"The use of APEDS was common among young males in the current study, and it was more related to the drive for muscularity and sexual orientation than symptoms of EDs. In a large national sample (N = 7401) of college and university students, including both sexes in the US (ages 18–30 years), the lifetime prevalence of the use of protein supplements and creatine was 23.8% and 7.7%, respectively [30]. The corresponding lifetime figures (Table 1) in our study of young males were 31.9% and 16.5%. Male sex was related to a greater likelihood of lifetime protein and creatin supplement use in the US study [30], which might partly explain larger prevalence figures in our study of young males. Focusing on male college students (18–26 years) from the top-10 National Collegiate Athletic Association Division I universities in the US, the rate of current use of appearance- or performance-enhancing supplements was 38.9% [31]. This is a highly selected sample in which athletic performance is assumably a top priority, and a very high current rate is expected. If “current rate” in our study is defined in terms of at least monthly use of these supplements, then it will amount to 23.1%. The anonymous nature of the study might increase the truthful report of use of such substances. It has been shown that computerized surveys leads to significantly more reporting of sensitive issues (e.g., socially undesirable behaviors) [32]. In a study on the role of anonymity and privacy in survey methodology, participants reported significantly higher mean comfort levels with anonymous surveys compared to non-anonymous [33]. Given the difficulties inherent in unknown representativity of Internet-based surveys, further replications using the same methodology are warranted to arrive at a robust estimate in use of appearance- and performance enhancing supplements among young males."


Ghaderi A, Welch E. Appearance and Performance-Enhancing Drugs and Supplements, Eating Disorders Symptoms, Drive for Muscularity, and Sexual Orientation in a Sample of Young Men. Nutrients. 2022 Nov 21;14(22):4920. doi: 10.3390/nu14224920. PMID: 36432606; PMCID: PMC9695459.