Performance-enhancing Drugs and Body Image

Luke Evans Excerpts

Tuesday 21st February 2023 Westminster Hall

[Dr Luke Evans (Bosworth) (Con)]

I beg to move,

That this House has considered the matter of steroid and image and performance enhancing drug use.

It is a pleasure to serve under your chairmanship, Ms Fovargue.

We need to talk about steroids in the UK. I am talking about not just any steroids but anabolic steroids and image and performance-enhancing drugs—or IPEDs. There are an estimated 500,000 to 1 million users in the UK, but no one is talking about it. The closest we get is the “natty or not?” discussions on social media about naturally built men and women versus people who are enhanced. There is particular discussion about Hollywood actors.

[David Mundell in the Chair]

I will not cast any aspersions about who does or does not use steroids and performance-enhancing drugs, but it is fair to say that the debate is becoming bigger and louder, not only in this country but in America and throughout the western world. The Priory Group did some research about 10 years ago and estimated that around 50,000 people were using steroids; its estimate now is that 500,000 people are using them. It says that

“we are sleepwalking into a health crisis”.

I know from my time as a GP that when it comes to—[Interruption.]

[David Mundell (in the Chair)]

Order.

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[David Mundell (in the Chair)]

The debate can continue to 5.38 pm.

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Until we were rudely interrupted by that vote, I was saying that we need to talk about steroids in the UK because, as the Priory Group has said:

“we are sleepwalking into a…crisis.”

As a GP, I know that the obesity epidemic has been a real problem, but part of the nation is actually getting fitter while part of it is getting fatter. I will concentrate on the part that is getting fitter, because of those who go the gym—mainly men—we know that one in 10 suffer from bigorexia. What am I talking about? Bigorexia is body dysmorphia—the idea that someone’s muscles are not big enough, no matter how much they eat or train. It is important to understand that this is a growing epidemic in our country; even more importantly, it is quite prolific in the gay community. I will break the issue down into three sections. I will talk a little bit about how I came to this topic, the drivers behind it, and, most importantly, what needs to be done.

Growing up, I was a fairly normal kid. At the age of 14 or 15, I was playing sport and was reasonably academic, but I was an outlier, because for my 15th birthday I had saved up £500 to buy a multigym. In my head, I wanted to improve my rugby, get girls, fight off bullies and improve my body image. Surprisingly, I was the under-16s first-team captain, but the other three aims fell to one side. Looking back, I think, “How many other young men feel like this?” That was 25 years ago. I think the points I mentioned are the driving forces behind why men want to go to the gym and improve their body image. Society says to them, “We need to be perfect”, but what is that perfect image?

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Social media and reality TV have played a huge part in promoting unrealistic body ideals, which we often do not think about when it comes to men’s self-esteem. Does the hon. Member agree that there should be some greater controls around edited, unrealistic imagery?

[Dr Evans]

The hon. Member is spot on. The advent of social media over the last 20 years has really brought home that idea of body image. With the likes of Instagram, if a man is interested in using a gym, they are sent hundreds of images in 30, 40 or 50 seconds. Each individual image in itself is not the issue, but the cumulative effect of repeatedly being sent such images is a problem.

I would argue that the way to solve the problem is through the social media companies’ algorithms, to ensure that there is transparency about what people are being sent. Facebook talked about diet pills aimed at young girls being a real problem. If we do not deal with male body image and body dysmorphia, this will be the next iteration of that problem.

As a doctor, over the last 10 to 15 years I have started to see more and more young men coming into my clinics and asking to be prescribed protein powders or creatine, and asking, “How do I bulk up?” I also started to see more and more men in their 20s, 30s and 40s who were using steroids and having side effects, including bad acne, scarring acne, mood problems and depression. I have even seen some men who have had strokes, heart attacks, liver problems, kidney problems and erectile dysfunction, none of which are really talked about when it comes to steroids.

The problem with steroids is that they work, so people use them and see a drastic improvement. People who want to build muscle will see that improvement, take the cycle of whatever substance it happens to be and then plateau, which is very hard for them to deal with because they no longer see the gains they were initially getting under their regime. They say, “Oh, I’ll only use it once”, but once becomes twice, twice becomes thrice, and so on.

[Sir James Duddridge (Rochford and Southend East) (Con)]

My hon. Friend listed symptoms, but I do not think that he mentioned swelling of the brain. Matt Dear, a 17-year-old from Essex, tried to build himself up by taking bodybuilding pills, because he was committed to a career serving in the armed forces. He took pills that he had bought for £30, his brain swelled up and, tragically, he died. The memory of Matt has helped to educate children in the community. Is my hon. Friend concerned that even taking these things once can be terminal?

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[Dr Evans]

My hon. Friend makes an incredibly important point—these are dangerous prescription drugs, if they are not used properly. There is a plethora of side effects that are not talked about, from the short-term acute stuff that could mean someone has swelling of the brain or a clot, or is having a heart attack, or the long-term effects, such as depression, scarring acne or erectile dysfunction, which, particularly for young men, can have a huge psychological effect when they are trying to find partners. My hon. Friend is spot on. My heart goes out to Matt’s family; I am pleased there is a memorial for him.

