From The New York Times: “Almost a third of boys are trying to gain weight or bulk up,” said Dr. Jason Nagata, an assistant professor of pediatrics at the University of California, San Francisco. 

In a recent study published online on May 18 in the journal JAMA Pediatrics, Dr. Nagata and colleagues found that young men who took creatine and other similar supplements were three times more likely than nonusers to be using anabolic steroids seven years later. “Some of these performance enhancing substances, which may be legal, can serve as sort of gateway drugs to steroid use,” he said.

Dr. Nagata, whose clinical practice focuses on adolescent eating disorders, has also found that male college students who used supplements were more likely to have disordered eating behaviors and attitudes, including restricting their diets and exercising compulsively.

Eating disorders in general are generally underrecognized in males, he said, which can lead to delays in diagnosis.

Dr. Nagata also cautioned that weight lifting and exercise can evolve into an obsession with being hypermuscular. “There’s something called muscle dysmorphia, which is commonly known as reverse anorexia or ‘bigorexia,’” he said. Regardless of how the person actually looks, he said, “they feel like they are insufficiently muscular.”