Steroids, Stigma, and Health: A Medical Anthropological Analysis of Anabolic Use in a Brazilian Bodybuilding Community

Steroids, Stigma, and Health: A Medical Anthropological Analysis of Anabolic Use in a Brazilian Bodybuilding Community | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Steroids, Stigma, and Health: A Medical Anthropological Analysis of Anabolic Use in a Brazilian Bodybuilding Community Luis Felipe Duarte Coutinho, Bernardo Aguiar Nunes, Ricardo Santiago Gomez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6568363/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Anabolic-androgenic steroids (AAS) are widely used in bodybuilding communities despite well-documented health risks. While previous studies have addressed AAS prevalence and physiological effects, few have examined how stigma and behavioral bias influence usage and acquisition patterns. This exploratory study applies Ajzen’s Theory of Planned Behavior, Bronfenbrenner’s Ecological Systems Theory, and Goffman’s stigma theory to analyze the sociocultural mechanisms shaping AAS use in a hard-to-reach community. A cross-sectional survey was conducted with 68 high-performance gym-goers at a private training center in Brazil, assessing prevalence, acquisition sources, risk perception, and social profile. Descriptive statistics were used alongside behavioral modeling theories to interpret user responses. Results reveal complex social factors, including physician-sourced supply despite simultaneously expressing distrust toward medical professionals when it comes to disclosure. These findings suggest a need for public health interventions that address stigma-related rationalizations, not only deterrence. The study highlights the importance of integrating anthropological and behavioral science into the epidemiology of AAS abuse. Traditional medical approaches often focus on physiological risks while neglecting the dynamics between macro and micro environments and social influences driving use. This work calls for holistic, evidence-based strategies and anthropologically informed public health initiatives that engage with the lived realities of stigmatized health practices. Biological sciences/Psychology/Human behaviour Biological sciences/Neuroscience/Social behaviour Health sciences/Risk factors Anabolic Androgenic Steroids Bodybuilding Perception Health Risk Figures Figure 1 INTRODUCTION NEW LENS ON BODYBUILDING AND STEROIDS: THE ANTHROPOLOGICAL LANDSCAPE OF AAS USE The pursuit of muscularity and enhanced physical aesthetics has become a prominent health and cultural ideal in many parts of the world. In Brazil—widely recognized as a global hub for bodybuilding and wellness culture—this ideal is deeply embedded in everyday health practices. According to a 2024 survey by Medicina S/A, based on IBGE data, over 21% of the Brazilian general population — around 45 million people — regularly attend gym 1 . Within this population are both amateur and professional bodybuilders, gym goers who subject their bodies to intense weight-training regimens aimed at achieving muscular forms that often exceed typical physiological norms. These practices reflect not only aesthetic goals but also complex negotiations of health, identity, and bodily agency shaped by broader cultural and social forces. The primary interest in bodybuilding is aimed at physiological benefits, such as gaining muscle mass and reducing body fat, as well as other health-related advantages 2 . While bodybuilding culture is associated with health, vitality, and improved quality of life, it is also marked by the widespread use of performance and image-enhancing substances. Among the most commonly used are anabolic-androgenic steroids (AAS), testosterone-like drugs which accelerate muscle growth and physical transformation. These substances are often referred to colloquially as “juice,” “gear,” “venom,” and “shots”—terms that evoke both potency and danger. Their use, particularly outside of medical supervision, reflects a broader cultural normalization of enhancement, even as it carries significant health risks. The use of anabolic steroids has extended well beyond the realm of professional bodybuilding—the 21st‑century explosion of fitness influencers and 24/7 gym marketing has normalized rapid body transformation as an everyday aspiration, not just as a niche sport anymore 2 . Increasingly, individuals with no competitive affiliation are turning to these substances in pursuit of idealized bodies shaped by aesthetics and rapid physical transformation. The anabolic effects of AAS—enhanced muscle mass, increased strength, and faster recovery—are highly sought after. In countries like the United States and Brazil, a significant portion of these users consume steroids without medical supervision, thus increasing the risks of severe adverse effects, such as cardiovascular problems, liver alterations, hormonal imbalances, and psychological disorders such as drug addiction 2 . High doses significantly alter blood lipids, coagulation factors, and cardiac contractile strength, increasing the risks of heart attacks, strokes, and sudden death 3,4,5 . In men, they impair spermatogenesis, while in both sexes they can intensify secondary sexual characteristics, such as hair growth and voice deepening 6,7,8 . Additionally, there are mental health impacts, with up to 30% of users exhibiting irritability, aggression, or mood disorders 9,10,11,12 . Body image concerns have become a key factor in the rising non-medical use of anabolic steroids within bodybuilding communities. This trend is fueled by powerful cultural narratives that link bodily enhancement to success, discipline, and personal value where its members have constructed communal identities independent of institutional health narratives. In this context, the body becomes both a site and symbol of social aspiration and self-making 2 . The central hypotheses guiding this study propose to explore how sociocultural factors play a significant role in predicting anabolic-androgenic steroid use among bodybuilding practitioners. Furthermore, aiming to foster a debate grounded in medical anthropology, examining how cultural meanings, stigma, and social norms shape enhancement practices. Growing interest in medical anthropology, as reflected in recent scholarly collections, underscores the need to consider cultural and social factors in understanding health and illness. In response to this assessment, we examine anabolic‑androgenic steroid use not simply within biomedical perspective, but as a set of culturally‑inflected practices in a marginalized subculture. Drawing on Ajzen’s Theory of Planned Behavior (1985) to examine how social norms, attitudes, and perceived control influence decision-making within fitness communities 13 . This pilot study investigates anabolic steroid use among Brazilian bodybuilders embedded in a high-performance training environment, using social science frameworks to examine stigma, risk perception, and medical legitimacy. Departing from broader studies on general gym populations, this research focuses on a distinct and well-known bodybuilding community—an intense microcosm where enhancement practices, health beliefs, and bodily norms intersect in unique ways. By analyzing this specific setting, the study uncovers behavioral patterns and social logics that have been largely overlooked in existing literature, offering a more nuanced understanding of how performance-enhancing drug use is associated within medical anthropology. By applying a medical anthropological lens, this exploratory study approaches anabolic-androgenic steroid (AAS) use not as an isolated health behavior, but as a socially constructed practice embedded in the bodybuilding subculture. In this context, performance-enhancing substances carry cultural significance—linked to ideals of autonomy, discipline, and physical achievement. Their use reflects ongoing negotiations around identity, legitimacy, and stigma. Drawing on empirical qualitative data from AAS users, the research engages with broader debates by examining how informal health economies, peer norms, and mistrust of institutional healthcare shape behavioral choices. This study challenges reductive, pathologizing views of drug use, foregrounding the complex socio cultural logics that guide health practices in fitness communities. METHODOLOGY Study design, setting and population This study employed a cross-sectional observational design to investigate sociocultural patterns of AAS use among bodybuilding practitioners. Data were collected over a six-month period (January to June 2024) at a private gym network located in Belo Horizonte, Brazil where participants completed a 25-question survey, covering topics such as age, education, gym usage, knowledge of anabolic-androgenic steroids, and past or current use. To align with bodybuilding event timelines and maximize engagement, data collection was timed with major competitions. Informed consent was obtained before participation. Responses were collected anonymously, and only the researchers had access to the data. The selected gym for this study was not merely a conventional fitness center but a highly specialized training facility recognized nationally and internationally for its role in competitive bodybuilding and elite athletic preparation. As the most specialized gym in the region, it serves as a central hub for both amateur and professional bodybuilders. The facility’s prestige is further reinforced by its association with professional bodybuilding events, including the live broadcasting of major competitions such as Mr. Olympia and Arnold Classic, globally recognized championships that set the standard for professional bodybuilding. This environment creates a unique cultural setting where performance enhancement, rigorous training routines, and physique optimization are deeply embedded in the community’s ethos. The gym also hosts and trains top-tier athletes, many of whom actively compete in bodybuilding federations, making it a critical setting for understanding the norms, behaviors, and influences that shape anabolic-androgenic steroid (AAS) use. The concentration of high-performance athletes, coupled with the gym’s status as an epicenter for elite bodybuilding, provided an unparalleled opportunity to study AAS use in a setting where its prevalence, social acceptance, and rationalization are likely distinct from general gym environments. This context allowed for a more accurate and in-depth sociocultural analysis, capturing microcosmic insights that would be difficult to obtain in less specialized fitness settings. The data collection instrument was a 25-item self-administered questionnaire adapted from a previously validated survey used in a Saudi Arabian study on AAS use.The questionnaire assessed demographic information (age, gender, education), gym usage patterns, knowledge and perceptions about AAS, and history of use 14 . Specific questions were also added in order to address participants’ trust in healthcare professionals, sources of AAS information, and attitudes toward medical supervision and public health reporting. The questionnaire was translated and culturally adapted for the Brazilian bodybuilding context by the researchers. A pretest was conducted with two bodybuilders and one fitness influencer ( not included in the final sample) to ensure clarity, language accuracy and content relevance. Participants and Recruitment Eligible participants were adults (≥ 18 years), of any gender, who were regular members of the selected gym and engaged in bodybuilding training. Recruitment employed purposive sampling to access this hard-to-reach, specialized population. Informed consent was obtained prior to participation, and all respondents were required to sign a Free and Informed Consent Form (FICF). Researchers approached potential participants in-person during workouts and distributed QR codes linking to an online questionnaire hosted on Google Forms. Data collection was conducted at varying times throughout the day and week to capture a representative cross-section of gym users. Study size The final sample size of the study was 68 participants which represented the bodybuilders available and actively training at the training center during the study period. The study sample provided meaningful exploratory insight into elite bodybuilding culture. However, future studies with larger cohorts are needed to generalize findings. Statistical methods Statistical analyses were conducted using R software (version 3.2.1). Descriptive statistics—including absolute frequencies, percentages, medians and interquartile range —were used to characterize the sample. Normality assumptions for continuous variables were evaluated using the Shapiro-Wilk test. Associations between categorical variables were analyzed using chi-square or Fisher’s exact tests, depending on the distribution and expected cell counts. For continuous variables that did not meet normality assumptions, the Wilcoxon rank-sum