Our role as responsible elected Members is to think about what we can do. The obvious area I get directed to is sport. It is actually quite hard to dope in sport, especially for an elite athlete. It does happen, but the culture is quite strong not to do so. Many athletes who want to be elite have come to me, as their GP, and have refused to take prescriptions because they are not sure whether it will be an exemption or clean, or whether it might get them in trouble with UK Anti-Doping.

Sport is an interesting area. I have met UN Anti-Doping a couple of times, and it is seeing people using these drugs to improve their image, but then finding out that they are quite good at sport and then getting into trouble with the authorities. The classic example is the young Welsh rugby player, who wants to look big on the streets when he is out and about, and wants to look good in Ibiza—and he finds out that having that size and strength is good on the rugby field. He starts playing semi-professionally and then gets picked up by UK Anti-Doping.

At the other end of the spectrum, we see cyclists, particularly affluent middle-aged men, who have the money and wherewithal to train, dedicate their time, buy the equipment they need, and start to see progression through the ranks of cycling. Then they meet the edge and ask, “What’s next? Let’s lose weight. Let’s have a fat burner. Let’s think about steroids or something else, like EPO.” That sees people caught out.

Those are the people going into elite or semi-elite athlete status; we have not even touched on society and the health aspects. We have heard a lot over the past 10 years about women’s health and body image, but less so about men’s. “Love Island” is back on TV at the moment, and we often hear a debate about how the females look: “Is there diversity? What about their shapes?” Very rarely do we hear that about the men. Nine out of 10 of them will have a six-pack, large shoulders and big biceps, and we seem to think that is okay.

Spencer Matthews from “Made in Chelsea” talked about the pressure and the need to use steroids he felt, because of his concern about what he looked like. We only have to look at what is currently in cinemas—the Marvel comic films—to see the aspiration set for young men.

[Nick Fletcher (Don Valley) (Con)]

I congratulate my hon. Friend on securing this debate. Does he agree that boys and men are in a unique position in the 21st century? There are all kinds of pressures on boys and men that are often not seen, and which they often do not talk about. Does he agree that one way the Government could help is by putting in place a men’s health strategy? We could look at subjects such as this, and other issues that men are facing, as a whole to help men today.

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[Dr Evans]

I am grateful to my hon. Friend for his intervention. I commend his work on the men’s health strategy, and on securing the men’s world health debate. He is right that these tend to be pertinent male issues. There is a difference: from my clinical approach, I see men’s health-seeking behaviours. It is apt to say that we should target some of these issues in these ways, particularly steroid abuse and performance-enhancing drugs used for imaging, because men tend to be most affected—not exclusively but mainly. My hon. Friend is absolutely right.

That leads to the fitness industry itself, which purports to put out images of the six-pack and shoulders bigger than a fridge. The problem is that those are stationary images of a point in time. Aspiring to live in that point in time is very difficult. Young people may not understand that many people in bodybuilding go through cycles of bulking up and then dropping weight to fit a certain image for their competitions. That is fine for a bodybuilder, but it is not good for a 19 or 20-year-old university student to aspire to that, because they are at a time of meeting other people and creating relationships.

There is a ratchet effect. We see images of very large, muscular men, which people aspire to, and there is a cheap and effective way to get there; that is a real concern. That leads to a wider issue currently faced by societies across the western world: what is masculinity?

We have heard a lot about toxic masculinity, which allows space for the likes of Andrew Tate to step in. Lots of people listen to what he has to say, in part because he is saying, “Be strong, stand up, look after yourself.” On the other hand, he has been found to be completely wanting and is now under investigation. Is that the kind of role model we want in front of our young men? Young men who do not understand what masculinity is because they are not told within society will look for other options—be they the Marvel comics or the likes of Andrew Tate—to tell them what is acceptable to be masculine. That is a dangerous place to settle in.

But we are waking up to the issue; the online culture is starting to move towards calling it out. The likes of James Smith and Ben Carpenter talk openly about the pros and cons of the fitness industry, and how it has been marketed. The Women and Equalities Committee did a report on body image, as did the Health and Social Care Committee. The Advertising Standards Authority produced an interim report that identified the key issue of depictions of muscularity in advertising, and it hopes to have further information about that in quarter four of 2023. Awareness is there and the culture is starting to think about it, but we are still at least 10 years off in comparison to the female idea of body image.

We are not doing enough, which comes out when we speak to the likes of UKAD. I thank Trevor Pearce and Jane Rumble from UKAD for providing me with information when I met them. In 2019, a UKAD survey found that 34% of gym goers are aware of IPEDs being used in their gym. That is certainly my experience as a gym goer. Wherever I have been in the country, I have been aware of such drugs being taken, because I have found syringes and packets in the changing rooms. That is quite a scary thought, from my own anecdotal experience—yet one in three men who use gyms is finding the same.

