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Steroid misuse more common among homosexual, bisexual adolescent boys
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Homosexual and bisexual adolescent boys are more likely to misuse anabolic-androgenic steroids and have an increased risk for victimization, depression, substance use and suicide, according to a study in Pediatrics.
Researchers analyzed data from Youth Risk Behavior Surveys conducted in 2005 and 2007, assembling a study cohort of 17,250 adolescent boys with a mean age of 16 years. Individuals who identified as bisexual or homosexual were considered “sexual minorities” and accounted for 3.7% of participants.
Data analysis showed sexual minorities were more likely to use anabolic-androgenic steroids throughout their lifetime compared with heterosexual boys (21% vs. 4%). Homosexual and bisexual boys reported higher levels of moderate (8% vs. 1.5%) and severe (4% vs. 0.7%) misuse of anabolic-androgenic steroids in comparison with heterosexual boys.
Researchers found that those who identified as sexual minorities were more likely to experience victimization, depressive symptoms, suicidal thoughts and increased substance use. When researchers controlled for victimization, depressive and suicidal symptoms and substance use, the association between anabolic-androgenic steroids misuse and sexual minority status remained significant, but weakened. There was a greater association between substance use, misuse of anabolic-androgenic steroids and sexual minority status than victimization and depressive and suicidal symptoms and sexual minority status.
“Sexual minority boys reported a lifetime prevalence of [anabolic-androgenic steroids] misuse at 21%, compared with 4% for heterosexual boys. Depressive symptoms/suicidality, victimization, and substance use may account for significant variance in the relationship between sexual minority status and [anabolic-androgenic steroids] misuse. Prevention and intervention efforts would benefit from focusing on this highly at-risk group,” study researcher Aaron J. Blashill, PhD, of Massachusetts General Hospital, and colleagues concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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J. Dennis Fortenberry, MD, MS
Inquiry into sexual attractions, sexual identity and gender of any sexual partners may yield information about a constellation of adverse psycho-social and behavioral outcomes that now includes anabolic-androgenic steroid use (AAS), in addition to poly-substance misuse, depression, suicidality and victimization. The severity of consequences of AAS use, and the marked disparity in rates of AAS use by sexual minority boys, suggests that inquiry about same-sex attraction and behaviors is an efficient use of about 2 minutes during health maintenance screening interviews with young men. For many young men, such inquiry may be the first opportunity to discuss such issues with a knowledgeable adult.
An additional benefit of inquiry into sexual minority status is the reminder that sexual minority status is not risky itself, and is neither a disease nor a condition. Most young people work through sexual feelings and attractions to develop a sexual identity that “fits” for them. A comfortable discussion with a physician can support this normal, non-traumatic development.A final implication of research is the importance of developing a response plan when young people identify as a sexual minority and report one or more of the health conditions for which sexual minority status is a marker. Discussions of sexual identity are necessarily couched in assurances of confidentiality. Discovery of health-harming behaviors such as AAS requires readdressing the confidentiality assurance to best address the young person’s needs, and maintaining respect for confidentiality.
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