test (Mann-Whitney U test) was applied. A two-tailed significance threshold of p < 0.05 was adopted for all inferential tests. Theoretical Framework This study adopted an interdisciplinary theoretical framework to interpret behavioral patterns and sociocultural meanings related to AAS use. Ajzen’s Theory of Planned Behavior (1985) provided a foundation for analyzing how individual attitudes, perceived social norms, and sense of control influence decision-making around performance-enhancing substances. Goffman’s concept of stigma (1963) 15 was used to explore how participants manage identity and legitimacy in the face of societal judgment, particularly regarding drug use. Additionally, Bronfenbrenner’s bioecological model supported the analysis of how multiple layers of social context—from peer interactions in gym settings to broader digital and institutional influences—shape health-related behaviors 16 . These theoretical lenses informed the design of specific survey questions and guided the interpretation of both behavioral trends and participant perceptions. By embedding data collection and analysis within these frameworks, the study situates AAS use as a culturally constructed practice rather than solely a matter of individual choice. RESULTS DESCRIPTIVE FINDINGS The sample consisted of 68 bodybuilding practitioners, composed by amateur and professional bodybuilders. It’s important to note that athletes achieve professional status by earning a pro card from their federation, typically through success in high-level amateur contests. A total of 68 bodybuilding practitioners were enrolled, including 12 women (18%) and 56 men (82%), comprising both amateur and professional athletes. Female participants were older overall (42% aged 31–35 years; 25% ≥ 41 years; 17% each aged 26–30 and 36–40; none aged 18–25), whereas male participants were predominantly younger (54% aged 18–25; 18% 26–30; 13% each 36–40 and ≥ 41). Educational attainment also differed: 92% of women versus 34% of men had completed higher education; 39% of men had incomplete higher education, 20% had completed secondary education, 1.8% had incomplete secondary education, and 3.6% held a master’s degree (Table 1 ). Gym attendance and motivation : Primary motivation for gym attendance was significantly associated with AAS use (p = 0.042): 78% (95% CI 54.8–91.0%) of those training for professional reasons reported AAS use, compared with 62.5% attending for work‑related purposes, 42% (95% CI 26.6–59.2%) for recreation, and 25% for strictly medical reasons. Training frequency was high: 75% of women and 82% of men trained daily; 8.3% of women and 16% of men trained four times weekly; and 17% of women versus 1.8% of men trained three times weekly. Awareness and perceptions: All participants (100%) were aware of AAS. Information sources varied by gender: public media (42% women, 48% men), healthcare professionals (33% women, 27% men), friends (17% women, 16% men), and gym trainers (8.3% women, 8.9% men). Beliefs about AAS effects were widespread: 92% of women and 96% of men believed steroids increase body weight; all women (100%) and 98% of men believed they enhance muscle strength. Half of women (50%) considered AAS harmful, whereas 61% of men disagreed or strongly disagreed. Most agreed that AAS can cause aggression (92% women, 80% men), and 8.9% of men (0% of women) believed steroids can improve mood. Cardiovascular risks were acknowledged by 83% of women and 68% of men (blood pressure) and by 75% of women and 61% of men (cholesterol). Liver toxicity was anticipated by 92% of women and 75% of men, and reduced fertility by 58% of women and 75% of men. Prevalence, acquisition and compounds Overall AAS use was significantly higher in men (59%; 95% CI 45.6–71.2%) than in women (25%; 95% CI 8.3–52.7%) (p = 0.033). Among users, 29% of men and 17% of women obtained AAS via a physician; 5.4% of men and 8.3% of women obtained them from a trainer. The most commonly used compounds were Testosterone Base (83% men, 75% women), Trenbolone (47% men, 50% women), Testosterone Blend (Durateston; 64% men, 50% women), Stanozolol (42% men, 25% women) and Oxandrolone (61% men, 75% women). Testosterone Undecanoate was reported by 5.6% of men only; Nandrolone Decanoate by 69% of men and no women. Nearly all participants knew someone using AAS (98% men, 92% women), yet 57% of men and 75% of women had never personally received AAS. Polypharmacy Use of narcotics or psychiatric drugs was more frequent among AAS users (47%) than non‑users (22%; p = 0.029). Cannabis use was reported by 47% of AAS users versus 16% of non‑users (p = 0.005). Cocaine use (5.4% of men), amphetamines (11% men; 8.3% women), and benzodiazepines (13% men; 8.3% women) showed no significant differences by gender or AAS use. Reporting attitudes : Attitudes toward reporting non‑medical AAS use differed significantly: only 41.7% of users (95% CI 27.1–57.8%) agreed that steroid use should be reported to health authorities, versus 62.5% of non‑users (95% CI 45.3–77.1%) (p = 0.034). Bivariate associations : Table 1 summarizes key correlations: gender (p = 0.033), gym motivation (p = 0.042), information source (p = 0.003), risk perception (p = 0.001), acquisition channel (p < 0.001) and reporting attitudes (p = 0.034) were all significantly associated with AAS use. Table 2 highlights a gender-specific association for Nandrolone Decanoate (p = 0.015), and Table 3 details the link between cannabis use and AAS use (p = 0.005). Use of Testosterone Base (p = 0.6), Trenbolone (p > 0.9), Testosterone Undecanoate (p > 0.9), Stanozolol (p = 0.6), amphetamines (p = 0.032), cocaine (p = 0.031), and opioids/benzodiazepines (p > 0.05) showed no significant associations. See Tables 1 – 3 for full details and exact counts. Table 1 Correlation between "Any use of AAS" and other factors. Characteristics Total N N = 68¹ Any use of AAS p Value² No N = 32¹ Yes N = 36¹ Gender. 0.033 Female 12 (18%) 9 (28%) 3 (8.3%) Male 56 (82%) 23 (72%) 33 (92%) Reason for going to the gym. 0.042 Work necessity 8 (12%) 3 (9.4%) 5 (14%) Medical necessity 4 (5.9%) 3 (9.4%) 1 (2.8%) Professional motivation 18 (26%) 4 (13%) 14 (39%) Recreational use 38 (56%) 22 (69%) 16 (44%) Source of knowledge of EAAs. 0.003 Friends 11 (16%) 5 (16%) 6 (17%) Through public media (TV, social networks, internet, magazines, radio) 32 (47%) 22 (69%) 10 (28%) Healthcare professional 19 (28%) 4 (13%) 15 (42%) Gym trainer 6 (8.8%) 1 (3.1%) 5 (14%) Do you agree that the use of AAS is bad for your health? 0.001 Totally agree. 7 (10%) 7 (22%) 0 (0%) I agree. 15 (22%) 10 (31%) 5 (14%) Totally disagree. 13 (19%) 3 (9.4%) 10 (28%) I disagree. 33 (49%) 12 (38%) 21 (58%) Agrees that professional authorities should be informed about the use of AAS. 0.034 Totally agree. 19 (28%) 14 (44%) 5 (14%) I agree. 16 (24%) 6 (19%) 10 (28%) Totally disagree. 10 (15%) 5 (16%) 5 (14%) I disagree. 23 (34%) 7 (22%) 16 (44%) Source of obtaining EAAs. < 0.001 Friend 8 (12%) 2 (6.3%) 6 (17%) Doctor 18 (26%) 0 (0%) 18 (50%) Pharmacy 2 (2.9%) 0 (0%) 2 (5.6%) Gym trainer 4 (5.9%) 0 (0%) 4 (11%) Cannabis use. 0.005 NO 46 (68%) 27 (84%) 19 (53%) YES 22 (32%) 5 (16%) 17 (47%) Drugs use. 0.012 NO 38 (56%) 23 (72%) 15 (42%) YES 30 (44%) 9 (28%) 21 (58%) AAS, Anabolic Androgenic Steroids. 1 n (%) 2 Chi-square test of independence; Fisher’s exact test Table 2 Correlation between “Gender” and other factors. Characteristics Total N N = 68¹ Any use of AAS p Value² Female. N = 12¹ Male. N = 56¹ Have you ever heard about AAS or anabolic hormones? YES 68 (100%) 12 (100%) 56 (100%) Have you ever used AAS? 0.033 NO 32 (47%) 9 (75%) 23 (41%) YES 36 (53%) 3 (25%) 33 (59%) Testosterone. 0.6 NO 7 (18%) 1 (25%) 6 (17%) YES 33 (83%) 3 (75%) 30 (83%) Trenbolone. > 0.9 NO 21 (53%) 2 (50%) 19 (53%) YES 19 (48%) 2 (50%) 17 (47%) Testosterone blend. 0.6 NO 15 (38%) 2 (50%) 13 (36%) YES 25 (63%) 2 (50%) 23 (64%) Testosterone Undecanoate. > 0.9 NO 38 (95%) 4 (100%) 34 (94%) YES 2 (5.0%) 0 (0%) 2 (5.6%) Stanozolol. 0.6 NO 24 (60%) 3 (75%) 21 (58%) YES 16 (40%) 1 (25%) 15 (42%) Oxandrolone. > 0.9 NO 15 (38%) 1 (25%) 14 (39%) YES 25 (63%) 3 (75%) 22 (61%) Nandrolone. 0.015 NO 15 (38%) 4 (100%) 11 (31%) YES 25 (63%) 0 (0%) 25 (69%) AAS, Anabolic Androgenic Steroids. 1 n (%) 2 Chi-square test of independence; Fisher’s exact test Table 3 Correlation between “Cannabis use” and other factors. Characteristics Total N N = 68¹ Cannabis use p Value² NO N = 46¹ YES N = 22¹ Have you ever used AAS? 0.005 NO 32 (47%) 27 (59%) 5 (23%) YES 36 (53%) 19 (41%) 17 (77%) Source of obtaining EAAs. 0.006 Friend 8 (12%) 4 (8.7%) 4 (18%) Personal contact 3 (4.4%) 1 (2.2%) 2 (9.1%) Doctor 18 (26%) 10 (22%) 8 (36%) Pharmacy 2 (2.9%) 0 (0%) 2 (9.1%) More than one 1 (1.5%) 0 (0%) 1 (4.5%) Do not want to inform 1 (1.5%) 1 (2.2%) 0 (0%) Never used AAS 31 (46%) 27 (59%) 4 (18%) Gym trainer 4 (5.9%) 3 (6.5%) 1 (4.5%) Testosterone. 0.7 NO 7 (18%) 3 (14%) 4 (22%) YES 33 (83%) 19 (86%) 14 (78%) Trenbolone. 0.8 NO 21 (53%) 12 (55%) 9 (50%) YES 19 (48%) 10 (45%) 9 (50%) Testosterone blend. 0.3 NO 15 (38%) 10 (45%) 5 (28%) YES 25 (63%) 12 (55%) 13 (72%) Testosterone Undecanoate. 0.5 NO 38 (95%) 20 (91%) 18 (100%) YES 2 (5.0%) 2 (9.1%) 0 (0%) Stanozolol. 0.4 NO 24 (60%) 12 (55%) 12 (67%) YES 16 (40%) 10 (45%) 6 (33%) Oxandrolone. 0.3 NO 15 (38%) 10 (45%) 5 (28%) YES 25 (63%) 12 (55%) 13 (72%) Nandrolone. 0.071 NO 15 (38%) 11 (50%) 4 (22%) YES 25 (63%) 11 (50%) 14 (78%) AAS, Anabolic Androgenic Steroids. 1 n (%) 2 Chi-square test of independence; Fisher’s exact test DISCUSSION THE FITNESS COMMUNITY: THE ROLE OF PLANNED BEHAVIOR THEORY Historically, Brazil has been recognized as one of the world’s leading centers of fitness culture, alongside countries like the United States. The country has not only reflected but also actively shaped global trends in bodybuilding and gym culture for decades 2 . Thus, the analysis of the presented data reveals a range of social, cultural, and gender issues that merit critical reflection. From the Theory of Planned Behavior perspective, in the context of bodybuilding, members' intentions to use anabolic–androgenic steroids are shaped by three key determinants 13 . First, attitude toward the behavior reflects each individual’s evaluation of AAS use— when the pros of its benefits outweigh its collateral impact it is more favorable to make the life changing decision, it's mostly reinforced by the chronic effects of steroids being the ones more visible. Second, subjective norms capture the perceived pressure from influential peers—coaches who assert that “achievable body dream is on a cycle,” training partners who share tips on dosing, or digital fitness influencers who glamorize “juicy” physiques as the more sexually attractive—making conformity to steroid use feel socially obligatory and dangerously logical. Finally, perceived behavioral control encompasses one’s confidence in acquiring and managing AAS safely, which depends on factors like access to a trusted supplier or sympathetic physician, familiarity with injection techniques, and knowledge of harm‑reduction strategies (e.g., liver‑support supplements and aromatic inhibitors). When athletes believe they can readily obtain, dose, and monitor steroids without undue difficulty, their perceived control further strengthens the intention to use. Building on these behavioral insights, international comparisons reveal both divergence and convergence in supply networks—such as in the Saudi Arabian study from which this questionnaire was adapted and where distinct regional patterns emerge 14 . Although the Saudi study did not differentiate participants by gender as this study does, meaningful comparisons can still be drawn between the two populations, highlighting both regional differences and paradoxical similarities to global bodybuilding trends. In the Saudi study, the majority of the users obtained steroids from trainers (38.8%) and friends (35.7%), reflecting an informal, peer-driven supply chain. In contrast, our study in Brazil reveals a stronger reliance on medical professionals, with 17% of women and 29% of men acquiring steroids from doctors, while only 8.3% of women and 5.4% of men sourced them from trainers. This divergence underscores regional differences in the legitimization of AAS access, yet paradoxically aligns with broader global bodybuilding trends, where both medical and underground markets play key roles in steroid distribution. Despite cultural and regulatory differences, the bodybuilding subculture appears to transcend regional boundaries, normalizing steroid use through varying yet converging channels of supply. Turning to the demographic patterns, a noteworthy issue concerns age and gender distributions. In this study, female bodybuilding practitioners were generally older than their male counterparts, potentially reflecting lifetime fear of drastic physical modification, masculinization or even later onset of intense training 17,18 . Conversely, the predominance of young men, particularly those aged 18–25, among