Peer pressure and muscular ideals linked to steroid use intentions in boys and men

Boys and men who have never used anabolic-androgenic steroids are more likely to say they intend to use them when they feel pressure about their appearance from peers, romantic partners, or media, and when they have internalized appearance ideals such as muscularity, thinness, or general attractiveness, according to a new study published in Harm Reduction Journal. The research, led by Kyle T. Ganson and colleagues including Jason M. Nagata, analyzed survey data from 1,515 boys and men in Canada and the United States who reported never having used AAS, offering a window into the factors that may precede first use of these performance- and appearance-enhancing drugs.

Anabolic-androgenic steroids are synthetic derivatives of testosterone that promote muscle growth, but their nonmedical use carries documented health risks. Because most research on steroid use examines people who already use them, understanding what predicts intentions among those who have never used them is a critical prevention target. The study team used linear regression analyses to test whether sociocultural pressures and the internalization of appearance ideals were associated with greater intentions to use AAS in this never-user sample.

The findings, reported in the article’s abstract, showed significant associations between internalization of three distinct appearance ideals and greater intentions to use AAS: the thin/low body fat ideal, the muscular ideal, and the general attractiveness ideal. Among these, the internalization of the muscular ideal stood out as the strongest correlate, suggesting that the degree to which boys and men adopt muscularity as a personal standard may be particularly tied to their willingness to consider steroid use.

Sociocultural pressures also emerged as important, but not uniformly. Pressure from peers, significant others, and media were each associated with greater intentions to use AAS, whereas pressure from family was not. Peer pressure was the most strongly associated of the three sources, a pattern the authors say underscores the specific role that peer environments play in shaping steroid-related intentions among boys and men.

The study’s conclusions point to clear prevention implications. The authors write that sociocultural pressures, particularly from peers, and internalization of appearance ideals, specifically the muscular ideal, are critical areas for consideration in prevention and intervention efforts designed to curtail AAS use initiation. In other words, programs aiming to stop steroid use before it starts may need to address not only the external messages boys and men receive about their bodies, but also the extent to which they have absorbed those messages as personal goals.

Methodologically, the cross-sectional design means the analysis captures associations at a single point in time rather than demonstrating that pressures or internalization cause intentions to use steroids. The sample was limited to boys and men in Canada and the United States who had never used AAS, and the study relied on linear regression to estimate the strength of each association. These constraints mean the findings should be read as identifying correlates of intentions, not established causal pathways, and the authors frame the results as areas for consideration in prevention work rather than as proof of mechanism.

Nevertheless, the specificity of the results is notable. The fact that family pressure was not associated with intentions, while peer, partner, and media pressure were, suggests that the source of appearance-related messaging matters. Similarly, the finding that muscular ideal internalization outpaced thin/low body fat and general attractiveness internalization in its association with intentions points to muscularity as a particularly relevant appearance standard in this population.

The study appears in Harm Reduction Journal, an open-access publication, and was published on 3 October 2026. The article is currently shared as an accepted manuscript version, citable with a permanent DOI, ahead of final editorial production. The work adds to a growing body of research on muscularity-oriented behaviors among boys and men, a field in which Ganson, Testa, Piatkowski, Rodgers, and Nagata have previously examined appearance- and performance-enhancing substance use.

For clinicians, educators, and public health practitioners, the study suggests that screening for appearance-related pressures, especially from peer groups, and for internalized muscularity ideals may help identify boys and men at greater risk of intending to initiate steroid use. Because the sample comprised never-users, the findings speak specifically to the pre-initiation window, when prevention efforts have the greatest potential to intervene before first use occurs.

Subject of Research: Associations between sociocultural pressures, appearance ideal internalization, and intentions to use anabolic-androgenic steroids among boys and men who have never used them.

Article Title: Sociocultural pressures and appearance ideal internalization are associated with intentions to use anabolic-androgenic steroids among boys and men

Article References: Ganson, K. T., Testa, A., Piatkowski, T., Rodgers, R. F., & Nagata, J. M. (2026). Sociocultural pressures and appearance ideal internalization are associated with intentions to use anabolic-androgenic steroids among boys and men. Harm Reduction Journal. https://doi.org/10.1186/s12954-026-01563-2

Image Credits: AI Generated

DOI: 10.1186/s12954-026-01563-2

Keywords: anabolic-androgenic steroids, appearance ideal internalization, muscular ideal, peer pressure, sociocultural pressures, body image, boys and men, Harm Reduction Journal, prevention, cross-sectional study, muscularity-oriented behaviors, steroid use intentions