000 MD musculardevelopment.com March 2019
[BUSTED!]LEGAL Q&A BY RICK COLLINS, Esq.
A
If “bigorexia” is a
mental illness, why do
we treat steroid users
like criminals?Q
Rick Collins, JD, CSCS [www.rickcollins.com] is the
lawyer that members of the bodybuilding community
and nutritional supplement industry turn to when
they need legal help or representation. [© Rick
Collins, 2018. All rights reserved. For informational
purposes only, not to be construed as legal or
medical advice.]Testosterone, Non-Binary
Identity and Bigorexia
Some men with legitimate hypogonadism (low T) who would
have been good candidates for TRT will likely never seek
treatment due to unwarranted fears.There are various names for this
subcategory of body dysmorphic
disorder (BDD): muscle dysmorphia,
“the Adonis Complex,” and, yes,
bigorexia.^1 The criteria for BDD include, “preoc-
cupation with one or more perceived defects or
fl aws in appearance that are not observable or
appear slight to others.” In muscle dysmorphia,
the perceived defect is inadequate muscular-
ity — thinking you’re puny no matt er how jacked
you get. The American Psychiatric Association
recognizes the disorder in its current Diagnostic
and Statistical Manual of Mental Disorders
(DSM-5, 2013).^2 Studies suggest prevalence
anywhere from 1 percent to 54 percent of the
male population. Among steroid users, one
study reported that muscle dysmorphia pre-
ceded steroid use in 73 percent of participants.^3
Your question raises an interesting
comparison I’ve been mulling over since
reading an essay about non-binary persons in
the LGBTQ community.^4 The essay describes
the personal benefi ts of physician-prescribed,
low-dose testosterone (T) therapy to someone
born female and not seeking a full gender
transition: “I’m non-binary, and I’m not
interested in presenting to the world as a ‘man’
based on whatever antiquated physical criteria
that might invite that assumption. When I took
the small amount of T that I did, the resulting
physical changes were subtle. Over the course
of months, my body fat redistributed, my
shoulders broadened, and my face changed
from soft to harder as my jawline squared off.
The starkest change was feeling much more at
home within my body.” The T is prescribed to
bring the non-binary person’s body into closer
alignment with how they see themselves.
Everyone should have the right to feel at home
in their own body.
Testosterone, an anabolic steroid and a
federal Schedule III controlled substance, can
including testosterone, to build bigger muscles
in a healthy person (i.e., non-medically) is
subject to a loss of license, criminal arrest,
felony prosecution, and imprisonment. If many
or even most steroid users have the disorder,
even if we don’t treat them with T, should we
really be putt ing them in jail?
I am in no way saying that greater
restrictions should be placed on non-binary
persons seeking testosterone. On the contrary,
I fully support people having the freedom to
live the lives they want to live in the bodies
that make them most comfortable. Frankly,
I’m not so sure either of these situations
should be classifi ed as mental disorders in
many circumstances. In the case of muscle
dysmorphia, who cares if the lack of muscle
appears “slight to others” if it bothers the
person himself? Isn’t the entire fi eld of cosmetic
surgery premised on the idea that it’s my own
comfort with my face or body that matt ers?
I don’t mean to trivialize the mental and
social seriousness of gender dysphoria. But it’s
time to make the important point that in one
situation we permit T therapy to achieve the
desired physical change and in the other we
arrest the person and threaten imprisonment.
While we may never see steroids allowed for
cosmetic purposes under principles of medical
ethics, isn’t the diff erence in treatment just too
great to bear? In Canada, for example, simple
unlawful possession of T or other anabolic
steroids is not a criminal off ense. Shouldn’t
the criminal implications of the placement of
testosterone within the U.S. War on Drugs—
especially for men with bigorexia— be worthy
at least of reevaluation in light of this disparity?References:- htt ps://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4977020/ - htt ps://mghocd.org/dsm-5/
- htt ps://www.sciencedirect.com/science/article/
pii/S2211266917300439#bib0145 - htt ps://www.vice.com/en_in/article/xwnzjz/
microdosing-testosterone-hormones-non-binary-
transition
120 MD musculardevelopment.com July 2019
only be lawfully prescribed for a legitimate
medical purpose. The DSM-5 classifi es
gender dysphoria— the distress a person
experiences as a result of the sex and gender
they were assigned at birth— as a mental
disorder. The disorder diagnosis is what
legally allows a T prescription for a non-
binary person. In eff ect, T is permissible to
help bridge the gap between the person’s
natural body and their self-image.For a person with muscle dysmorphia, the
situation is very diff erent. T is not a treatment
option. Now, I’m not suggesting that desiring
bigger muscles is nearly equivalent to gender
dysphoria. I also recognize that the T doses for
bodybuilding present greater health risks than
microdosing. But the diff erence in available
treatment options isn’t the point. The point is
that while the person with gender dysphoria
gets treated with testosterone, the person
with muscle dysmorphia gets treated to a
pair of handcuff s ... and so does his doctor. A
physician who prescribes any anabolic steroid,