Starting the ethical debate about performance and image enhancing drug use in Flanders (Belgium)

INDHR commentary

By An De Kock

According to recent reports from the Belgian Multidisciplinary Hormone Cell, anabolic androgenic steroids (AAS) are the most commonly used doping products (Hormonencel, 2010, 2011). To tackle the issue, the Flemish government undertakes targeted controls in fitness centers and has started an information campaign (Vlaamse overheid, 2012). However, in order to develop a sound prevention program, it is important to know why people take cuch products and to what lifestyles and subcultures this behavior is connected. Nevertheless, research in Flanders about recreational performance and image enhancing drug use        (PIED-use) in fitness centers is rare, which was the reason why I wanted to explore this issue.

In 2012, Alenteyns and I wrote our thesis about anabolic androgenic steroid use (AAS-use) by recreational fitness participants (De Kock & Alenteyns, 2012). Our preliminary research project existed of six in-depth interviews with (ex-) AAS-users. An important question we asked was which ethical problems are related to AAS-use. For this we made use of the research model developed by Tolleneer & Schotsmans (2012) (see figure 1). Starting from the simple question ‘precisely who or what is at stake?’ this model identifies five levels on which doping can be interpreted as being (un)ethical: the self, the other, the play (the sport), the display (spectator sport), and the humanity. For all five levels, one can identify arguments for and against enhancement. The results of our interviews were used to adapt the five level model of Tolleneer & Schotsmans (2012) to the specific culture of image-enhancing drug use. Of course these interviews are just a starting point and due to the small sample our conclusions are not representative for the whole Flemish recreational fitness population. However it was our goal to perform an exploratory study about PIED-use in Flanders in order to start the ethical debate.

Figure 1: Five level model for the analysis of ethical arguments in the debate about performance enhancing drugs (Tolleneer & Schotsmans, 2012)

Athletic enhancement?


Because it e.g.:

What is at stake?

Athletic enhancement?


Because it e.g.:


my health

1. The self

Helps in fulfilling

my aspirations

Reduces the

opponent’s chances

2. The other


equal chances


the spirit of sport

3. Play   

Aligns sport with other

cultural phenomena


negative role models


4. Display
    (Spectator sport)

Reinforces sport’s

heroic character


human nature


5. Humanity

(human nature)

Fulfills the mission

to push back frontiers


Looking at level one ‘the self’, one could argue against PIED- use because of its negative side-effects. According to our interviews all the subjects had experienced common side-effects like acne or shrinking testicle while using AAS. However they looked at those side-effects as a necessary tradeoff they had to make. On the other hand one could use the autonomy argument to justify PIED-use: people have the right to decide for themselves if they want to use those products. Some of our interviewees referred to the fact that one can also decide if he/she wants to eat unhealthy food and live a sedentary life, which is not healthy either. However, the use of PIEDs is forbidden by Belgian law, while eating and living unhealthy is a legal choice one can make. At the second level of the five level model we look at positive and negative consequences for ‘the other’. A possible side-effect of AAS is becoming aggressive which was experienced by two interviewees. This means there is a potential danger for others when someone has taken AAS.  This argument could be in favor of those people who are against PIED-use. However, most of our interviewees were sceptical about the so-called “roid rages” and did not experience any aggressive behavior at all. Dealing with fair play, the third level needs our special attention since recreational fitness is different from competitive and high-level performance. According to authors like Christiansen & Bojsen-Møller (2012) the fairness argument is not applicable in a recreational fitness context. Our interviewees also made clear they only use PIEDs for themselves and not to win a sport competition. At level four one could say muscular fitness participants who use PIEDs function as negative role models for others at the gym. Our interviewees stated they did not advise people to use AAS. Only when they have the impression that those people are going to use it anyway they provide them with information to ensure they do it in a responsible manner. The fifth level of the model is the most fundamental level. People against image-enhancement argue PIED-use is a desecration of human nature which means it is unnatural to push back frontiers with artificial methods. Opponents however use the argument PIED-use provides unique opportunities to improve humanity.

The above mentioned ethical arguments for and against PIED-use by recreational fitness participants indicate that we cannot address this issue the same way as we do with competitive athletes. The main reason to substantiate this is the fact it is mainly a health issue. After all the motivation to use AAS is image-enhancement, while performance-enhancement is a positive side-effect and the majority of our interviewees did not engage in competitive sports. However, in Flanders fitness participants who look suspicious (read: very muscular) can be controlled and sanctioned by the doping controller. For example in 2012 there were 105 doping controls a year in fitness centers (Dopinglijn, 2012). It is doubtful that this is the right method to prevent PIED-use by fitness participants. First of all we can dispute the effectiveness of those controls to scare off fitness participants to use PIEDs. According to our subjects the controls would not stop them from taking AAS. Secondly, it seems unethical to humiliate people by having a pee when someone is watching them. Thirdly, some of those PIED-users will take AAS anyway, even if they have to pay a penalty after a positive control. Maybe in this case harm reduction is a better approach to deal with the issue. This means the government provides trustful information about PIEDs and channels which help people who are confronted with side-effects. Another important focus should be fighting the trade of PIEDs and the suppliers. However due to the internet, this is a very difficult operation which needs a cooperation between different countries. One thing is for sure: whatever the age, the background and the context of the users, their aim is not, or not primarily, performance-enhancement, but rather physical appearance-enhancement and boosting confidence. That is why the World Anti-Doping Agency’s (WADA) efforts to undertake doping controls, to find detection methods and to carry out prevention programs cannot simply be transferred from competitive sports to the world of recreational fitness use.


Bojsen-Møller J; Christiansen AV, 2010, Use of performance- and image-enhancing substances among recreational athletes: a quantitative analysis of inquiries submitted to the
Danish anti-doping authorities, Scandinavian journal of medicine & science in sports, 20:861-867.

De Kock A; Alenteyns M, 2012, Masterthesis physical education and kinesiology KU Leuven Fitness, doping en ethiek: literatuurstudie en diepte-interviews, 1-98.

Dopinglijn, 2012, Jaartotaal detail weergave.

Multidisciplinaire Hormonencel, 2010, Jaarverslag, (online versie van december 2012;

Multidisciplinaire Hormonencel, 2011, Jaarverslag Geïntegreerde politie, 1-38.

Tolleneer J; Schotsmans P, 2012, Self, other, play, display and humanity : development of a five-level model for the analysis of ethical arguments in the athletic enhancement debate, in 
Tolleneer J; Bonte P; Sterckx S (eds), Athletic enhancement, human nature and ethics. Threats and opportunities of doping technologies, Springer Science, 21-43.

Vlaamse Overheid, 2012, Conceptnota actieplan gezond sporten, 1-29.