Objective: Many individuals, attempting to gain muscle or lose fat, use ‘dietary supplements’. Though widely available over the counter or by mail order in America and Europe, some of these ‘supplements’ are actually potent drugs such as androstenedione and ephedrine. We sought to estimate the prevalence of these forms of drug use in American gymnasiums. Methods: We distributed anonymous questionnaires to 511 clients entering five gymnasiums, asking about use of both supplements and anabolic steroids. Results: Among men, 18% reported use of androstenedione and/or other adrenal hormones, 25% reported ephedrine use, and 5% reported anabolic steroid use within the last 3 years; among women these rates were 3, 13 and 0%. Extrapolating from these figures to the United States as a whole, we estimated that possibly 1.5 million American gymnasium clients have used adrenal hormones and 2.8 million have used ephedrine within the last 3 years. Conclusions: Millions of men and women are currently using potent drugs, widely sold over the counter as ‘supplements’, despite their known adverse effects, unknown long-term risks, and possible potential for causing abuse or dependence.

2.
Pope HG Jr, Phillips KA, Olivardia R: The Adonis Complex: The Secret Crisis of Male Body Obsession. New York, Free Press, 2000.
3.
Gruber AJ, Pope HG Jr: Psychiatric and medical effects of anabolic-androgenic steroid use in women. Psychother Psychosom 2000;69:19–26.
4.
Nissen S, Sharp P, Ray M, Rathmacher JA, Rice D, Fuller JC Jr, Connelly AS, Abumrad N: Effect of leucine metabolite beta-hydroxy-beta-methylbutyrate on muscle metabolism during resistance exercise training. J Appl Physiol 1996;81:2095–2104.
5.
Juhn MS, Tarnopolsky M: Potential side effects of oral creatine supplementation: A critical review. Clin J Sports Med 1998;8:298–304.
6.
King DS, Sharp RL, Vukovich MD, et al: Effect of oral androstenedione on serum testosterone and adaptations to resistance training in young men: A randomized controlled trial. JAMA 1999;281:2020–2028.
7.
Kachhi PN, Henderson SO: Priapism after androstenedione intake for athletic performance enhancement. Ann Emerg Med 2000;35:391–393.
8.
Whitehouse AM, Duncan JM: Ephedrine psychosis rediscovered. Br J Psychiatry 1987;150:258–261.
9.
Vahedi K, Domigo V, Amarenco P, Bousser M-G: Ischaemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatry 2000;68:112–113.
10.
Capwell RR: Ephedrine-induced mania from an herbal diet supplement. Am J Psychiatry 1995;152:647.
11.
Centers for Disease Control and Prevention: Adverse events associated with ephedrine-containing products – Texas, December 1993 – September 1995. Mor Mortal Wkly Rep 1996;45:689–693.
12.
Food and Drug Administration: Dietary Supplements Containing Ephedrine Alkaloids. Document No. 221 CFR Part III: Washington, United States Department of Health and Human Services, 1997.
13.
Gruber AJ, Pope HG Jr: Ephedrine abuse among 36 female weightlifters. Am J Addict 1998;7:256–261.
14.
Yesalis CE: Medical, legal, and societal implications of androstenedione use. JAMA 1999;281:2043–2044.
15.
Graves G: Andro closer to being called a steroid. USA Today June 27, 2000, p. 1C.
16.
National Household Survey on Drug Abuse, data available online at http://www.icpsr.umich.edu/cgi-bin/SDA11/hsda3.
17.
Johnston LD, O’Malley PM, Bachman JG: National Survey Results on Drug Use from the Monitoring the Future Study, 1975–1998, vol II: College Students and Young Adults. Bethesda, National Institute on Drug Abuse, 1999.
18.
Garner DM: Body image survey. Psychol Today 1997;30:30–84.
19.
McCaulay M, Mintz L, Glenn AA: Body image, self-esteem, and depression-proneness: Closing the gender gap. Sex Roles 1988;18:381–390.
20.
Wiseman CV, Gray JJ, Mosimann JE, Ahrens AH: Cultural expectations of thinness in women: An update. Int J Eat Disord 1992;11:85–89.
21.
Pope HG Jr, Gruber AJ, Mangweth B, Bureau B, deCol C, Jouvent R, Hudson JI: Body image perception among men in three countries. Am J Psychiatry 2000;157:1297–1301.
22.
Pope HG Jr, Gruber AJ, Choi PY, Olivardia R, Phillips KA: Muscle dysmorphia: An underrecognized from of body dysmorphic disorder. Psychosomatics 1997;38:548–557.
23.
Olivardia R, Pope HG Jr, Hudson JI: ‘Muscle dysmorphia’ in male weightlifters: A case-control study. Am J Psychiatry 2000;157:1291–1296.
24.
Mangweth B, Pope HG Jr, Kemmler G, Ebenbichler C, Hausmann A, De Col C, Kinzl J, Biebl W: Body image and psychopathology in male bodybuilders. Psychother Psychosom 2001;70:38–43.
25.
Garfinkel PE: Eating disorders; in Kaplan HI, Sadock BK (eds): Comprehensive Textbook of Psychiatry, ed 6. Maryland, Williams & Wilkins: 1995, chap 22, pp 1361–1371.
26.
Mangweth B, Pope HG Jr, Hudson JI, Olivardia R, Kinzl J, Biebl W: Eating disorders in Austrian men: An intra-cultural and cross-cultural comparison study. Psychother Psychosom 1997;66:214–221.
27.
Brownell KD, Napolitano MA: Distorting reality for children: Body size proportions of Barbie and Ken dolls. Int J Eat Disord 1995;18:295–298.
28.
Pope HG Jr, Olivardia R, Gruber A, Borowiecki J: Evolving ideals of male body image as seen through action toys. Int J Eat Disord 1999;26:65–72.
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