The Medichecks survey of people who go to the gym found that 61% of men want to be bigger, and that 80% of men are aware of some of the side effects of steroids, yet three out of four of those men would consider using steroids or IPEDs. As I mentioned, one in 10 gym goers has bigorexia—a number that is thought to be increasing. Thinking back to being that young boy with my multigym at the age of 15, if I had had the online ability to get hold of such substances, and an ever-growing social media pressure to conform and have muscles, maybe I would have been tempted? That is a scary thought for the generations coming through.

In 2020, The Times reported that users could easily buy steroids through Instagram, even though they are class C drugs. The law says that class C drugs are lawful for personal use with a prescription, but it is illegal to distribute or supply them. In 2021, Border Force seized 1.225 million doses of anabolic steroids, which was down on the number seized a few years before—that does not cover other drugs that are available, such as the fat-stripping drug Clenbuterol—yet there were only 37 convictions for possession or supply last year. The trend has been for between 30 and 40 people to be convicted each year, over the last five years.

The Government have produced an updated drug strategy, called “From harm to hope: A 10-year drugs plan to cut crime and save lives”. The House of Commons Library confirmed to me that there is no mention of the words “steroid” or “IPED” in that report. The start of the report says:

“Over 300,000 people are addicted to heroin and crack cocaine in England. This is the biggest section of the illegal drugs market”.

Is it? Given that we expect 500,000 to 1 million people to have taken steroids, we simply do not know. That is the point I am driving at. The report talks about the principle of

“putting evidence at the heart of this approach”.

When it comes to IPEDs and steroids, we need data and evidence.

That leads me to my asks of the Government. Given that a Health Minister is responding, I think it is fair to concentrate on simply the health aspect of the issue. I ask for three things. First, will he commission the research into steroids and IPEDs suggested in the Health and Social Care Committee report on body image? Secondly, will he pull together the different Departments that the issue crosses over? The issue is not a single departmental issue. It is not covered simply by the Department of Health and Social Care, the Department for Digital, Culture, Media and Sport, the Home Office or the Government Equalities Office; it is all of them—there is a crossover. We need to pull together in roundtables and a taskforce to think about how we deal with this.

My third ask is for education and awareness. We need to think about schools, outside agencies and the NHS—a bit like the Government have done with eating disorders. The number of people suffering eating disorders has skyrocketed, and the Government have responded well by getting the information and support out, and looking at ways to strategise. We are a long way off dealing with eating disorders, but this is the next big, similar crisis. I urge the Government to take that kind of strategy forward.

It would be remiss of me to come to the debate without offering wider solutions and there are some ideas that need to be talked about. They have pros and cons; I raise them because we need to have the conversation. We could look at compulsory mandatory education for personal trainers, who are the most likely people to come into contact with gym goers. We could change the IPED laws, and make sentencing more severe; or do the opposite, and take them out, and say, “No, this is a health issue that we need to deal with.” The debate needs to happen.

We can look at examples from across the world. Norway has licensing of gyms. If new drugs were being found in a nightclub—with new drugs being found and one in three people being aware of the situation—the authorities would be knocking on the door saying, “Should we be licensing? Should we revoke that licence? What should we do about it?” We are a long way off putting such a scheme in place, but it is not beyond our remit to have a discussion about whether that is something we should do to increase the responsibility of the gym owners. There are pros and cons. Fundamentally, we do not have the data and none of the details has been explored enough. That leads us full circle; we really need to start a conversation—we need to talk about steroids in the UK.

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[Dr Evans]

Thank you for your chairmanship, Mr Mundell. Indeed, I thank both the Chairs we have had during this debate, as well as the Clerks for staying late and the officials for being here.

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for talking about algorithms and body image. My hon. Friend the Member for Rochford and Southend East (Sir James Duddridge), who is no longer in his place, raised the sad case of Matt. The constant campaigning of my hon. Friend the Member for Don Valley (Nick Fletcher) for men’s health has been fantastic. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) hit the nail on the head: this issue is about how we record data.

I am grateful to the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) for his point about bold ideas. The whole point of this discussion is that no stone should be left unturned. The bold ideas might not be right, but they need to be explored, because that is the key thing to do when trying to deal with this issue.

I am glad to hear about the twins of the hon. Member for Croydon Central (Sarah Jones). These are exactly the conversations that people should be having up and down the country. Mothers, fathers, grandfathers and grandmothers should be asking questions about what young people are aware of and what they are seeing.

It is lovely to come into a debate after three years and hear that there is unanimous support across the House on this issue and a desire to fill the void, because there is a worry that the likes of Andrew Tate will step into it. I would love to take the Minister up on his “keen pursuit”—to quote him—of this issue. We are at the start of a road, and this is all about having a conversation about steroids in the UK.

Question put and agreed to.

Resolved,

That this House has considered the matter of steroid and image and performance enhancing drug use.