The Role of Social Media Influencers in the Online Steroid Market

Estimated reading time: 11 minutes

Introduction

In the research paper “Across the spectrum of legality: The market activities of influencers specialized in steroids and other performance and image enhancing drugs,” Letizia Paoli and Luke Thomas Joseph Cox explore the controversial realm of social media influencers who promote performance and image enhancing drugs (PIEDs), specifically androgenic anabolic steroids (AAS). These substances are increasingly discussed and promoted by influencers, but the specifics of their promotional activities and the associated legal implications have remained largely uncharted.

The study set out to identify key influencers in the PIED space, scrutinize their market behaviors, and evaluate the legality of their actions. Over a six-month period, the researchers carefully analyzed the social media accounts of 20 influencers, providing a comprehensive look at the complex world of online PIED promotion.

Social Media Influencers and Performance and Image Enhancing Drugs

Influencers are often seen as credible and authentic sources of information. They achieve niche celebrity status, and some become brands themselves. Followers often form emotional attachments to influencers, enhancing their influence.

Steroid users are particularly susceptible to influencers’ messages, often distrusting the medical community and relying on ‘bro science’. While this knowledge can be a powerful harm reduction tool, it also makes users vulnerable to misinformation.

Few studies have focused on PIED influencers. Previous research has noted that influencers encourage PIED use, but detailed analyses are rare. Notable studies have examined the quality of YouTube videos on SARMs and the activities of ‘sponsored athletes’ and ‘anabolics coaches,’ who primarily operate offline and have limited followings.

The study by Paoli and Cox seeks to address this gap by focusing on three key objectives:

1. Identifying prominent influencers who specialize in PIEDs and steroids,
2. Exploring their market activities on social media, and
3. Assessing the legality of these activities.

Identifying the Most Prominent Anabolic Social Media Influencers

Paoli and Cox began by identifying 25 prominent influencers through extensive searches on popular social media platforms: Facebook, Instagram, TikTok, Twitter, and YouTube. These platforms were selected for their vast reach and influential role in image and video sharing. In addition, they added one small Dutch influencer at the request of anti-doping authorities for an initial pool of 26 influencers. After all, Doping Authority Netherlands (DAN) was funding the study and used their influence accordingly.

Aside from the single DAN-selected influencer, the researchers used keywords related to steroids and PIEDs to tap into the sophisticated algorithms of these platforms—a process known as “algorithmic sampling”—and uncover relevant accounts. Cox’s background as a regular gym user, former personal trainer, and PIED researcher added valuable cultural insight, enhancing the effectiveness of the search. YouTube, in particular, proved to be a significant resource.

From this pool, 20 influencers were selected for detailed analysis. Over six months, from July to December 2021, they observed the influencers’ public accounts on Facebook, Instagram, TikTok, and YouTube, and gathered data from other public communication channels, such as personal websites, e-books, and Wikipedia when they were available. This data formed the basis for content analyses.

The final step was assessing the legality of these activities using European Union (EU) legislation as a benchmark. The primary reference was Directive 2001/83/EC on the Community code relating to medicinal products for human use, which governs the sale and advertisement of medical products across the EU. For food supplements, Directive 2002/46/EC was also consulted. Occasionally, the researchers referred to the laws of other countries when necessary. It should be noted that the assessment remained theoretical, as no PIED influencer had been charged with violations to the best of their knowledge.

What Researchers Learned About PIED Influencers

Paoli and Cox uncovered a landscape dominated by current or former bodybuilders, predominantly male and based in the United States.

Who are the PIED influencers?

The 26 influencers selected for this study are all current or former bodybuilders and fitness enthusiasts. Their impressive physiques lend them power and credibility, attracting a significant following. Similar to offline ‘steroid mentors’ and ‘anabolics coaches’, these influencers combine their bodily capital with extensive knowledge of training, diet, and PIEDs protocols to offer online coaching. Their target audience includes less informed or aspiring bodybuilders and recreational gym trainers concerned with their body image, muscularity, and strength.