AAS users may be linked to greater societal pressure to develop muscular physiques early in life, a masculinized ideal that emphasizes ultimate strength and physical vigor 2,16 . Gender and age differences in AAS engagement reflect deeper sociocultural conditioning: although men and women—and younger and older—navigate distinct body‑ideal scenarios, both groups still turn to steroids to enhance sexuality, perceptions of attractiveness, and social validation—behaviors shaped by communal norms in body image driving settings, as described by the Theory of Planned Behavior 13 . In addition, social patterns are also reflected in the educational disparities between genders. Among men, 34% had completed higher education and 39% had incomplete higher education, whereas 92% of women had completed higher education. This raises questions such as whether these educational differences influence the perception of risks associated with steroid use. Women appear more aware of health risks, including effects on blood pressure, cholesterol, liver damage, and fertility, aligning with a lower tendency to use AAS, as evidenced by data showing that 75% of women had not used anabolic steroids. Meanwhile, men, despite recognizing the risks, were predominantly users (59%), potentially underestimating the dangers or prioritizing perceived physical benefits. This result corroborates the results of other studies 19 and reveals that the Brazilian pattern of AAS users is not different from other countries. Moreover, an important medical social critique centers on the role of media (TV, social networks, internet, magazines, radio) as a health information source, with this study showing that 47% of participants obtain information about AAS through these channels, which are often biased or incomplete. Furthermore, exacerbating the misuse of steroids and the spread of informal, non-scientific knowledge 15 . Unlike most drugs, AAS transforms the body into a visible symbol of discipline, success, and social status which is easily circulable in social media and less socially condemning than narcotic use for example. Thus, highlighting the urgent need for even more formal education and public online campaigns to address the risks of AAS. Notably, the divergence of opinions on whether health authorities should be informed about AAS use for non-medical purposes reflects a complex social and public health issue: the normalization of AAS use and distrust of health policies interventions on this topic. When asked about mandatory reporting to health authorities, 18% of respondents of the present study strongly disagreed, and 36% partially disagreed, totaling 54% with a negative perception of the topic. This aligns with the stigma often associated with AAS users, who are socially perceived as engaging in risky behavior by consuming substances considered as dangerous drugs of abuse 20 . A 2004 North American study also revealed significant distrust among AAS users regarding physicians’ knowledge of these substances. While physicians were seen as reliable on general health topics like smoking and alcohol, their credibility on AAS was rated similarly to friends, internet sources, or steroid suppliers 21 . Two decades later, the present study confirms that such distrust persists, also possibly amplified by the rise of alternative sources of information on AAS such as the internet and social media, which often spread inaccurate knowledge contrary to medical advice and lacking proper scientific evidence 21 . These findings highlight ongoing skepticism toward conventional medical approaches that often distances and harms the doctor-patient relationship, a fitness revolution that changed the way of approaching weight lifting practitioners and gym enthusiasts 22 . The 2004 recommendation that physicians enhance their knowledge of anabolic steroids and adopt a more patient-centered approach still remains relevant and essential in these scenarios. The following discussion explores these barriers in greater depth, emphasizing how deeper theoretical insights can inform more ethical and effective research practices with marginalized or medically disengaged populations. SOCIOCULTURAL AND BEHAVIORAL DETERMINANTS OF AAS USE: STIGMA-BASED PERSPECTIVE AND PUBLIC HEALTH AAS use is deeply embedded in gym culture, where peer reinforcement and exposure to performance-enhancing drug (PED)-related content on different interactions can normalize its consumption. To interpret these behavioral patterns, we apply Bronfenbrenner’s bioecological theory, which frames human behavior as influenced by layered environmental systems 16 . At the microsystem level, the gym environment and peer groups exert daily, face-to-face pressures that normalize AAS use and reinforce body ideals. As shown in this study, male users—particularly younger ones—are more likely to engage with steroids, responding to social scripts linking masculinity to muscularity, discipline, and control. Here, performance-enhancing substances are not simply tools for transformation but markers of achievable goals and validation. This misperception fuels a self-diagnosis common in the fitness community: identifying as “hard gainers”—those believed to be genetically incapable of significant muscular development. However, this belief often stems from a misunderstanding of muscle maturity, natural physiological timelines, and the long-term processes required for strength and hypertrophy. Rather than reflecting biological limitations, these frustrations are amplified by unrealistic benchmarks set by the enhanced peers. The mesosystem, encompassing the interactions between settings (e.g., peers, family, and digital fitness communities), amplifies these pressures 16,23 . A younger bodybuilder who constantly receives aesthetic praise and glory from friends while also consuming fitness content online becomes embedded in a cycle of reinforcement, where physical achievement is both a trace of persona and social obligation. At the exosystem level, institutions such as media, supplement industries, and loosely regulated health markets shape accessibility and knowledge. The present study also revealed the same relationship: that participants often distrusted formal healthcare while simultaneously seeking prescriptions—highlighting an institutional paradox: medical legitimacy is valued symbolically, but not functionally. This supports earlier work suggesting that users employ medical channels to manage stigma, not necessarily to reduce risk . Finally, the macrosystem encompasses cultural values—particularly the Western idealization of hyper-muscular, athletic bodies—that frame enhancement as not only acceptable but aspirational. In Brazil, as in other fitness-centric cultures, body capital has become a proxy for social capital. AAS use, in this sense, becomes a rational, even logical response to societal expectations and the normalization of enhancement within a competitive, appearance-driven subculture 23 . In parallel, stigma appears to play a pivotal role in the present study when it comes to shaping behavioral decisions regarding AAS acquisition and justification of use, as well as the use of polypharmacy profiles. As previously discussed before, many participants expressed a preference for obtaining AAS through medical professionals rather than underground sources, suggesting that institutional legitimacy reduces self-stigma while still allowing continued use. This aligns with Goffman’s (1963) concept of stigma management, where individuals navigate social judgment by seeking “acceptable” pathways to engage in stigmatized behaviors 15 . However, despite access to medical oversight, a significant portion of these users still reported unsafe practices such as polypharmacy with use of other drugs of addiction, primarily cannabis, indicating that stigma reduction does not necessarily lead to harm reduction. Furthermore, gender differences in AAS-related stigma were evident, with women exhibiting greater resistance to AAS use—likely a reflection of societal expectations that associate female muscularity with deviance, reinforcing their reluctance to engage in injectable drugs 24, . This contrast suggests that stigma is not only a deterrent but also a selective force shaping who engages in AAS use, how they justify it, and through what means they acquire substances 22,23 . Several participants described previous encounters with physicians in which their use of AAS was ridiculed or linked to misconceptions—particularly the idea that steroid use reflects sexual dysfunction, insecurity, or ignorance. A common example cited was the mocking association of AAS with testicular atrophy, which physicians used to delegitimize users’ choices or question their masculinity. Such interactions reinforce social stigma and deepen users’ resistance to institutional medical oversight. Drawing on Goffman’s theory of stigma, these findings highlight how users navigate what he terms a “spoiled identity.” They often engage in information control—managing what is revealed and to whom—to avoid being labeled as reckless, cheaters, or deviant. In this context, the decision to bypass doctors is less about a rejection of health information and more about preserving social dignity in spaces perceived as hostile and at the same time, vulnerable . Ironically, despite avoiding professional medical input, many participants in this study demonstrated strong awareness of AAS-related health risks. The majority correctly identified potential side effects such as cardiovascular strain, liver toxicity, hormonal disruption, and fertility issues. This challenges the stereotype of the uninformed user and underscores a critical disconnect: the issue is not a lack of knowledge, but a lack of trust. As one participant noted, “If I already have negative feelings toward the doctor, I’m not going to be honest during anamnesis.” This pattern echoes again earlier research, including the 2004 study of 80 bodybuilders in Florida, which found that AAS users ranked physicians less trustworthy when it came to steroid-related guidance 21 . This paradox exposes a critical gap in medical practice: while bodybuilders seek professional prescriptions for legitimacy, they avoid engagement in ways that could facilitate harm reduction and long-term health monitoring. Addressing this issue requires medical professionals to adopt non-judgmental, evidence-based, and harm-reduction approaches that build trust and encourage open dialogue 21 . By fostering a more inclusive and informed healthcare environment, physicians can help integrate AAS users into proactive medical care rather than pushing them further into underground networks of misinformation. Source: This figure was designed by the authors. BRIDGING THE GAP: A CALL FOR POLICY AND HEALTH INTERVENTION IN THE BODYBUILDING COMMUNITY The use of anabolic-androgenic steroids (AAS) is not merely an individual decision but a reflection of broader social, cultural, and psychological influences. Although limited by sample size and geographic specificity, the present study seeks not to generalize, but to contribute to a critical dialogue in medical anthropology regarding enhancement and fitness culture, stigma negotiation, and healthcare distrust within bodybuilding communities. Studies examining the history and sociodemographic characteristics of AAS use have emphasized the importance of cultural and regional contexts—particularly contrasting Western and Eastern practices 2,22 . Although bodybuilding everywhere shares a common devotion to the “cult of the body,” it is reasonable to expect distinct regional patterns in AAS motivations, sourcing, and administration and therefore future ethnographic and cross-cultural studies are encouraged to deepen and expand this line of inquiry. Moreover, in Brazil and many other countries, the possession and distribution of anabolic steroids without a medical prescription are subject to criminal penalties. This observation adds nuance to account for the sensitivity of disclosure and adopt research designs that prioritize participant confidentiality, safety, and specially trust between researcher and participant. The findings and discussions also invite us to reconsider the strong correlation between AAS use and exposure to other substances, yet many users dismiss potential health risks. At the same time, they oppose professional oversight, revealing a fundamental distrust in healthcare authorities. These contradictions expose a significant gap between the bodybuilding community and public health initiatives, suggesting that since the popularization of bodybuilding practice in the 80s “Golden Era”, conventional regulatory approaches systematically failed to align with the realities of those who use these substances for performance and image enhancing 2 . AAS use presents a complex bioethical dilemma, where personal autonomy conflicts with public health concerns. While users view AAS consumption as a matter of individual choice, their decisions are often