New research shows how long-term use of muscle-building supplements such as protein supplements and creatine may be linked to specific health risks for LGBTQIA+ people.

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New research highlights the health risks associated with LGBTQIA+ people that can stem from addiction to appearance and performance enhancing drugs and supplements (APEDS). Peter Berglund/Getty Images

Much has been written in recent years about the popularity of muscle building supplements, particularly anabolic androgenic steroids (AAS).

Research has highlighted the health issues that swirl around some of these substances, particularly some of the mental health and body dysmorphic issues that can affect those who may become overly dependent on supplements as they try to develop their muscle mass for aesthetic or sporting reasons.

Now, a new study is examining the use of these appearance and performance enhancing drugs and supplements (APEDS) – think protein supplements, steroids and creatine, for example – on gender minorities, including people transgender, genderqueer and non-binary.

The popularity of these substances among these communities mirrors similar rates seen in the general LGBTQIA+ population, with researchers pointing to the associated health issues that can arise from addiction to these supplements.

New study was published in the International Journal of Eating Disorders.

Researchers interviewed 1,653 gender minority people, including 1,120 who fell under a broad identity of being “gender expansive”, which was defined by the study as “a wide range of gender identities situated outside the conventional gender binary, including genderqueer and non-binary people.

Additionally, 352 respondents were transgender men and 181 were transgender women.

They were all recruited as part of The Population Research in Identity and Disparities for Equality Study in 2018.

The results?

Lifetime use of APEDS was reported by 30.7% of gender-broad people, 45.2% of transgender men, and 14.9% of trans women. They also found that protein supplements, along with creatine supplements, were the most commonly used of these substances.

This study was important in illustrating a link between the use of these types of supplements and evidence of eating disorders and different types of body dysmorphia.

Lifetime use of APEDS was linked to higher eating disorder scores and evidence of “food restriction, binge eating, forced/thrusted exercise, and muscle dysmorphic symptoms,” reads -on in the article.

Beyond that, APEDS use was related to laxative use among gender-broad people. For transgender women, APEDS use was “not significantly associated with eating disorder or muscle dysmorphic symptoms.”

The study’s lead author, Dr. Jason Nagata, an assistant professor of pediatrics in the division of adolescent and young adult medicine at the University of California, San Francisco (UCSF), told Healthline that the use of muscle building supplements “is common among LGBTQ+ people”.

“The idealized male body is tall and muscular. Almost half of transgender men use muscle-building supplements like protein or creatine. The use of muscle-building supplements is linked to symptoms of muscle dysmorphia in gay and transgender men. Muscle dysmorphia is a condition characterized by a preoccupation with not being muscular enough,” Nagata explained.

When asked why rates of muscle-building supplement use might be so high among study participants, especially trans men and non-binary people, for example, Nagata said that the “norms Traditional male gender and bodily ideals in our society often revolved around “muscles”.

“Transgender men may engage in muscle-building behaviors to alter their body shape in part to assert their gender identity,” he added.

This differs from some of the societal pressures centered on female bodies.

“Gender norms and body ideas among women are often focused on leanness, leanness and weight loss,” Nagata said. “Therefore, transgender women may engage in weight loss behaviors more often than muscle building behaviors.”

To put all of this into context, these rates of muscle-building supplement use among gender minorities are no different than those seen among cisgender LGB (lesbian, gay, and bisexual) people.

Nagata authored a similar study which found that 44% of gay men, 42% of bisexual men, 29% of lesbian women, and 30% of bisexual women reported using creatine, steroids, or protein supplements .

Nagata said LGBTQIA+ people in society face high rates of discrimination, as well as cultural and social stigma, which “can contribute to psychological stress and body dissatisfaction.”

He explained that LGBTQIA+ people might face pressure to try to achieve a muscular or lean body from their peers, partners, or even through social media.

Nagata said gay male bodies, in particular, “are on display more than ever” on social media platforms. He pointed research that Instagram use among bisexual and gay men is linked to “muscle dissatisfaction and steroid use.

Another study found that “more sexual partners in the past month are linked to protein, creatine and steroid use among gay men,” Nagata said.

Dr. Matthew Hirschtritt, MPH, a psychiatrist and researcher at Kaiser Permanente in Northern California, said social threats of harassment, bullying, and invalidation are part of a harsh reality familiar to many LGBTQIA+ people.

When asked why the rates of this type of substance use are so high in these populations, he replied that these negative experiences can contribute to fueling a “negative self-image”.

“This, in turn, could cause LGBTQ+ people to use drugs and supplements to alter their physical appearance. This phenomenon is likely even more pronounced with social media,” said Hirschtritt, who was not affiliated with this new research.

When asked to put this particular study and the rates of muscle-building supplement use in transgender, non-binary, and genderqueer people into context, Hirschtritt said that “transgender people, in particular, may use these substances to augment or replace prescribed hormone therapy. .”

“This could be especially true for people who don’t have access to gender-affirming hormone therapy,” he added.

There are a number of health risks associated with addiction to muscle building supplements.

Hirschtritt explained that the use of anabolic steroids, for example, is linked to “a wide range of health risks,” including heart and liver damage, increased risk of infection, and aggression or mania.

“Steroids should only be used as prescribed for specific medical conditions – and at the lowest effective dose for the shortest duration,” he added. “Anyone, regardless of sexual orientation or gender identity, should work closely with a clinician if they need to use a steroid for a medical condition.”

Nagata echoed these thoughts, pointing to evidence that using steroids can lead to heart disease, kidney problems, and liver damage.

“Steroid use can affect the brain and lead to extreme irritability, aggression, paranoia, and poor mental health,” Nagata said.

For those who use these types of supplements and are concerned about the effect they might have on their overall health, Hirschtritt stressed that it’s important to “step back and think about your mass gain goals. muscular”.

“Do you want to achieve a certain look or do you want to improve your overall health? Gaining muscle mass is just one way to improve your health. Being healthy goes beyond the skin and may not conform to what is broadcast on Instagram,” he added. “You can talk to your doctor if you have questions about supplements and decide together if it’s safe to use certain substances.”

Hirschtritt said that whether you already use these types of supplements or are considering switching to them, always seek support from others.

He pointed to the ANAD (National Association of Anorexia Nervosa and Related Disorders) moderate peer support groups, which specifically include groups for LGBTQIA+ people.

For her part, Nagata also pointed to the National Eating Disorder Association (NEDA) hotline for support, resources and advice.

“Wherever possible, transgender people should seek advice from a healthcare professional for gender-affirming care. Gender-affirming care has been shown to decrease body dissatisfaction in transgender people,” said Nagata said, “Healthcare professionals should foster a welcoming environment in their practices for people of all genders and sexual orientations.

Nagata added that muscle building supplements can be purchased online or over the counter with little to no regulations imposed on them. He pointed to studies that show these products are often “mislabeled and may be tainted with harmful substances like steroids.” Nagata also cited studies that show that protein and creatine supplement use may be “associated with future steroid use”.

Essentially, anyone considering using these substances should exercise caution and be alert to the ramifications they may have on their mental or physical health.

“People who use muscle-building supplements may have a higher risk of developing an eating disorder or muscle dysmorphia, although many do not. Warning signs include preoccupation with food, supplements, appearance, height, weight, or exercise in a way that worsens their quality of life,” Nagata explained. “LGBTQ+ people may be less likely to seek care for eating disorders or muscle dysmorphia due to barriers to health care access or experiences of discrimination in health care settings.”