James Smith is a supremely fit personal trainer, but struggled with body issues throughout his 20s.
"I was going through a phase of my life where training became the most important thing to me," he says.
"My job was incredibly average and my relationships were incredibly average … the one thing I could focus on was training in the gym."
But no matter how hard he trained, he started to plateau before reaching his "physique goals".
'I only planned to do one cycle'
James turned to steroids.
"Why would I train a year for something when I can do it in three months?" he told himself.
"I only planned to do one cycle," he says, "then I recovered and thought … one more, then the third time.
"All of the physiques that I'd been aspiring to started to look like the physique that I was obtaining through taking steroids."
And he wasn't the only one to notice the difference.
"There aren't many drug use and abuse issues where you get complimented or rewarded for addiction," he said.
Men struggle with body image issues too
In Australia, the number of men experiencing body dissatisfaction has risen from 15 to 45 per cent over the past 25 years.
Studies show that up to one in four people experiencing eating disorders such as anorexia nervosa or bulimia are male, and almost half of the people experiencing binge eating disorders are male.
Muscle dysmorphia is another eating disorder that is on the rise among men.
Scott Griffiths is a senior research fellow at the University of Melbourne's School of Psychological Sciences and an expert in body image, eating disorders, muscle dysmorphia and anabolic steroid use.
"I think of it like reverse anorexia," Dr Griffiths says when describing muscle dysmorphia, and most sufferers are boys and men.
"The body type they're trying to achieve is lean and muscular," he continues, describing big biceps and a six-pack.
"They are often objectively large and muscular, but if you asked them how they feel about themselves, they would say 'too skinny' or 'overweight' – there's a gulf between what they are and how they see themselves."
There are other body image concerns among men too, like baldness, penis size and even height.
"There are leg lengthening surgeries that very few men will try to have done, but more common are things like shoes that have lifts concealed in them," he says.
The factors that contribute to eating disorders are remarkably similar between men and women, but the end result is often where it differs.
Hereditary factors, Dr Griffith explains, include having parents who struggled with issues like compulsive exercising.
Character and personality should also be taken into account, he adds.
For example, a perfectionist might apply that mentality to their body and training, and "believe they're not living up to that perfect, ideal body."
Finally, there are social and environmental considerations.
"If you were bullied as a child for being overweight, or were late to puberty and teased because of your size, you can be prone to ruminating on your appearance," Dr Griffiths says.
'My face was holding water'
A bad reaction to a steroid cycle is what turned James off the drug.
"My face was holding water, I would get very red if I went in the sun for more than minute – but I wasn't burnt," he explains.
It turns out that it was his blood pressure.
"I didn't sleep good or feel good," he adds.
He was also concerned about the side effects of steroid use.
"If I had had to have heart bypass before I was 60, would it be worth it?" he asked himself.
"If I couldn't have kids when I was older, how would I feel – would it have been worth it?"
In the pursuit of the perfect body, Australian men – like James – are turning to dangerous and illegal supplements.
The latest research from Dr Griffiths shows that steroids accounted for two per cent of all injection drug users in 2010 – and rose to seven per cent in 2014.
"Steroids work as intended," Dr Griffiths says.
"So if you're very insecure about the way you look, and there's a substance out there that works well, there's a temptation to use it."
When people are on steroids, they can feel better for a time because "you'll be likely to build muscle" and "you get the progress that was frustrating you before".
Once people come off steroids, all the gains will be lost and "that will be extremely stressful" for many.
"The weight you can lift will go down, reps will go down, weight loss will occur," Dr Griffiths explains.
"The spectre of steroids stays because you can make all of that go away by taking steroids again."
Around one-third of steroid users become psychologically dependent on it, according to the latest research by Dr Griffiths.
The immediate side effects of steroid use can include loss of hair, severe acne, gynecomastia (also referred to as 'man boobs') and hypogonadism (the shrinking of testicles).
Long-term use can result in impaired cardiovascular function.
"There's evidence that the heart becomes enlarged – and enlarged hearts are weaker and pump less efficiently," Dr Griffiths explains.
Related to hypogonadism, high doses of testosterone – like those that come from using anabolic steroids – can impair natural testosterone production.
"When you flood the body with that much testosterone from outside, the ability for the body to bounce back and resume making testosterone naturally can be reduced," Dr Griffiths says.
"This puts men at risk of infertility or being put on testosterone replacement therapy – it's a lifelong impediment."
Even professional athletes feel pressure to look a certain way
Australian boxer Harry Garside has won a bronze medal at the Olympics in 2020, and a gold medal at the Commonwealth Games two years before that.
But even at the peak of his boxing career, he wasn't happy with his physique.
When I won the Commonwealth Games in 2018, I still woke up the next day and felt quite unhappy," he says.
"I thought, maybe when I win the Olympic gold medal I'll feel happy."
Harry opened up about his struggles with self-criticism on The Drum.
"I think the reason why I've been so ambitious stemmed from a place of insecurity," he explains.
"I have thought that when I look a certain way, I will then be happy."
But he's learned over the years that achieving the desired physique – or any other goal – won't make him happy.
"No matter what you look like in the mirror – no matter the success, the money, the cars – if they're the things you're striving for, and if it comes from a place of insecurity and low self-worth, no matter when you get that, you'll feel the exact same," he says.
"I think it's so important to go from the inside out.
"It's how you feel about yourself, that's the most important thing."
How to develop a positive body image
Dr Griffiths says the first thing men can do if they're struggling with their body image, is to talk with someone.
But it's not that easy.
"Men who worry about how they look are often not talking in earnest about how they feel to many people," he explains.
Online forums for body builders and gym enthusiasts are typically filled with joking and light trolling.
"This is great for camaraderie, but not necessarily for unpacking why someone feels poorly about how they look, or feel the urge to look a certain way," he says.
Dr Griffiths recommends starting the conversation with an expert from a specialist organisation like the Butterfly Foundation.
"For a lot of guys, they've been training, dieting, and feeling poorly about how they look for so long, and it can be hard to see clearly how regimented their diet and exercise has been."
Harry says he's still a work in progress when it comes to having a healthy body image.
"I'm trying my best to build myself up with a lot more love and positivity," he says.
He wants to get to a point where "it doesn't really matter about the goals I achieve, or the things that I do in my life, or the way I look – as long as I feel good on the inside out."
"I think that's more important to any young person out there."
James also reflected on the impact that targeted social media can have on young men.
"If you stop and watch a video of one guy doing a chest workout on TikTok, the algorithm now knows your interest and is going to feed you more juiced up dudes doing chest workouts," he says.
"You're going to teach the algorithms exactly where your insecurities are, and they're going to prey on them."
Dr Griffiths agrees that social media has a great impact on people's body image – even greater than more traditional forms of media like magazines and the movies.
"Social media allows us to present idealised, filtered, curated versions of ourselves, and we can get instant, wide-ranging feedback on those images," he explains.
"It can make people quite sensitive and make their self-esteem contingent on others."
James' message to young men is: physique isn't everything.
"It's quite a wild bet to double down – to believe that everything that's important in your life is tied to how much muscle you have and how low your body percentage is," he says.
"Your relationship to your reflection is not the only thing that will build long-term happiness in you."
