit market |
Appearance |
| Bardick 2006 [20] |
Not specified |
Weight training |
Not specified |
Appearance, confidence, media, personal security, psychological well-being, sports |
| Bilard 2011 [21] |
Not specified |
Bodybuilding |
Friends, dealers, others, relatives, teammates |
Appearance, muscle, physiological recovery, psychological, sports, sports norm, other |
| Boyadjiev 2000 [22] |
19 years |
Bodybuilding, cycling |
Not specified |
Sports |
| Copeland 2000 [23] and Peters 1997 [24] |
14 to 46 years; mean 25 years |
Not specified |
Coaches/trainers, dealers, doctors, friends, gym employees, other, pharmacists, mail order relatives, veterinarians |
Appearance, muscle, other, physiological recovery/injury prevention, sports |
| Cornford 2014 [9] |
≤ 30 years (n = 14) |
Not specified |
Not specified |
Muscle, personal security, physiological recovery, sports |
| Fudala 2003 [25] |
≤ 26 years |
Negative body image, poor self-esteem, psychological disorders, troubled background |
Not specified |
Appearance, psychological |
| Fudala 2003 [25] |
≤ 31 years |
Negative body image, low self-efficacy, troubled background |
Not specified |
Appearance, muscle |
| Fudala 2003 [25] |
17 years |
Football |
Relative |
Appearance, muscle, sports |
| Fudala 2003 [25] |
26 years |
Troubled background |
Not specified |
Appearance, muscle |
| Fudala 2003 [25] |
21 years |
Binge eating, psychological disorders, troubled background |
Not specified |
Not specified |
| Fudala 2003 [25] |
27 years |
Troubled background, weightlifting |
Friend |
Sports |
| Fudala 2003 [25] |
24 years |
Bodybuilding |
Not specified |
Sports |
| Grogan 2006 [26] |
15 years, 16 years, 18 years, 19 years, 20 years, 21 years, 23 years, 29 years |
Bodybuilding |
Not specified |
Appearance, media, occupational, sports, sport/social norm |
| Gruber 1999 [27] |
Not specified |
Polydrug use, psychological disorders, troubled background |
Trainer |
Appearance, muscle, personal security |
| Hegazy 2013 [28] |
22 years |
Polydrug use, psychological disorders, troubled background |
Friends |
Appearance, muscle, recovery |
| Joubert 2014 [7] |
16 to 24 years |
Low self-esteem, negative body image, troubled background |
Not specified |
Appearance, confidence, family influence, muscle, peer influence, personal security, psychological well-being, self-esteem, social pressure |
| Katz 1990 [29] |
21 years |
Bodybuilding |
Not specified |
Sports |
| Khorrami 2002 [30] |
Not specified |
Football, negative body image, weightlifting |
Gym employee |
Appearance, family influence, muscle, sports |
| Kimergård 2014 [6,8] |
16 years; mean age 25 years |
Not specified |
Not specified |
Appearance, muscle, occupational, sports |
| Klötz 2010 [31] |
Not specified |
Not specified |
Not specified |
Aggression, appearance, muscle, other, psychological, sports, sport/social norm |
| Korkia 1993 [12] |
16 years, 18 years, 32 years, 54 years |
Weight training |
Coach, dealers, doctors, friends/teammates, gym owner/employee |
Muscle, physiological recovery, sports |
| Korkia 1996 [13] |
19 years, 23 years |
Not specified |
Friends, gym owners/employees, husbands/boyfriends |
Muscle, sports |
| Kusserow 1990 [32] |
14 years, 15 years, 17 years, 18 years, ≤ 25 years† |
Football, bodybuilding, negative body image, polydrug use |
Coach/team doctor, dealers, doctors, friends/teammates, gym employees, pharmacists, veterinarians |
Aggression, sports scholarship, appearance, coaches’ approval, famous athletes, media influence, parental approval, peer influence, sexual attraction, sports |
| Malone 1995 [33] |
24 years |
Weightlifting |
Not specified |
Appearance, muscle, injury prevention/recovery, sports, sport norm |
| Maycock 2005 [34] and 2007 [35] |
24 years, 25 years |