shaped by misinformation and reliance on non-medical sources, raising ethical concerns about informed consent. The principle of non-maleficence is also at risk, as unsupervised steroid use is linked to serious health consequences 5 . Among the many testosterone‑derived compounds, only two—nandrolone decanoate and testosterone blend—are officially available in pharmacies for strictly medical use. Although both are prescribed for legitimate human indications rather than aesthetic enhancement, it is notable that they were the most commonly used agents in our sample, highlighting physicians’ influence on AAS cycles. All other compounds reported are intended solely for veterinary use. Beyond direct health risks, AAS use contributes to broader societal challenges. Enhanced physiques, often driven by steroid use, reinforce unrealistic body standards, influencing younger individuals to adopt potentially harmful practices. This ethical concern extends beyond competitive sports, permeating fitness culture and reshaping perceptions of an ideal body 22 . An important dimension emerging from this study is the way in which bodybuilders perceive themselves as stigmatized by healthcare professionals. Participants reported a strong sense of moral judgment and clinical suspicion from doctors during the conduction of the present study, who often, according to the participants, associate AAS users with deviance, irresponsibility, or addiction. However, this perception is not aligned with the lived reality of most users in this study. Although anabolic steroids are classified as controlled substances and regulated as drugs of abuse, the majority of users do not engage in criminal behavior or illicit activity beyond the scope of unsupervised enhancement. Here, the paradox becomes visible again and the conflation of enhancement practices with criminality contributes to a breakdown in trust, discouraging open conversations with medical professionals and pushing users toward informal networks. This illustrates a key anthropological insight: stigma is not just a reaction to risk, but a cultural mechanism that marginalizes certain health behaviors and reinforces institutional boundaries between “legitimate” and “illegitimate” bodies. This dynamic necessitates a shift from strict prohibition toward harm reduction strategies that prioritize education and open dialogue in order to improve the number of more consistent reports and evidence-based interventions 24 . Regional context, bioecological dynamics, community norms, and modes of communication all introduce biases that—together with polypharmacy and the use of over 1,000 different steroid compounds—must be accounted for to truly understand and address the multifaceted nature of steroid abuse 2,25 . From its physical to its mental-health consequences, steroid use demands a holistic, non‑judgmental framework 26 . Medical anthropology offers exactly that: a comprehensive ethnological perspective on addiction that adds dimension to guide more effective, culturally sensitive interventions 2,18 . In conclusion, the use of anabolic androgenic steroids presents a complex bioethical dilemma, balancing individual autonomy with public health concerns. While users may perceive AAS as a personal choice, the lack of informed consent—due to misinformation and reliance on non-medical sources—raises ethical concerns about autonomy. Additionally, the issue of fairness emerges in both competitive sports and broader societal expectations, where enhanced physiques create unrealistic body standards, influencing younger individuals to engage in potentially harmful practices 27,28 . Furthermore, the distrust between AAS users and healthcare professionals challenges effective public health interventions, highlighting the need for harm reduction strategies rather than strict prohibition. By integrating behavioral theory with anthropological insights, this work offers a foundation for rethinking health interventions that more accurately reflect the lived realities of fitness communities. Therefore, addressing AAS use ethically requires a nuanced approach, recognizing both individual rights and the broader societal responsibility to ensure health and safety. Declarations ETHICS DECLARATION All methods were performed in accordance with the Declaration of Helsinki and have been approved by the Ethics and Research Committee of the Faculty of Medical Sciences of Minas Gerais (CAAE: 73550423.5.0000.5134). The study carried no harmful risks as it was observational. All participants agreed to participate and provided informed consent. COMPETING INTERESTS The authors declare no competing interests. Author Contribution L.F.D.C. and B.A.N conceptualized and designed the study. L.F.D.C. wrote the first draft of the manuscript;L.F.D.C. and B.A.N acquired the data and designed the methodology; carried out the analysis and interpreted the results; R.S.G were responsible for project administration, supervision and revision . L.F.D.C. and B.A.N. draw the figure and tables. All authors read and approved the final version of the manuscript. All authors read and approved the final version of the manuscript. Acknowledgement We, the authors, also would like to thank all study participants for their time and commitment. Data Availability The datasets generated and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. References Medicina S/A. Quantidade de academias no Brasil: número de frequentadores por estado. Medicina S/A (2024). Available at: https://medicinasa.com.br/academias-brasil/ (Accessed April 25, 2025). Kanayama, G. & Pope, H. G. Jr. History and epidemiology of anabolic androgens in athletes and non-athletes. Mol. Cell. Endocrinol. 464 , 4–13 (2018). Charal, C. M. S., Costa, E. T., Fernandes, H. C., Araújo, A. A. & Monteiro, L. H. L. Uso de esteroides anabolizantes por frequentadores de academias: motivos e perspectivas. Rev. Soc. Dev. 10 , e22010615735 (2021). Charni-Natan, M., Aloni-Grinstein, R. & Rotter, V. Liver and steroid hormones—can a touch of p53 make a difference? Front. 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Psychiatric morbidity among men using anabolic steroids. Depression and Anxiety , 39, 805–812. https://doi.org/10.1002/da.23287 Silva, A. L. F., Medeiros, J. A., Batista, M. M. & Dantas, E. C. Uso de esteroides anabolizantes androgênicos e seus efeitos fisiopatológicos. Rev. Cient. Multidiscip. Núcleo Conhecimento 1 , 128–151 (2019). Mendell, A. L. & MacLusky, N. J. Neurosteroid metabolites of gonadal steroid hormones in neuroprotection: implications for sex differences in neurodegenerative disease. Front. Mol. Neurosci. 11 , 359 (2018). Hauger, L. E., Westlye, L. T. & Bjørnebekk, A. Structural brain characteristics of anabolic-androgenic steroid dependence in men. Addiction 114 , 1405–1415 (2019). Ajzen, I. From intentions to action: a theory of planned behavior. In Action-Control: From Cognition to Behavior (eds. Kuhl, J. & Beckmann, J.) 11–39 (Springer-Verlag, 1985); http://dx.doi.org/10.1007/978-3-642-69746-3_2. Alharbi, F. F., Alkhail, B. A., Almohaimeed, H. M., Alghonaim, Y. & Alajaji, R. Knowledge, attitudes and use of anabolic-androgenic steroids among male gym users: a community based survey in Riyadh, Saudi Arabia. Saudi Pharm. J. 27 , 254–263 (2019). Goffman, E. Stigma: Notes on the Management of Spoiled Identity . (Prentice-Hall, 1963) Bronfenbrenner, U. The Ecology of Human Development: Experiments by Nature and Design . (Harvard Univ. Press, 1979). https://doi.org/10.4159/9780674028845. Zaiser, E. The relationship between anabolic androgenic steroid use and body image, eating behavior, and physical activity by gender: a systematic review. Neurosci. Biobehav. Rev. 163, 105168 (2024). https://pubmed.ncbi.nlm.nih.gov/38879097/ Piatkowski, T., Robertson, J., Lamon, S. & Dunn, M. Gendered perspectives on women’s anabolic–androgenic steroid (AAS) usage practices. Harm Reduct. J. 20, 1 (2023). Sagoe, D., Molde, H., Andreassen, C. S., Torsheim, T. & Pallesen, S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Ann. Epidemiol. 24 , 383–398 (2014). Oliveira, L. L. & Cavalcante Neto, J. L. Fatores sociodemográficos, perfil dos usuários e motivação para o uso de esteroides anabolizantes entre jovens adultos. Rev. Bras. Cienc. Esporte 40 , 309–317 (2018). Pope, H. G., Kanayama, G., Ionescu-Pioggia, M. & Hudson, J. I. Anabolic steroid users’ attitudes towards physicians. Addiction 99, 1189–1194 (2004). Andreasson, J. & Johansson, T. The Fitness Revolution: Historical Transformations in a Global Gym and Fitness Culture. Sport Sci. Rev. 23, 247–274 (2014). Coutinho, L. F. D., Nascimento-Salgado, L. V., Monteiro-Bontempo, V. & Martins-Chaves, R. R. Stigma, taboo, and public health: a sociological and bioecological approach to the use of performance and image-enhancing drugs. Adv. Soc. Sci. Res. J. 12, 264–272 (2025). https://journals.scholarpublishing.org/index.php/ASSRJ/article/view/18241 Bates, G., Van Hout, M. C., Teck, J. T. W., McVeigh, J. Treatments for people who use anabolic androgenic steroids: a scoping review. Harm Reduct. J. 16, 1 (2019). Mantri, S., et. al. Bodybuilding: a comprehensive review of performance-enhancing substance use and public health implications. Cureus 15, e41600 (2023). https://doi.org/10.7759/cureus.41600 Cox, L., Piatkowski, T., McVeigh, J. “I would never go to the doctor and speak about steroids”: Anabolic androgenic steroids, stigma and harm. Drugs, Education, Prevention and Policy. https://doi.org/10.1080/09687637.2024.2373056 (2024). Sport Integrity Australia. The worrying trend of steroid use in young adults. Sport Integrity Australia. Preprint at: https://www.sportintegrity.gov.au/news/integrity-blog/2023-05/worrying-trend-of-steroid-use-young-adults (2023). Woolf, J. “If everyone is using, shouldn’t I?”: Perceived norms of anabolic androgenic steroid use among high school athletes. Preprint at: https://www.wada-ama.org/sites/default/files/2023-06/woolf_wada_report_aug2012_002.pdf (2013). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 27 May, 2025 Editor assigned by journal 27 May, 2025 Submission checks completed at journal 06 May, 2025 First submitted to journal 06 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6568363","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":463275187,"identity":"5899bbd1-fe74-447d-8857-7439d9531055","order_by":0,"name":"Luis Felipe Duarte Coutinho","email":"data:image/png;base64,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","orcid":"","institution":"Faculty of Medical Sciences of Minas Gerais ( FCMMG)","correspondingAuthor":true,"prefix":"","firstName":"Luis","middleName":"Felipe Duarte","lastName":"Coutinho","suffix":""},{"id":463275188,"identity":"ea242795-7346-41b2-89e4-1b93f442b217","order_by":1,"name":"Bernardo Aguiar Nunes","email":"","orcid":"","institution":"Faculty of Medical Sciences of Minas Gerais ( FCMMG)","correspondingAuthor":false,"prefix":"","firstName":"Bernardo","middleName":"Aguiar","lastName":"Nunes","suffix":""},{"id":463275189,"identity":"0b6883ee-9de5-4866-bb3a-a1e4815e62e7","order_by":2,"name":"Ricardo Santiago Gomez","email":"","orcid":"","institution":"Federal University of Minas Gerais (UFMG)","correspondingAuthor":false,"prefix":"","firstName":"Ricardo","middleName":"Santiago","lastName":"Gomez","suffix":""}],"badges":[],"createdAt":"2025-05-01 00:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6568363/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6568363/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83629743,"identity":"7c1f8042-1126-42af-8808-6409df043666","added_by":"auto","created_at":"2025-05-29 18:34:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41714,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic summarizing Sociological Theories links to AAS use.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSource: This figure was designed by the authors.