Exploring user narratives of self-medicated black market IPED use for therapeutic & wellbeing purposes

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Abstract

With the rising use of IPEDs, it is important to understand how user motivations and practices influence harms, in order to formulate effective harm reduction policy. Existing work has consequently developed user typologies to address this need for specific interventions for differing users. Within this, the ‘wellbeing’ user type is one of the most prominent, however this broad category encompasses a range of users with distinct motivations and needs. This paper consequently explores the subcategory of therapeutically-motivated IPED users, whose IPED use is targeted at repair, rehabilitation, and self-medicating for health conditions, and considers the specific needs of this user category.

Findings are drawn from a connective ethnography of gyms in South-West England, and digital fitness platforms, to analyze the motivations of therapeutically-oriented users, and how their behaviors and experiences are important to formulating interventions and broader policy discussions.

Motivations explored include: (1) repair and injury rehabilitation, including those who access IPEDs for repair relating to sporting or competitive endeavors, as well as those whose IPED use is self-medicating for chronic health conditions. (2) General ‘wellbeing’ motivations for which participants self-medicated with IPEDs, including: health-oriented fat loss, rehabilitation for sleep, irritable bowel syndrome, and offsetting the negative health effects of hard sporting training. And (3) self-medicated testosterone replacement therapy (TRT) to offset negative symptoms ascribed to ‘low testosterone’, in both older gym participants whose natural levels were declining and who were looking to offset this, as well as men who experienced mental health difficulties such as depression, and sought to restore wellbeing through use of black market testosterone.

This article demonstrates the breadth of therapeutic motivations for IPED use, and points to the ways in which the specific needs of this user category may be distinct from broader ‘wellbeing’ users. Significantly, participant narratives regarding the medical community's perceived unwillingness to treat them, and their feelings that this pushed them to access illicit IPEDs, indicate the importance of understanding the specific needs in relation to harm reduction policy formation.Keywords: IPED; HED; TRT; self-medication; wellness enhancement

Section snippets

Background

Enhancement drugs are an increasingly important topic for public health research, with data indicating they are used by a growing portion of the population (Bates, McVeigh & Leavey, 2021). With these drugs associated with a number of harms (Pope et al., 2014), contemporary research has sought to understand how and why they are accessed and used, in order to formulate effective harm reduction policies (Kimergård & McVeigh, 2014; McVeigh & Begley, 2016). Existing explorations of enhancement drugs

Approach

Findings are drawn from a multi-year, multi-sited ethnography of IPED user cultures, exploring both offline and online sites, forming a ‘connective ethnography’ (Gibbs & Hall, 2021) of UK gyms and international digital contexts. This multi-sited approach to work spanning both digital and gym fieldsites has been adopted by a number of IPED researchers in recent years, and reflects the increasing significance of overlap between these spaces in the lives of cultural participants, both as part of

Injury repair/rehabilitation

The most commonly-cited form of therapeutic use identified in participant interviews related to injury repair and rehabilitation. With several participants belonging to sporting cultures, where remaining injury-free and minimizing time out of training was important, repair-focussed use was commonplace among those already using IPEDs for more conventional purposes:

‘[my IPED use] was mainly for strength gains, but I would use something every now and then [therapeutically], like I used some Anavar

Contributions of the research

This article builds on existing literature examining the heterogeneous behavior profiles of IPED users, and exploring the ways in which greater understanding of their motivations may help in formulating effective harm reduction policy for this population. Building on prior explorations which have developed typologies to understand IPED consumption, and how behaviours and motives correlate within user populations (Christiansen et al., 2017; Zahnow et al., 2018), this article has pointed to a

Declaration of Competing Interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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      This debate highlights that harm reduction approaches need to be appropriate to those that they are targeting and we must recognise the substantial diversity in IPED communities such as relating to types of IPEDs used (Begley et al., 2017), methods of administration (van de Ven et al., 2020), attitudes towards risk (Christiansen et al., 2016; Zahnow et al., 2018), and motivations for use (Brennan et al., 2016; Greenway & Price, 2018). While studies of IPED use in the UK have commonly focused on young white males, studies highlight IPED use amongst other demographic groups including women (Begley et al., 2017), men who have sex with men (Hibbert et al., 2021), older men (Harvey et al., 2021; Turnock, 2021), and South Asian communities (Van Hout & Kean, 2015), which adds to this diversity. There is therefore great variation in needs and preferences for healthcare, services, and interventions.

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