Growing role of body image drugs

In the current issue of Psychotherapy and Psychosomatics Kanayama et al. analyse the growing role of body image drugs.

Patterns of illicit drug use vary widely around the world. Culture influences not only attitudes towards illicit drug use in general, but also which particular drugs people choose to use; a drug effect sought by one population might have little appeal for another. In this study, a group of investigators explores a form of drug abuse that is strikingly asymmetric across cultures: the use of 'body image drugs' such as anabolic-androgenic steroids (AAS). The AAS are a family of hormones that includes the natural male hormone testosterone and its numerous synthetic derivatives.

In high doses, AAS permit users (who are mostly though not always, male) to achieve marked increases in muscularity and decreases in body fat, often well beyond the limits attainable by natural means. Now, AAS have been used worldwide by millions of men, many of whom have no athletic aspirations, but simply want to look more muscular. Such men often also use various other body image drugs to gain muscle or lose body fat, including substances such as human growth hormone, thyroid hormones, insulin, clenbuterol and ephedrine. Concern about the dangers of these drugs has mounted over the last decade, with increasing recognition of their possible cardiac, neuroendocrine and psychiatric effects, including the frequent development of dependence syndromes.

Why then are AAS almost completely restricted to the West? The investigators suggest that the explanation dates back millennia and is grounded in psychosomatics. Western cultures have extolled muscularity since ancient times, as illustrated by Samson in the Bible, or by the supernaturally muscular gods of ancient Greece and Rome. Consider for example the ancient Farnese statue of Hercules, now at the Museo Archeologico Nazionale Napoli and depicted in a 17th-century drawing by famed Italian anatomist Bernardino Genga. These same venerable Western traditions of muscularity have continued to flourish into modern times, as illustrated by muscular action toys for children, male bodies in magazine advertisements, Hollywood movie characters and numerous other images.

Will body image drugs such as AAS eventually infiltrate the Far East? That will depend on whether Western attitudes towards muscularity, augmented by the forces of media and marketing, can trump the equally venerable opposing attitudes in Asia.

And what about new drugs on the horizon? Progress in pharmacology will likely yield not only new intoxicants, but also cognitive enhancers, drugs that may someday allow individuals to 'dial' their own body weight, and other substances with a variety of psychosomatic properties. These and other drugs will increasingly be diffused on the Internet, with the consequent tendency towards a globalization of cultures. How, in the brave new world of expanding pharmacological options and growing electronic access, will people in different cultures choose from the menu available to them? These issues, and indeed many elements of our above discussion, remain speculative. Clearly, however, the interface between culture and drug abuse will remain a fertile area for future exploration, with implications for public health, international policy and ethics.