Reflecting the gender imbalance in bodybuilding, most influencers in the sample are male, with only six being women. Notably, four of the influencers are deceased, yet their online personas remain active, managed by others, indicating that they have become brands in their own right. For example, Zyzz, a well-known PIED influencer, continues to have an active online presence maintained by his brother, friends, and fans.

Where do PIED Influencers live?

Over half of the influencers (14 out of 26) are based in the United States, with three U.S.-born influencers working from Thailand. The third most prominent influencer is Canadian, indicating a predominance of North American influencers. This trend likely reflects the cultural embeddedness of bodybuilding in North America, the U.S. origin of most social media platforms, and the dominance of English as a global lingua franca. However, the influencer with the largest following is from Germany, and other influencers hail from the UK, Netherlands, and Russia.

The table below summarizes the influencers’ geographic distribution and social media presence:

Regardless of nationality, 24 out of the 26 influencers provide content exclusively in English, targeting a global audience. Only the two Dutch influencers offer content in Dutch.

Which social media platforms do PIED influencers use?

These influencers are active across multiple social media platforms, with some variations in usage. Almost all are present on Instagram, with the exception of two. All but three post content on YouTube. Additionally, 18 have Facebook accounts, 12 use Twitter, and eight are active on TikTok.

Beyond social media, many influencers utilize other communication methods to amplify their messages. Sixteen direct followers to their personal websites, which vary in sophistication. Eight use Linktree accounts to house all their social media links and websites. Two offer personal podcasts, and seven share or sell their e-books.

How many followers do PIED influencers have?

Several influencers boast substantial followings. According to Harrigan et al.’s typology:

• Macro-influencers: Three influencers have over one million followers/subscribers on Instagram or Facebook.
• Meso-influencers: Twenty-one influencers have between 10,000 and one million followers. Among these, three have more than 500,000 followers, and another three have more than 250,000 followers.
• Micro-influencers: Two influencers have less than 10,000 followers.

As a group, their reach is much wider than that of ‘local’ influencers examined in previous studies, indicating their significant influence within the PIED and bodybuilding communities.

The Varied and Often Ambiguous Legal Terrain of PIED Influencers

Social media influencers who promote AAS and PIEDs engage in a range of market activities that stretch across the entire spectrum of legality. From selling training plans to advertising steroids, their actions raise significant legal questions. The blurred lines between coaching, advertising, and selling often obscures the legality of their actions.

Legal Market Activities: Training and Diet Plans

Among the most common activities, 18 of the 20 selected influencers sell training and diet plans. These offerings, found on personal websites or social media bios, are often tailored to the customer’s needs after an initial consultation. However, despite their popularity, none of these influencers hold the necessary legal qualifications to be recognized as dietitians or trainers.

Market Activities with Uncertain Legal Status

The legal status of several other market activities performed by PIED influencers is murky, contingent on various factors:

1. Advertisement and Sale of Nutritional Supplements

Every influencer in the study engages in advertising and selling nutritional supplements. Some own or co-own supplement companies, while others promote third-party products. The rapid growth of the global supplement market complicates the legal assessment of these activities. Regulations vary widely, even within the EU. Various directives apply, including those on dietary supplements and medicinal products, restricting the advertisement and sale of certain substances. Many supplements sold online contain undeclared or harmful substances, making their promotion potentially illegal.

2. Advertisement and Sale of Blood Testing and Analyses

Eight influencers promote companies offering blood testing services for PIED users and charge fees to analyze the results. The influencers lack medical training, raising concerns about the accuracy and safety of their advice. The legality of these practices is particularly questionable concerning the authorization of blood testing labs and the handling of personal health data, which is tightly regulated under the EU General Data Protection Regulation (GDPR).

3. Sale of Customized AAS Protocols

Five U.S.-based meso-influencers sell customized AAS protocols. These protocols, which detail drug usage, dosages, and schedules, aim to optimize steroid use but do not include access to the steroids themselves. However, promoting these protocols can be seen as advertising medicinal products, which is regulated by EU directives that prohibit the advertisement of prescription-only medicines and unauthorized medicines to the public.