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6568363/v1/fc51c6865495744240625e10.jpg"},{"id":83630307,"identity":"15cc777c-33d9-4f96-b423-2f3bb9be33e5","added_by":"auto","created_at":"2025-05-29 18:42:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1482643,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6568363/v1/d8839182-6e7c-4871-9eb0-ba665cb6986e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Steroids, Stigma, and Health: A Medical Anthropological Analysis of Anabolic Use in a Brazilian Bodybuilding Community","fulltext":[{"header":"INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eNEW LENS ON BODYBUILDING AND STEROIDS: THE ANTHROPOLOGICAL LANDSCAPE OF AAS USE\u003c/h2\u003e \u003cp\u003eThe pursuit of muscularity and enhanced physical aesthetics has become a prominent health and cultural ideal in many parts of the world. In Brazil\u0026mdash;widely recognized as a global hub for bodybuilding and wellness culture\u0026mdash;this ideal is deeply embedded in everyday health practices. According to a 2024 survey by Medicina S/A, based on IBGE data, over 21% of the Brazilian general population \u0026mdash; around 45\u0026nbsp;million people \u0026mdash; regularly attend gym\u003csup\u003e1\u003c/sup\u003e. Within this population are both amateur and professional bodybuilders, gym goers who subject their bodies to intense weight-training regimens aimed at achieving muscular forms that often exceed typical physiological norms. These practices reflect not only aesthetic goals but also complex negotiations of health, identity, and bodily agency shaped by broader cultural and social forces. The primary interest in bodybuilding is aimed at physiological benefits, such as gaining muscle mass and reducing body fat, as well as other health-related advantages\u003csup\u003e2\u003c/sup\u003e. While bodybuilding culture is associated with health, vitality, and improved quality of life, it is also marked by the widespread use of performance and image-enhancing substances. Among the most commonly used are anabolic-androgenic steroids (AAS), testosterone-like drugs which accelerate muscle growth and physical transformation. These substances are often referred to colloquially as \u0026ldquo;juice,\u0026rdquo; \u0026ldquo;gear,\u0026rdquo; \u0026ldquo;venom,\u0026rdquo; and \u0026ldquo;shots\u0026rdquo;\u0026mdash;terms that evoke both potency and danger. Their use, particularly outside of medical supervision, reflects a broader cultural normalization of enhancement, even as it carries significant health risks.\u003c/p\u003e \u003cp\u003eThe use of anabolic steroids has extended well beyond the realm of professional bodybuilding\u0026mdash;the 21st‑century explosion of fitness influencers and 24/7 gym marketing has normalized rapid body transformation as an everyday aspiration, not just as a niche sport anymore\u003csup\u003e2\u003c/sup\u003e. Increasingly, individuals with no competitive affiliation are turning to these substances in pursuit of idealized bodies shaped by aesthetics and rapid physical transformation. The anabolic effects of AAS\u0026mdash;enhanced muscle mass, increased strength, and faster recovery\u0026mdash;are highly sought after. In countries like the United States and Brazil, a significant portion of these users consume steroids without medical supervision, thus increasing the risks of severe adverse effects, such as cardiovascular problems, liver alterations, hormonal imbalances, and psychological disorders such as drug addiction\u003csup\u003e2\u003c/sup\u003e. High doses significantly alter blood lipids, coagulation factors, and cardiac contractile strength, increasing the risks of heart attacks, strokes, and sudden death\u003csup\u003e3,4,5\u003c/sup\u003e. In men, they impair spermatogenesis, while in both sexes they can intensify secondary sexual characteristics, such as hair growth and voice deepening\u003csup\u003e6,7,8\u003c/sup\u003e. Additionally, there are mental health impacts, with up to 30% of users exhibiting irritability, aggression, or mood disorders\u003csup\u003e9,10,11,12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBody image concerns have become a key factor in the rising non-medical use of anabolic steroids within bodybuilding communities. This trend is fueled by powerful cultural narratives that link bodily enhancement to success, discipline, and personal value where its members have constructed communal identities independent of institutional health narratives. In this context, the body becomes both a site and symbol of social aspiration and self-making\u003csup\u003e2\u003c/sup\u003e. The central hypotheses guiding this study propose to explore how sociocultural factors play a significant role in predicting anabolic-androgenic steroid use among bodybuilding practitioners. Furthermore, aiming to foster a debate grounded in medical anthropology, examining how cultural meanings, stigma, and social norms shape enhancement practices.\u003c/p\u003e \u003cp\u003eGrowing interest in medical anthropology, as reflected in recent scholarly collections, underscores the need to consider cultural and social factors in understanding health and illness. In response to this assessment, we examine anabolic‑androgenic steroid use not simply within biomedical perspective, but as a set of culturally‑inflected practices in a marginalized subculture. Drawing on Ajzen\u0026rsquo;s Theory of Planned Behavior (1985) to examine how social norms, attitudes, and perceived control influence decision-making within fitness communities\u003csup\u003e13\u003c/sup\u003e. This pilot study investigates anabolic steroid use among Brazilian bodybuilders embedded in a high-performance training environment, using social science frameworks to examine stigma, risk perception, and medical legitimacy. Departing from broader studies on general gym populations, this research focuses on a distinct and well-known bodybuilding community\u0026mdash;an intense microcosm where enhancement practices, health beliefs, and bodily norms intersect in unique ways. By analyzing this specific setting, the study uncovers behavioral patterns and social logics that have been largely overlooked in existing literature, offering a more nuanced understanding of how performance-enhancing drug use is associated within medical anthropology.\u003c/p\u003e \u003cp\u003eBy applying a medical anthropological lens, this exploratory study approaches anabolic-androgenic steroid (AAS) use not as an isolated health behavior, but as a socially constructed practice embedded in the bodybuilding subculture. In this context, performance-enhancing substances carry cultural significance\u0026mdash;linked to ideals of autonomy, discipline, and physical achievement. Their use reflects ongoing negotiations around identity, legitimacy, and stigma. Drawing on empirical qualitative data from AAS users, the research engages with broader debates by examining how informal health economies, peer norms, and mistrust of institutional healthcare shape behavioral choices. This study challenges reductive, pathologizing views of drug use, foregrounding the complex socio cultural logics that guide health practices in fitness communities.\u003c/p\u003e \u003c/div\u003e"},{"header":"METHODOLOGY","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eStudy design, setting and population\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional observational design to investigate sociocultural patterns of AAS use among bodybuilding practitioners. Data were collected over a six-month period (January to June 2024) at a private gym network located in Belo Horizonte, Brazil where participants completed a 25-question survey, covering topics such as age, education, gym usage, knowledge of anabolic-androgenic steroids, and past or current use. To align with bodybuilding event timelines and maximize engagement, data collection was timed with major competitions. Informed consent was obtained before participation. Responses were collected anonymously, and only the researchers had access to the data.\u003c/p\u003e \u003cp\u003eThe selected gym for this study was not merely a conventional fitness center but a highly specialized training facility recognized nationally and internationally for its role in competitive bodybuilding and elite athletic preparation. As the most specialized gym in the region, it serves as a central hub for both amateur and professional bodybuilders. The facility\u0026rsquo;s prestige is further reinforced by its association with professional bodybuilding events, including the live broadcasting of major competitions such as Mr. Olympia and Arnold Classic, globally recognized championships that set the standard for professional bodybuilding. This environment creates a unique cultural setting where performance enhancement, rigorous training routines, and physique optimization are deeply embedded in the community\u0026rsquo;s ethos. The gym also hosts and trains top-tier athletes, many of whom actively compete in bodybuilding federations, making it a critical setting for understanding the norms, behaviors, and influences that shape anabolic-androgenic steroid (AAS) use. The concentration of high-performance athletes, coupled with the gym\u0026rsquo;s status as an epicenter for elite bodybuilding, provided an unparalleled opportunity to study AAS use in a setting where its prevalence, social acceptance, and rationalization are likely distinct from general gym environments. This context allowed for a more accurate and in-depth sociocultural analysis, capturing microcosmic insights that would be difficult to obtain in less specialized fitness settings.\u003c/p\u003e \u003cp\u003eThe data collection instrument was a 25-item self-administered questionnaire adapted from a previously validated survey used in a Saudi Arabian study on AAS use.The questionnaire assessed demographic information (age, gender, education), gym usage patterns, knowledge and perceptions about AAS, and history of use\u003csup\u003e14\u003c/sup\u003e. Specific questions were also added in order to address participants\u0026rsquo; trust in healthcare professionals, sources of AAS information, and attitudes toward medical supervision and public health reporting.\u003c/p\u003e \u003cp\u003eThe questionnaire was translated and culturally adapted for the Brazilian bodybuilding context by the researchers. A pretest was conducted with two bodybuilders and one fitness influencer ( not included in the final sample) to ensure clarity, language accuracy and content relevance.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Recruitment\u003c/h3\u003e\n\u003cp\u003eEligible participants were adults (\u0026ge;\u0026thinsp;18 years), of any gender, who were regular members of the selected gym and engaged in bodybuilding training. Recruitment employed purposive sampling to access this hard-to-reach, specialized population. Informed consent was obtained prior to participation, and all respondents were required to sign a Free and Informed Consent Form (FICF).\u003c/p\u003e \u003cp\u003e Researchers approached potential participants in-person during workouts and distributed QR codes linking to an online questionnaire hosted on Google Forms. Data collection was conducted at varying times throughout the day and week to capture a representative cross-section of gym users.\u003c/p\u003e\n\u003ch3\u003eStudy size\u003c/h3\u003e\n\u003cp\u003eThe final sample size of the study was 68 participants which represented the bodybuilders available and actively training at the training center during the study period. The study sample provided meaningful exploratory insight into elite bodybuilding culture. However, future studies with larger cohorts are needed to generalize findings.\u003c/p\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eStatistical analyses were conducted using R software (version 3.2.1). Descriptive statistics\u0026mdash;including absolute frequencies, percentages, medians and interquartile range \u0026mdash;were used to characterize the sample. Normality assumptions for continuous variables were evaluated using the Shapiro-Wilk test. Associations between categorical variables were analyzed using chi-square or Fisher\u0026rsquo;s exact tests, depending on the distribution and expected cell counts. For continuous variables that did not meet normality assumptions, the Wilcoxon rank-sum test (Mann-Whitney U test) was applied. A two-tailed significance threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted for all inferential tests.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheoretical Framework\u003c/h2\u003e \u003cp\u003eThis study adopted an interdisciplinary theoretical framework to interpret behavioral patterns and sociocultural meanings related to AAS use. Ajzen\u0026rsquo;s Theory of Planned Behavior (1985) provided a foundation for analyzing how individual attitudes, perceived social norms, and sense of control influence decision-making around performance-enhancing substances. Goffman\u0026rsquo;s concept of stigma (1963) \u003csup\u003e15\u003c/sup\u003ewas used to explore how participants manage identity and legitimacy in the face of societal judgment, particularly regarding drug use. Additionally, Bronfenbrenner\u0026rsquo;s bioecological model supported the analysis of how multiple layers of social context\u0026mdash;from peer interactions in gym settings to broader digital and institutional influences\u0026mdash;shape health-related behaviors\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThese theoretical lenses informed the design of specific survey questions and guided the interpretation of both behavioral trends and participant perceptions. By embedding data collection and analysis within these frameworks, the study situates AAS use as a culturally constructed practice rather than solely a matter of individual choice.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDESCRIPTIVE FINDINGS\u003c/h2\u003e \u003cp\u003eThe sample consisted of 68 bodybuilding practitioners, composed by amateur and professional bodybuilders. It\u0026rsquo;s important to note that athletes achieve professional status by earning a pro card from their federation, typically through success in high-level amateur contests.