Gay and bisexual boys are almost six times as likely as their heterosexual peers to misuse steroids, according to a new study.
"What was most surprising to us was the magnitude of the disparities that emerged between sexual minority and heterosexual boys," Aaron J. Blashill from Massachusetts General Hospital in Boston told Reuters Health in an email.
Upwards of 5 percent of adolescent boys use anabolic-androgenic steroids to enhance strength, athletic performance, and muscle size, but nobody had studied the association between sexual orientation and steroid abuse before, Blashill and his colleague Steven A. Safren noted.
Long-term misuse of steroids can lead to heart problems, hormone-related changes and psychiatric disorders.
The researchers were concerned that gay and bisexual boys might be more likely to misuse steroids because of other factors that have been tied to steroid and other substance abuse. Those include depression, victimization, suicidal thoughts and intent and poor body image.
To see if that was the case, Blashill and Safren used data from the 2005 and 2007 U.S. Youth Risk Behavior Surveys of 17,250 teenage boys, including 635 who were gay or bisexual.
About 21 percent of gay and bisexual boys said they had abused steroids at some time in their lives, compared with only 4 percent of heterosexual boys.
Gay and bisexual boys were also nearly six times as likely as heterosexual boys to report moderate use of steroids (at least 10 times) or severe use (at least 40 times), according to the report in the journal Pediatrics.
In an effort to understand why, the researchers looked at other factors thought to be important contributors to steroid use. They found drug and alcohol use, depression or suicidal tendencies and feelings of victimization played a role in steroid misuse.
Even after taking those factors into account, though, being gay or bisexual was still linked to an increased risk of steroid abuse.
"Gay and bisexual boys are often targets of bullying, and some boys (particularly if they also possess poor body image) may turn to anabolic-androgen steroids (AAS) use as a means to obtain a more muscular build, in hopes it would deter others from bullying them," Blashill said.
"Parents should be mindful of their son's school climate regarding bullying, in general, and specifically, attitudes toward sexual minorities."
Steroids are often used covertly, he noted, so it may be hard for parents to observe their use directly. But they may be able to monitor related behaviors, like excessive exercise and weightlifting.
"On a broader point, sexual minority boys report high levels of body dissatisfaction (more similar to levels of heterosexual girls than heterosexual boys), so parents should also be mindful that body image concerns may well be a factor in their sons' lives," Blashill said.
"Often, I'll hear from patients telling me how they are frequently told they're 'too skinny' or that they need to 'put some meat on those bones' from family/friends, who are often well-intentioned," or who even meant to compliment them, he added.
"These boys, quite eloquently, state how such a double-standard exists, that calling a boy 'so skinny' is akin to calling a girl 'fat,' but it appears that society, by and large, feels the former is more socially acceptable. But, these comments, coming from peers, family (and) coaches, can have real impacts on boys' body image," Blashill said.