Performance-enhancing Drugs and Body Image

Debate between Margaret Ferrier and Luke Evans

Tuesday 21st February 2023 Westminster Hall

[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.

International Men’s Day

Debate between Margaret Ferrier and Luke Evans

Thursday 17th November 2022 Commons Chamber

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

I congratulate the hon. Member for Don Valley (Nick Fletcher) on securing this year’s debate and on chairing the APPG so well, and I thank the Backbench Business Committee for granting this debate in the Chamber this year.

International Men’s Day is an opportunity to celebrate boys and men, and their contributions to society and their communities. It is also an opportunity to look at the issues facing them in the modern world, raise awareness and, I hope, spark meaningful change. It would be remiss of me not to mention the team behind Movember, who for so many years now have worked hard in successive Novembers to raise awareness of prostate cancer, which is a really important issue to shine a light on for men across the UK. I also want to thank the Samaritans for sharing its briefing with colleagues ahead of today’s debate, so that we can address one of the most crucial issues impacting men today and the reasons behind suicide. I want to pass on my sympathy to the hon. Member for Ynys Môn (Virginia Crosbie) on the loss of her brother.

Some of the darkest statistics we will hear today are around suicide. Men account for three quarters of all suicides, and it is the leading cause of death in men under 50 here in the UK. Each life lost to suicide is devastating. It leaves a hole in the lives of families, friends and communities that can never be filled. Most tragically, almost all suicides could be preventable if the person had access to the right support, and if societal and socio-economic factors could be addressed.

Today’s social media age has brought with it new challenges, building on a pressure—the pressure to look good—that has existed for women for centuries. This was not a new phenomenon that came with the birth of Facebook or Instagram, and men will also have been influenced by glossy photos of celebrities and models on magazine stands and in films. That constant pressure has consequences for those of us who do not wake up every day looking like an airbrushed model from a catalogue. The discourse around this issue often focuses on the impact felt by women, and although there are reasons for that—the pressure is ingrained in girls from a much younger age, and much more overtly—the impact that that pressure is having on boys and men is often overlooked. The way such pressure manifests in girls and women might look different, and is perhaps more easily recognised, while men struggling with body image or eating disorders might focus their energy on exercise or the gym. To the naked eye that might seem healthy, because they are bulking up and building muscle.

[Dr Luke Evans]

I am hugely grateful to the hon. Lady because she brings up such an important point about body image, and especially the male physique. Between 0.5 million to 1 million people are using anabolic steroids to try to get that perfect image, and that is ongoing in the UK without us being aware. Does she think there should be more focus from the Government on those kinds of issues that specifically affect men?

[Margaret Ferrier]

The hon. Gentleman is an expert in this area, and I absolutely agree with him. It would be good if the Government could look at that issue—hence me raising it in this debate. Societal beauty standards are different for men, and while thinness might be an aspirational expectation set through the media for women, for men it generally is not. For men there is an image of fitness and muscular build, which means that often those signs in men are not recognised.

Eating disorders are indiscriminate when it comes to gender. There are many, and while anorexia is of course devastating, there is also bulimia and compulsive eating. Those disorders can ravage the body, but they also have an extreme detrimental effect on the mind. Although research on eating disorders in men is inconsistent, having only really begun in recent years, there are some figures that might illustrate how much more prevalent such disorders are than many of us realise. A 2021 study by Beat estimated that approximately 1.25 million people in the UK have an eating disorder. The same survey estimated that about 25% of those people are male. That is tens of thousands of men and boys suffering with these conditions, and struggling to access the right support. Some of those males may not even realise that they have an eating disorder.

Two big issues are at play, and both come down to eating disorders being viewed as a “female” problem. First is the social stigma and difficulty that men experience in recognising that they have an eating disorder and in seeking help. Anorexia, for example, is often seen as a problem caused by vanity, which is not only untrue but a simplistic and narrow view of an unbelievably complex disease. The social stigma attached to male mental health is huge, and the less such issues are spoken about, the more isolating and shameful it can feel. Secondly, as a result, men and boys will hide their feelings, and they will not proactively seek help. With the NHS as stretched as it is, and because eating disorders are more commonly recognised in women, health professionals are less likely to spot the signs in men.

I referred to the body ideal for men as being seen as muscular, and I want to touch on muscle dysmorphia, a form of body dysmorphic disorder, which has a higher incidence in men. Sometimes referred to as “reverse anorexia”, muscle dysmorphia is defined by being preoccupied by worries that one’s body is too small or not muscular enough, despite having a normal build, or in many cases an objectively extremely “buff” physique. It is basically a completely distorted view of their body. Although muscle dysmorphia has some overlap with eating disorders, it is not one, but the fixation on that body type, and the steps men take when pursuing it, can lead to unhealthy eating habits, strict dieting, and develop into an eating disorder. Media and pop culture, magazines, TV and computer games all perpetuate that imagery and stereotype, which is unnecessary and only feeds into a hyper-masculine cultural ideal that is harmful to men and boys in somany ways.

The occurrence of eating disorders in men and boys is closely linked to a number of other mental health conditions. Risk factors include depression, anxiety, obsessive compulsive disorder and mood disorders. One study showed that men with eating disorders are twice as likely to have comorbid substance abuse issues, misusing drugs such as cocaine or stimulants for their appetite-suppressing side effects. That is a monumental issue for the men experiencing those problems. It needs better recognition.