Complacent trainers, negative body image, weight training |
Dealers |
Appearance, aggression, coaches’ approval, peer influence, sexual attraction, sports |
| McKillop 1987 [36] |
Not specified |
Not specified |
Not specified |
Aggression, injury prevention/recovery, muscle, sports |
| Midgley 1999 [37] |
Not specified |
Not specified |
Not specified |
Appearance, injury prevention/recovery, psychological well-being, muscle, peer influence, sports, sexual attraction |
| Nøkleby 2013 [38] |
Not specified |
Other drug use, sports/exercise |
Friend |
Appearance, muscle, psychological well-being, sports |
| O’Sullivan 2000 [39] |
Not specified |
Not specified |
Friends, gym dealers, medical practitioners |
Appearance, muscle |
| Olrich 1999 [40] |
23 years |
Bodybuilding |
Not specified |
Appearance, curiosity, occupational, peer influence, psychological well-being, social/sexual attraction, sports, sport/social norm |
| Pappa 2012 [41] |
Not specified |
Athletics |
Not specified |
Appearance, concentration, curiosity, muscle, social influence, sports, sport norm |
| Petrocelli 2008 [42] |
Not specified |
Long-term exposure to muscle magazines, negative body image, weight training |
Dealer, friend, external internet, gym dealer |
appearance, confidence, muscle, psychological well-being, sexual attraction |
| Pope 1990 [43] |
30 years |
Weightlifting |
Not specified |
Not specified |
| Pope 1990 [43] |
21 years |
Weightlifting |
Not specified |
Sports |
| Pope 1990 [43] |
20 years |
Weightlifting |
Not specified |
Sports |
| Pope 1993 [44] |
19 years |
Anorexia nervosa, negative body image, psychological disorders, weightlifting |
Not specified |
Appearance |
| Pope 1993 [44] |
18 years |
Anorexia nervosa, negative body image, weightlifting |
Not specified |
Appearance |
| Pope 1993 [44] |
24 years |
Anorexia nervosa, negative body image, weightlifting |
Not specified |
Appearance |
| Pope 1996 [45] |
14 years |
Psychological disorders, weightlifting |
Not specified |
Appearance, confidence, muscle, psychological |
| Rashid 2000 [14] |
38 years |
Psychological disorders, other drug use, troubled background |
Not specified |
Appearance, confidence, muscle, psychological |
| Schwingel 2012 [46] |
Not specified |
Not specified |
Friends, illicit market |
Appearance, muscle, occupational, sport |
| Scull 2013 [47] |
18 years |
Male stripping |
Not specified |
Appearance, muscle, occupational |
| Skårberg 2008 [49] |
20 years |
Troubled background, weight training |
Friend |
Appearance, muscle |
| Skårberg 2008 [49] |
21 years |
Troubled background, weight training |
Friend |
Muscle |
| Skårberg 2008 [49] |
16 years |
Irritability, troubled background, weight training |
Not specified |
Curiosity, muscle |
| Skårberg 2008 [49] |
20 years |
Bodybuilding, other sports |
Not specified |
Appearance, sports, sport norm |
| Skårberg 2008 [49] |
20 years |
Bodybuilding, troubled background, |
Not specified |
Sports, sport norm |
| Skårberg 2008 [49] |
21 years |
Other sports, troubled background, weight training |
Intimate partner |
Appearance, muscle |
| Skårberg 2009 [50] and 2007 [48] |
15 to 28 years |
Troubled background |
Not specified |
Appearance, muscle, sports |
| Tallon 2007 [11] |
18 to 43 years |
Weight training, other sports |
Friends/training partners |
Appearance, confidence, injury/illness prevention, muscle, psychological, sexual attraction |
| Todd 1987 [51] |
Not specified |
Powerlifting |
Dealer |
Sports, sport norm |
| Vassalo 2010 [52] |
Not specified |
Football |
Not specified |
Sports scholarship |
| Walker 2011 [10] |
20 to 30 years† |
Not specified |
Gym dealer |
Appearance, muscle |
| Wilson-Fearon 1999 [53] | Not specified | Bodybuilding | Not specified | Sports |
†Majority.