\u003c/p\u003e \u003cp\u003eA total of 68 bodybuilding practitioners were enrolled, including 12 women (18%) and 56 men (82%), comprising both amateur and professional athletes. Female participants were older overall (42% aged 31\u0026ndash;35 years; 25% \u0026ge; 41 years; 17% each aged 26\u0026ndash;30 and 36\u0026ndash;40; none aged 18\u0026ndash;25), whereas male participants were predominantly younger (54% aged 18\u0026ndash;25; 18% 26\u0026ndash;30; 13% each 36\u0026ndash;40 and \u0026ge;\u0026thinsp;41). Educational attainment also differed: 92% of women versus 34% of men had completed higher education; 39% of men had incomplete higher education, 20% had completed secondary education, 1.8% had incomplete secondary education, and 3.6% held a master\u0026rsquo;s degree (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eGym attendance and motivation\u003c/b\u003e: Primary motivation for gym attendance was significantly associated with AAS use (p\u0026thinsp;=\u0026thinsp;0.042): 78% (95% CI 54.8\u0026ndash;91.0%) of those training for professional reasons reported AAS use, compared with 62.5% attending for work‑related purposes, 42% (95% CI 26.6\u0026ndash;59.2%) for recreation, and 25% for strictly medical reasons. Training frequency was high: 75% of women and 82% of men trained daily; 8.3% of women and 16% of men trained four times weekly; and 17% of women versus 1.8% of men trained three times weekly.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAwareness and perceptions:\u0026ensp;\u003c/b\u003eAll participants (100%) were aware of AAS. Information sources varied by gender: public media (42% women, 48% men), healthcare professionals (33% women, 27% men), friends (17% women, 16% men), and gym trainers (8.3% women, 8.9% men). Beliefs about AAS effects were widespread: 92% of women and 96% of men believed steroids increase body weight; all women (100%) and 98% of men believed they enhance muscle strength. Half of women (50%) considered AAS harmful, whereas 61% of men disagreed or strongly disagreed. Most agreed that AAS can cause aggression (92% women, 80% men), and 8.9% of men (0% of women) believed steroids can improve mood. Cardiovascular risks were acknowledged by 83% of women and 68% of men (blood pressure) and by 75% of women and 61% of men (cholesterol). Liver toxicity was anticipated by 92% of women and 75% of men, and reduced fertility by 58% of women and 75% of men.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePrevalence, acquisition and compounds\u003c/strong\u003e \u003cp\u003eOverall AAS use was significantly higher in men (59%; 95% CI 45.6\u0026ndash;71.2%) than in women (25%; 95% CI 8.3\u0026ndash;52.7%) (p\u0026thinsp;=\u0026thinsp;0.033). Among users, 29% of men and 17% of women obtained AAS via a physician; 5.4% of men and 8.3% of women obtained them from a trainer. The most commonly used compounds were Testosterone Base (83% men, 75% women), Trenbolone (47% men, 50% women), Testosterone Blend (Durateston; 64% men, 50% women), Stanozolol (42% men, 25% women) and Oxandrolone (61% men, 75% women). Testosterone Undecanoate was reported by 5.6% of men only; Nandrolone Decanoate by 69% of men and no women. Nearly all participants knew someone using AAS (98% men, 92% women), yet 57% of men and 75% of women had never personally received AAS.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePolypharmacy\u003c/strong\u003e \u003cp\u003eUse of narcotics or psychiatric drugs was more frequent among AAS users (47%) than non‑users (22%; p\u0026thinsp;=\u0026thinsp;0.029). Cannabis use was reported by 47% of AAS users versus 16% of non‑users (p\u0026thinsp;=\u0026thinsp;0.005). Cocaine use (5.4% of men), amphetamines (11% men; 8.3% women), and benzodiazepines (13% men; 8.3% women) showed no significant differences by gender or AAS use.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eReporting attitudes\u003c/b\u003e: Attitudes toward reporting non‑medical AAS use differed significantly: only 41.7% of users (95% CI 27.1\u0026ndash;57.8%) agreed that steroid use should be reported to health authorities, versus 62.5% of non‑users (95% CI 45.3\u0026ndash;77.1%) (p\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e \u003cp\u003e \u003cb\u003eBivariate associations\u003c/b\u003e: Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes key correlations: gender (p\u0026thinsp;=\u0026thinsp;0.033), gym motivation (p\u0026thinsp;=\u0026thinsp;0.042), information source (p\u0026thinsp;=\u0026thinsp;0.003), risk perception (p\u0026thinsp;=\u0026thinsp;0.001), acquisition channel (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and reporting attitudes (p\u0026thinsp;=\u0026thinsp;0.034) were all significantly associated with AAS use. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e highlights a gender-specific association for Nandrolone Decanoate (p\u0026thinsp;=\u0026thinsp;0.015), and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e details the link between cannabis use and AAS use (p\u0026thinsp;=\u0026thinsp;0.005). Use of Testosterone Base (p\u0026thinsp;=\u0026thinsp;0.6), Trenbolone (p\u0026thinsp;\u0026gt;\u0026thinsp;0.9), Testosterone Undecanoate (p\u0026thinsp;\u0026gt;\u0026thinsp;0.9), Stanozolol (p\u0026thinsp;=\u0026thinsp;0.6), amphetamines (p\u0026thinsp;=\u0026thinsp;0.032), cocaine (p\u0026thinsp;=\u0026thinsp;0.031), and opioids/benzodiazepines (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) showed no significant associations.\u003c/p\u003e \u003cp\u003eSee Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for full details and exact counts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between \"Any use of AAS\" and other factors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal N\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;68\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAny use of AAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;32\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;36\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReason for going to the gym.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork necessity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical necessity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecreational use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource of knowledge of EAAs.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrough public media (TV, social networks, internet, magazines, radio)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGym trainer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you agree that the use of AAS is bad for your health?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotally agree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI agree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotally disagree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI disagree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgrees that professional authorities should be informed about the use of AAS.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotally agree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI agree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotally disagree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI disagree.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource of obtaining EAAs.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGym trainer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCannabis use.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrugs use.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAAS, Anabolic Androgenic Steroids.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1 n (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2 Chi-square test of independence; Fisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between \u0026ldquo;Gender\u0026rdquo; and other factors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal N\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;68\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAny use of AAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale.\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;12\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale.\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;56\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you ever heard about AAS or anabolic hormones?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave you ever used AAS?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTestosterone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrenbolone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTestosterone blend.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTestosterone Undecanoate.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStanozolol.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOxandrolone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNandrolone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAAS, Anabolic Androgenic Steroids.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1 n (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2 Chi-square test of independence; Fisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between \u0026ldquo;Cannabis use\u0026rdquo; and other factors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal N\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;68\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCannabis use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep Value\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;22\u0026sup1;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you ever used AAS?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSource of obtaining EAAs.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than one\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not want to inform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever used AAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGym trainer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTestosterone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrenbolone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTestosterone blend.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTestosterone Undecanoate.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStanozolol.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOxandrolone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNandrolone.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAAS, Anabolic Androgenic Steroids.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1 n (%)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2 Chi-square test of independence; Fisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTHE FITNESS COMMUNITY: THE ROLE OF PLANNED BEHAVIOR THEORY\u003c/h2\u003e \u003cp\u003eHistorically, Brazil has been recognized as one of the world\u0026rsquo;s leading centers of fitness culture, alongside countries like the United States. The country has not only reflected but also actively shaped global trends in bodybuilding and gym culture for decades\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThus, the analysis of the presented data reveals a range of social, cultural, and gender issues that merit critical reflection. From the Theory of Planned Behavior perspective, in the context of bodybuilding, members' intentions to use anabolic\u0026ndash;androgenic steroids are shaped by three key determinants\u003csup\u003e13\u003c/sup\u003e. First, attitude toward the behavior reflects each individual\u0026rsquo;s evaluation of AAS use\u0026mdash; when the pros of its benefits outweigh its collateral impact it is more favorable to make the life changing decision, it's mostly reinforced by the chronic effects of steroids being the ones more visible. Second, subjective norms capture the perceived pressure from influential peers\u0026mdash;coaches who assert that \u0026ldquo;achievable body dream is on a cycle,\u0026rdquo; training partners who share tips on dosing, or digital fitness influencers who glamorize \u0026ldquo;juicy\u0026rdquo; physiques as the more sexually attractive\u0026mdash;making conformity to steroid use feel socially obligatory and dangerously logical. Finally, perceived behavioral control encompasses one\u0026rsquo;s confidence in acquiring and managing AAS safely, which depends on factors like access to a trusted supplier or sympathetic physician, familiarity with injection techniques, and knowledge of harm‑reduction strategies (e.g., liver‑support supplements and aromatic inhibitors). When athletes believe they can readily obtain, dose, and monitor steroids without undue difficulty, their perceived control further strengthens the intention to use.