Gender conformity linked to use of laxatives, muscle-building products by young

Last Updated: 2016-07-14

By Will Boggs MD

NEW YORK (Reuters Health) - Highly gender-conforming adolescents and young adults are more likely than others to use laxatives and muscle-building products, according to findings from the Growing Up Today Study (GUTS).

"We were surprised that conforming to social norms around femininity among girls had a strong link to laxative abuse, and that conforming to social norms around masculinity among boys had a strong link to muscle-building product use, and that these links held for youth of all sexual orientations," Dr. Jerel P. Calzo, of Boston Children's Hospital, told Reuters Health by email.

These gender differences -- females using laxatives, males using muscle-building products -- are not new, but emerging epidemiologic data suggest there may be disparities by sexual orientation identity, too.

Dr. Calzo's team used questionnaire data from GUTS to examine the associations between childhood gender conformity and laxative use and muscle-building product use among heterosexual and sexual minority (gay, lesbian, bisexual, mostly heterosexual) males and females ranging in age from 13 to 25 years.

While laxative use increased with age among females (15-fold between ages 13-15 and 23-25), males reported virtually no laxative use, according to the July 14 Pediatrics online report.

In contrast, fewer than 1% of females used muscle-building products at each age period, while 12% of young adult men reported using muscle-building products, a greater than three-fold increase since age 13-15.

Sexual minority females were more than twice as likely as heterosexual females to use laxatives for weight loss, and females in the top quartile of conformity had 50% greater odds of using laxatives relative to females who were the least conforming.

Among males, there was no sexual orientation difference in muscle-building product use, but males who were more gender conforming were up to 109% more likely than the least gender conforming males to use muscle-building products.

"Often in research on health disparities around gender and sexual orientation, gender nonconformity -- that is, defying or not fitting with social norms around gender -- is considered a risk factor for negative health outcomes because often times gender nonconforming people are victimized, bullied, or stigmatized for not fitting in," Dr. Calzo said. "What this study demonstrated is that oppressive gender role norms concerning appearance may be linked with harmful outcomes for all youth."

"Laxatives are not medically approved for weight loss, and yet they can be purchased easily over the counter and can be marketed for purposes that lead to misuse and abuse (e.g., 'cleanses')," Dr. Calzo explained. "Laxative abuse can lead to serious consequences, including dependence and organ damage. Likewise, muscle-building products are notoriously under-regulated and can include dangerous amounts of pharmaceutical ingredients or analogues of banned substances. Laxative use and muscle-building product use can be dangerous, and it is important for health providers to spell out those potential dangers up front."

"To maximize the opportunity for prevention and early intervention, clinicians should begin conversations about the dangers of laxative use and muscle-building product use early because product use increases with age," he said.

Dr. Francisco J. Sanchez, of the University of Missouri, Columbia, told Reuters Health by email, "For children whose sense of self depends on their physical appearance and/or athletic prowess, it only seems reasonable to suspect that they are aware of these substances and have considered using them. If anything, we need to be supportive and open to discussing these struggles with them; and we need to ask what they have heard about these products and how often (and not 'if') they have tried them to potentially open a dialogue with them."

"At some point, I think that the manufacturers of these unregulated products are going to need to assume greater accountability for their products," he said. "It's one thing for fully developed adults to opt to take these products -- many which contain unknown, 'proprietary' ingredients. It's another thing for developing children to take these supplements. What long-term physical and neurological consequences may there be from using creatine, unknown stimulants, and other muscle-gaining products from a very young age?"

The National Institutes of Health funded the Growing Up Today Study. The authors made no disclosures.

SOURCE: http://bit.ly/2acD4II

Pediatrics 2016.