4. Advertisement of Testosterone Replacement Therapy (TRT) and Clinics

Three influencers promote TRT and refer followers to specialized TRT clinics, primarily in the U.S., that provide controlled access to testosterone and other PIEDs under medical supervision. While TRT is medically appropriate for certain conditions, promoting clinics willing to broadly prescribe steroids raises legal and ethical issues. The compliance of these clinics with legal requirements remains unclear.

5. Promotion of SARMs

Six meso-influencers promote Selective Androgen Receptor Modulators (SARMs), often providing personalized discount codes. While SARMs are generally unregulated and sold as research chemicals, their promotion for human consumption can lead to legal issues, particularly under EU directives prohibiting the advertisement of unauthorized medicines. The sale and use of SARMs become illegal if sold as nutritional supplements or containing unapproved drugs.

Illegal Market Activities: Advertising Steroids and Other PIEDs

A smaller group of influencers engages in clearly illegal activities by advertising various PIEDs, including steroids, human growth hormone, and drugs meant to treat the side effects of steroid use. These influencers often act as middlemen, profiting from sales through referral and discount codes. The websites they endorse typically lack authorization as online pharmacies and often sell prescription-only drugs without the required prescriptions. The promotion of these substances is prohibited under EU directives.

The Influencers’ Business Models

The study revealed diverse business models among influencers, reflecting varying degrees of compliance with regulatory standards. Macro-influencers generally avoid illegal activities, except for promoting nutritional supplements and, in one case, blood testing. Similarly, most female influencers and some from the UK and Netherlands largely steer clear of illegal actions, though they may engage in questionable practices like selling AAS protocols or interpreting blood analyses. In contrast, U.S.-based male meso-influencers frequently engage in activities ranging from legal to fully illegal, with some exhibiting particularly risky business models.

A Complex Legal Landscape

Influencers specialized in PIEDs navigate a wide range of market activities, some legal, others clearly illegal, and many falling into a gray area. The legality of these activities often depends on specific details such as the content of the products, the providers of services, the jurisdictions involved, and how the products are presented and recommended.

This diverse range of activities highlights the complex and often ambiguous legal landscape surrounding PIEDs. It underscores the need for nuanced and case-by-case and country-by-country legal assessments.

Policy Recommendations and Public Health Implications

Paoli and Cox emphasize the urgent need for multifaceted policy interventions to prevent influencers from becoming major sources of PIED information and access. Their recommendations include:

• Law Enforcement: Targeting the most problematic influencers and companies selling illegal PIEDs to ensure regulatory compliance.
• Public Health Campaigns: Providing accurate information to counteract influencers’ narratives about PIEDs.
• Partnerships with Responsible Influencers: Leveraging credible influencers to promote harm reduction and safer consumption practices.
• Regulatory Reforms: Considering the legalization of certain enhancement products under strict medical supervision to reduce the black market for PIEDs and associated harms.

Bridging Gaps and Proposing Reforms

The researchers stress the importance of bridging the gap between the medical and bodybuilding communities. Encouraging open discussions about PIED use can foster safer consumption patterns. Initiatives like the “Anabolic clinic” in a Dutch public hospital and Peter Bond’s Android Health Clinic, where physicians work closely with influencers, could serve as effective models.

Moreover, Paoli and Cox advocate for regulatory reforms, such as allowing physicians to prescribe higher doses of testosterone and other enhancement products for image-enhancing or anti-aging purposes. They also suggest considering the over-the-counter distribution of certain enhancement drugs. While these reforms might not eradicate the black market for PIEDs, they could diminish the influence of irresponsible influencers and the prevalence of illegal purchases, ultimately promoting public health.

References

Paoli, L., & Joseph Cox, L. T. (2024). Across the spectrum of legality: The market activities of influencers specialized in steroids and other performance and image enhancing drugs. International Journal of Drug Policy, 123, 104246. https://doi.org/10.1016/j.drugpo.2023.104246