\u003c/p\u003e \u003cp\u003eBuilding on these behavioral insights, international comparisons reveal both divergence and convergence in supply networks\u0026mdash;such as in the Saudi Arabian study from which this questionnaire was adapted and where distinct regional patterns emerge\u003csup\u003e14\u003c/sup\u003e. Although the Saudi study did not differentiate participants by gender as this study does, meaningful comparisons can still be drawn between the two populations, highlighting both regional differences and paradoxical similarities to global bodybuilding trends. In the Saudi study, the majority of the users obtained steroids from trainers (38.8%) and friends (35.7%), reflecting an informal, peer-driven supply chain. In contrast, our study in Brazil reveals a stronger reliance on medical professionals, with 17% of women and 29% of men acquiring steroids from doctors, while only 8.3% of women and 5.4% of men sourced them from trainers. This divergence underscores regional differences in the legitimization of AAS access, yet paradoxically aligns with broader global bodybuilding trends, where both medical and underground markets play key roles in steroid distribution. Despite cultural and regulatory differences, the bodybuilding subculture appears to transcend regional boundaries, normalizing steroid use through varying yet converging channels of supply.\u003c/p\u003e \u003cp\u003eTurning to the demographic patterns, a noteworthy issue concerns age and gender distributions. In this study, female bodybuilding practitioners were generally older than their male counterparts, potentially reflecting lifetime fear of drastic physical modification, masculinization or even later onset of intense training\u003csup\u003e17,18\u003c/sup\u003e. Conversely, the predominance of young men, particularly those aged 18\u0026ndash;25, among AAS users may be linked to greater societal pressure to develop muscular physiques early in life, a masculinized ideal that emphasizes ultimate strength and physical vigor\u003csup\u003e2,16\u003c/sup\u003e. Gender and age differences in AAS engagement reflect deeper sociocultural conditioning: although men and women\u0026mdash;and younger and older\u0026mdash;navigate distinct body‑ideal scenarios, both groups still turn to steroids to enhance sexuality, perceptions of attractiveness, and social validation\u0026mdash;behaviors shaped by communal norms in body image driving settings, as described by the Theory of Planned Behavior\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, social patterns are also reflected in the educational disparities between genders. Among men, 34% had completed higher education and 39% had incomplete higher education, whereas 92% of women had completed higher education. This raises questions such as whether these educational differences influence the perception of risks associated with steroid use. Women appear more aware of health risks, including effects on blood pressure, cholesterol, liver damage, and fertility, aligning with a lower tendency to use AAS, as evidenced by data showing that 75% of women had not used anabolic steroids. Meanwhile, men, despite recognizing the risks, were predominantly users (59%), potentially underestimating the dangers or prioritizing perceived physical benefits. This result corroborates the results of other studies\u003csup\u003e19\u003c/sup\u003e and reveals that the Brazilian pattern of AAS users is not different from other countries.\u003c/p\u003e \u003cp\u003eMoreover, an important medical social critique centers on the role of media (TV, social networks, internet, magazines, radio) as a health information source, with this study showing that 47% of participants obtain information about AAS through these channels, which are often biased or incomplete. Furthermore, exacerbating the misuse of steroids and the spread of informal, non-scientific knowledge\u003csup\u003e15\u003c/sup\u003e. Unlike most drugs, AAS transforms the body into a visible symbol of discipline, success, and social status which is easily circulable in social media and less socially condemning than narcotic use for example. Thus, highlighting the urgent need for even more formal education and public online campaigns to address the risks of AAS.\u003c/p\u003e \u003cp\u003eNotably, the divergence of opinions on whether health authorities should be informed about AAS use for non-medical purposes reflects a complex social and public health issue: the normalization of AAS use and distrust of health policies interventions on this topic. When asked about mandatory reporting to health authorities, 18% of respondents of the present study strongly disagreed, and 36% partially disagreed, totaling 54% with a negative perception of the topic. This aligns with the stigma often associated with AAS users, who are socially perceived as engaging in risky behavior by consuming substances considered as dangerous drugs of abuse\u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA 2004 North American study also revealed significant distrust among AAS users regarding physicians\u0026rsquo; knowledge of these substances. While physicians were seen as reliable on general health topics like smoking and alcohol, their credibility on AAS was rated similarly to friends, internet sources, or steroid suppliers\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTwo decades later, the present study confirms that such distrust persists, also possibly amplified by the rise of alternative sources of information on AAS such as the internet and social media, which often spread inaccurate knowledge contrary to medical advice and lacking proper scientific evidence\u003csup\u003e21\u003c/sup\u003e. These findings highlight ongoing skepticism toward conventional medical approaches that often distances and harms the doctor-patient relationship, a fitness revolution that changed the way of approaching weight lifting practitioners and gym enthusiasts\u003csup\u003e22\u003c/sup\u003e. The 2004 recommendation that physicians enhance their knowledge of anabolic steroids and adopt a more patient-centered approach still remains relevant and essential in these scenarios.\u003c/p\u003e \u003cp\u003eThe following discussion explores these barriers in greater depth, emphasizing how deeper theoretical insights can inform more ethical and effective research practices with marginalized or medically disengaged populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSOCIOCULTURAL AND BEHAVIORAL DETERMINANTS OF AAS USE: STIGMA-BASED PERSPECTIVE AND PUBLIC HEALTH\u003c/h2\u003e \u003cp\u003eAAS use is deeply embedded in gym culture, where peer reinforcement and exposure to performance-enhancing drug (PED)-related content on different interactions can normalize its consumption. To interpret these behavioral patterns, we apply Bronfenbrenner\u0026rsquo;s bioecological theory, which frames human behavior as influenced by layered environmental systems\u003csup\u003e16\u003c/sup\u003e. At the microsystem level, the gym environment and peer groups exert daily, face-to-face pressures that normalize AAS use and reinforce body ideals. As shown in this study, male users\u0026mdash;particularly younger ones\u0026mdash;are more likely to engage with steroids, responding to social scripts linking masculinity to muscularity, discipline, and control. Here, performance-enhancing substances are not simply tools for transformation but markers of achievable goals and validation. This misperception fuels a self-diagnosis common in the fitness community: identifying as \u0026ldquo;hard gainers\u0026rdquo;\u0026mdash;those believed to be genetically incapable of significant muscular development. However, this belief often stems from a misunderstanding of muscle maturity, natural physiological timelines, and the long-term processes required for strength and hypertrophy. Rather than reflecting biological limitations, these frustrations are amplified by unrealistic benchmarks set by the enhanced peers.\u003c/p\u003e \u003cp\u003eThe mesosystem, encompassing the interactions between settings (e.g., peers, family, and digital fitness communities), amplifies these pressures\u003csup\u003e16,23\u003c/sup\u003e. A younger bodybuilder who constantly receives aesthetic praise and glory from friends while also consuming fitness content online becomes embedded in a cycle of reinforcement, where physical achievement is both a trace of persona and social obligation.\u003c/p\u003e \u003cp\u003eAt the exosystem level, institutions such as media, supplement industries, and loosely regulated health markets shape accessibility and knowledge. The present study also revealed the same relationship: that participants often distrusted formal healthcare while simultaneously seeking prescriptions\u0026mdash;highlighting an institutional paradox: medical legitimacy is valued symbolically, but not functionally. This supports earlier work suggesting that users employ medical channels to manage stigma, not necessarily to reduce risk .\u003c/p\u003e \u003cp\u003eFinally, the macrosystem encompasses cultural values\u0026mdash;particularly the Western idealization of hyper-muscular, athletic bodies\u0026mdash;that frame enhancement as not only acceptable but aspirational. In Brazil, as in other fitness-centric cultures, body capital has become a proxy for social capital. AAS use, in this sense, becomes a rational, even logical response to societal expectations and the normalization of enhancement within a competitive, appearance-driven subculture \u003csup\u003e23\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn parallel, stigma appears to play a pivotal role in the present study when it comes to shaping behavioral decisions regarding AAS acquisition and justification of use, as well as the use of polypharmacy profiles. As previously discussed before, many participants expressed a preference for obtaining AAS through medical professionals rather than underground sources, suggesting that institutional legitimacy reduces self-stigma while still allowing continued use. This aligns with Goffman\u0026rsquo;s (1963) concept of stigma management, where individuals navigate social judgment by seeking \u0026ldquo;acceptable\u0026rdquo; pathways to engage in stigmatized behaviors\u003csup\u003e15\u003c/sup\u003e. However, despite access to medical oversight, a significant portion of these users still reported unsafe practices such as polypharmacy with use of other drugs of addiction, primarily cannabis, indicating that stigma reduction does not necessarily lead to harm reduction. Furthermore, gender differences in AAS-related stigma were evident, with women exhibiting greater resistance to AAS use\u0026mdash;likely a reflection of societal expectations that associate female muscularity with deviance, reinforcing their reluctance to engage in injectable drugs\u003csup\u003e24,\u003c/sup\u003e. This contrast suggests that stigma is not only a deterrent but also a selective force shaping who engages in AAS use, how they justify it, and through what means they acquire substances\u003csup\u003e22,23\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeveral participants described previous encounters with physicians in which their use of AAS was ridiculed or linked to misconceptions\u0026mdash;particularly the idea that steroid use reflects sexual dysfunction, insecurity, or ignorance. A common example cited was the mocking association of AAS with testicular atrophy, which physicians used to delegitimize users\u0026rsquo; choices or question their masculinity. Such interactions reinforce social stigma and deepen users\u0026rsquo; resistance to institutional medical oversight.\u003c/p\u003e \u003cp\u003eDrawing on Goffman\u0026rsquo;s theory of stigma, these findings highlight how users navigate what he terms a \u0026ldquo;spoiled identity.\u0026rdquo; They often engage in information control\u0026mdash;managing what is revealed and to whom\u0026mdash;to avoid being labeled as reckless, cheaters, or deviant. In this context, the decision to bypass doctors is less about a rejection of health information and more about preserving social dignity in spaces perceived as hostile and at the same time, vulnerable .\u003c/p\u003e \u003cp\u003eIronically, despite avoiding professional medical input, many participants in this study demonstrated strong awareness of AAS-related health risks. The majority correctly identified potential side effects such as cardiovascular strain, liver toxicity, hormonal disruption, and fertility issues. This challenges the stereotype of the uninformed user and underscores a critical disconnect: the issue is not a lack of knowledge, but a lack of trust. As one participant noted, \u0026ldquo;If I already have negative feelings toward the doctor, I\u0026rsquo;m not going to be honest during anamnesis.\u0026rdquo; This pattern echoes again earlier research, including the 2004 study of 80 bodybuilders in Florida, which found that AAS users ranked physicians less trustworthy when it came to steroid-related guidance\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis paradox exposes a critical gap in medical practice: while bodybuilders seek professional prescriptions for legitimacy, they avoid engagement in ways that could facilitate harm reduction and long-term health monitoring. Addressing this issue requires medical professionals to adopt non-judgmental, evidence-based, and harm-reduction approaches that build trust and encourage open dialogue\u003csup\u003e21\u003c/sup\u003e. By fostering a more inclusive and informed healthcare environment, physicians can help integrate AAS users into proactive medical care rather than pushing them further into underground networks of misinformation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSource: This figure was designed by the authors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBRIDGING THE GAP: A CALL FOR POLICY AND HEALTH INTERVENTION IN THE BODYBUILDING COMMUNITY\u003c/h2\u003e \u003cp\u003eThe use of anabolic-androgenic steroids (AAS) is not merely an individual decision but a reflection of broader social, cultural, and psychological influences. Although limited by sample size and geographic specificity, the present study seeks not to generalize, but to contribute to a critical dialogue in medical anthropology regarding enhancement and fitness culture, stigma negotiation, and healthcare distrust within bodybuilding communities. Studies examining the history and sociodemographic characteristics of AAS use have emphasized the importance of cultural and regional contexts\u0026mdash;particularly contrasting Western and Eastern practices\u003csup\u003e2,22\u003c/sup\u003e. Although bodybuilding everywhere shares a common devotion to the \u0026ldquo;cult of the body,\u0026rdquo; it is reasonable to expect distinct regional patterns in AAS motivations, sourcing, and administration and therefore future ethnographic and cross-cultural studies are encouraged to deepen and expand this line of inquiry. Moreover, in Brazil and many other countries, the possession and distribution of anabolic steroids without a medical prescription are subject to criminal penalties. This observation adds nuance to account for the sensitivity of disclosure and adopt research designs that prioritize participant confidentiality, safety, and specially trust between researcher and participant.\u003c/p\u003e \u003cp\u003eThe findings and discussions also invite us to reconsider the strong correlation between AAS use and exposure to other substances, yet many users dismiss potential health risks. At the same time, they oppose professional oversight, revealing a fundamental distrust in healthcare authorities. These contradictions expose a significant gap between the bodybuilding community and public health initiatives, suggesting that since the popularization of bodybuilding practice in the 80s \u0026ldquo;Golden Era\u0026rdquo;, conventional regulatory approaches systematically failed to align with the realities of those who use these substances for performance and image enhancing\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAAS use presents a complex bioethical dilemma, where personal autonomy conflicts with public health concerns. While users view AAS consumption as a matter of individual choice, their decisions are often shaped by misinformation and reliance on non-medical sources, raising ethical concerns about informed consent. The principle of non-maleficence is also at risk, as unsupervised steroid use is linked to serious health consequences\u003csup\u003e5\u003c/sup\u003e. Among the many testosterone‑derived compounds, only two\u0026mdash;nandrolone decanoate and testosterone blend\u0026mdash;are officially available in pharmacies for strictly medical use. Although both are prescribed for legitimate human indications rather than aesthetic enhancement, it is notable that they were the most commonly used agents in our sample, highlighting physicians\u0026rsquo; influence on AAS cycles. All other compounds reported are intended solely for veterinary use.\u003c/p\u003e \u003cp\u003eBeyond direct health risks, AAS use contributes to broader societal challenges. Enhanced physiques, often driven by steroid use, reinforce unrealistic body standards, influencing younger individuals to adopt potentially harmful practices. This ethical concern extends beyond competitive sports, permeating fitness culture and reshaping perceptions of an ideal body\u003csup\u003e22\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAn important dimension emerging from this study is the way in which bodybuilders perceive themselves as stigmatized by healthcare professionals. Participants reported a strong sense of moral judgment and clinical suspicion from doctors during the conduction of the present study, who often, according to the participants, associate AAS users with deviance, irresponsibility, or addiction. However, this perception is not aligned with the lived reality of most users in this study. Although anabolic steroids are classified as controlled substances and regulated as drugs of abuse, the majority of users do not engage in criminal behavior or illicit activity beyond the scope of unsupervised enhancement. Here, the paradox becomes visible again and the conflation of enhancement practices with criminality contributes to a breakdown in trust, discouraging open conversations with medical professionals and pushing users toward informal networks. This illustrates a key anthropological insight: stigma is not just a reaction to risk, but a cultural mechanism that marginalizes certain health behaviors and reinforces institutional boundaries between \u0026ldquo;legitimate\u0026rdquo; and \u0026ldquo;illegitimate\u0026rdquo; bodies.\u003c/p\u003e \u003cp\u003eThis dynamic necessitates a shift from strict prohibition toward harm reduction strategies that prioritize education and open dialogue in order to improve the number of more consistent reports and evidence-based interventions\u003csup\u003e24\u003c/sup\u003e. Regional context, bioecological dynamics, community norms, and modes of communication all introduce biases that\u0026mdash;together with polypharmacy and the use of over 1,000 different steroid compounds\u0026mdash;must be accounted for to truly understand and address the multifaceted nature of steroid abuse\u003csup\u003e2,25\u003c/sup\u003e. From its physical to its mental-health consequences, steroid use demands a holistic, non‑judgmental framework\u003csup\u003e26\u003c/sup\u003e. Medical anthropology offers exactly that: a comprehensive ethnological perspective on addiction that adds dimension to guide more effective, culturally sensitive interventions\u003csup\u003e2,18\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn conclusion, the use of anabolic androgenic steroids presents a complex bioethical dilemma, balancing individual autonomy with public health concerns. While users may perceive AAS as a personal choice, the lack of informed consent\u0026mdash;due to misinformation and reliance on non-medical sources\u0026mdash;raises ethical concerns about autonomy. Additionally, the issue of fairness emerges in both competitive sports and broader societal expectations, where enhanced physiques create unrealistic body standards, influencing younger individuals to engage in potentially harmful practices\u003csup\u003e27,28\u003c/sup\u003e. Furthermore, the distrust between AAS users and healthcare professionals challenges effective public health interventions, highlighting the need for harm reduction strategies rather than strict prohibition. By integrating behavioral theory with anthropological insights, this work offers a foundation for rethinking health interventions that more accurately reflect the lived realities of fitness communities. Therefore, addressing AAS use ethically requires a nuanced approach, recognizing both individual rights and the broader societal responsibility to ensure health and safety.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eETHICS DECLARATION\u003c/h2\u003e \u003cp\u003e All methods were performed in accordance with the Declaration of Helsinki and have been approved by the Ethics and Research Committee of the Faculty of Medical Sciences of Minas Gerais (CAAE: 73550423.5.0000.5134). The study carried no harmful risks as it was observational. All participants agreed to participate and provided informed consent.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCOMPETING INTERESTS\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.F.D.C. and B.A.N conceptualized and designed the study. L.F.D.C. wrote the first draft of the manuscript;L.F.D.C. and B.A.N acquired the data and designed the methodology; carried out the analysis and interpreted the results; R.S.G were responsible for project administration, supervision and revision . L.F.D.C. and B.A.N. draw the figure and tables. All authors read and approved the final version of the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe, the authors, also would like to thank all study participants for their time and commitment.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMedicina S/A. 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Cureus 15, e41600 (2023). https://doi.org/10.7759/cureus.41600\u003c/li\u003e\n\u003cli\u003eCox, L., Piatkowski, T., McVeigh, J. \u0026ldquo;I would never go to the doctor and speak about steroids\u0026rdquo;: Anabolic androgenic steroids, stigma and harm. \u003cem\u003eDrugs, Education, Prevention and Policy.\u003c/em\u003ehttps://doi.org/10.1080/09687637.2024.2373056 (2024).\u003c/li\u003e\n\u003cli\u003eSport Integrity Australia. The worrying trend of steroid use in young adults. Sport Integrity Australia. Preprint at: https://www.sportintegrity.gov.au/news/integrity-blog/2023-05/worrying-trend-of-steroid-use-young-adults (2023).\u003c/li\u003e\n\u003cli\u003eWoolf, J. \u0026ldquo;If everyone is using, shouldn\u0026rsquo;t I?\u0026rdquo;: Perceived norms of anabolic androgenic steroid use among high school athletes. Preprint at: https://www.wada-ama.org/sites/default/files/2023-06/woolf_wada_report_aug2012_002.pdf (2013).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anabolic Androgenic Steroids; Bodybuilding, Perception, Health Risk","lastPublishedDoi":"10.21203/rs.3.rs-6568363/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6568363/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAnabolic-androgenic steroids (AAS) are widely used in bodybuilding communities despite well-documented health risks. While previous studies have addressed AAS prevalence and physiological effects, few have examined how stigma and behavioral bias influence usage and acquisition patterns. This exploratory study applies Ajzen\u0026rsquo;s Theory of Planned Behavior, Bronfenbrenner\u0026rsquo;s Ecological Systems Theory, and Goffman\u0026rsquo;s stigma theory to analyze the sociocultural mechanisms shaping AAS use in a hard-to-reach community. A cross-sectional survey was conducted with 68 high-performance gym-goers at a private training center in Brazil, assessing prevalence, acquisition sources, risk perception, and social profile. Descriptive statistics were used alongside behavioral modeling theories to interpret user responses. Results reveal complex social factors, including physician-sourced supply despite simultaneously expressing distrust toward medical professionals when it comes to disclosure. These findings suggest a need for public health interventions that address stigma-related rationalizations, not only deterrence. The study highlights the importance of integrating anthropological and behavioral science into the epidemiology of AAS abuse. Traditional medical approaches often focus on physiological risks while neglecting the dynamics between macro and micro environments and social influences driving use. This work calls for holistic, evidence-based strategies and anthropologically informed public health initiatives that engage with the lived realities of stigmatized health practices.\u003c/p\u003e","manuscriptTitle":"Steroids, Stigma, and Health: A Medical Anthropological Analysis of Anabolic Use in a Brazilian Bodybuilding Community","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-29 18:34:33","doi":"10.21203/rs.3.rs-6568363/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-05-28T03:00:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-27T17:49:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-06T19:07:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-06T19:06:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a48cd5b3-20cb-4583-8c16-d6dd5d1e73e7","owner":[],"postedDate":"May 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":49193579,"name":"Biological sciences/Psychology/Human behaviour"},{"id":49193580,"name":"Biological sciences/Neuroscience/Social behaviour"},{"id":49193581,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-05-29T18:34:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-29 18:34:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6568363","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6568363","identity":"rs-6568363","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}