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His patients also try to persuade him to give them the good stuff. "I've had one person practically shake me, begging me, 'Please, I'm HIV-negative, please, start me on a cycle, you have to.' I can quote him, I think it went, 'I just want to be bigger.' Needless to say, he never got them out of me."
This desperation is hardly surprising, Canas says, given the importance of body image on the Beach. "Of course, steroids are used illegally everywhere, but this city is warm and beachy, and everybody's so body-conscious. This is something they might not be doing much out in Iowa."
Ironically, it is the very effectiveness of steroids in countering the wasting that has made AIDS seem not quite so bad to the younger generation of gay men. "They see guys not only living with AIDS but looking better than ever, and better than the HIV-negative guys," Canas says. "It sort of glamorizes HIV to those who haven't seen the ravages of AIDS, who haven't lost someone. Younger people are easily misled. They think, 'Well, it's not so bad. They have that cocktail [of AIDS drugs], don't they? And now I can do a cycle!'
"It does glamorize the illness, but it's complex, because people who have AIDS really do need the steroids, and I wouldn't take it away from them."
Yes, they're illegal without a prescription. Yes, they're bad for you. But the debate over steroid use in the gay community stretches far beyond the medical.
Roberto Olivardia, a sociologist and a colleague of McLean's Harrison Pope, recently studied gay male steroid users. He says he was unaware that such a subculture-within-a-subculture existed until a couple of years ago. Previously he and Pope had studied mostly steroid use in straight men, which has also been increasing. The anecdotal evidence from the gay users he surveyed last year completely blindsided him.
Earlier studies showed that, on the whole, the "ideal" physique among gay men tended to be rather slender, Olivardia says. "When I told that to the men in this study, they all said basically the same thing, like a broken record: 'That was the Eighties, this is the Nineties.'" With the arrival of the AIDS virus and its horrors, lithe androgyny was the last look these gay men wanted.
The impulse to bulk up coincided with increased knowledge about steroids. Although the drag queen persists as a stereotypical gay role, the "size queen" -- more often than not augmented by steroids -- appears far more prevalent today in mainstream gay society.
And not everyone within that society is happy about it. In his book Life Outside -- The Signorile Report on Gay Men: Sex, Drugs, Muscles, and the Passages of Life, Michelangelo Signorile, a New York City-based columnist for Out magazine, delivered a scathing critique of the role of steroids in gay culture. Signorile, perhaps best known for "outing" closeted gay public figures, posits in this book that steroid use represents an obsession with physical appearance that bodes ill for gay culture.
"I think it's had a really damaging effect," Signorile says in a phone interview from his home. "The body ideal has become narrower and narrower. And the ideal to which men must conform is drug-enhanced. In the Seventies and Eighties, you had more of a range of looks. Now it's chiseled, steroid-enhanced, smooth and hairless, tanned, the California/Miami look. It's very difficult for the vast majority of gay men to meet, but many want to try to fit it."
Olivardia and Pope are writing a book about body dysmorphic disorder in men, a syndrome in which people form a skewed perception of their bodies based in part on the "ideal" images they see every day. What can happen, Olivardia says, is a kind of reverse anorexia: Men think they need to keep getting bigger. "Women see all these thin, waif models, and they think, 'Thin is in,'" he explains. "With men in advertising, companies have realized that muscle sells. Male models are increasingly muscular. A lot of these images we're seeing are steroid-induced, but the lay person doesn't necessarily know that. They think, 'Wow, he got that way through hard work, and if I do that, I'm going to look like that.'"
In Life Outside Signorile repeatedly condemns the Circuit Party, a handful of bashes held in cities around the United States and Canada as benefits for AIDS charities. Despite their noble mission, these parties have developed a reputation for libertine behavior among their guests. (Miami Beach has the Winter Party and the White Party.)
DiBiaso knows all about Signorile. He talks about the author as one would a blood enemy. "Michelangelo Signorile has an agenda he's trying to pursue, which is that we should all try to be more straightlike, and integrate ourselves into the community at large, as opposed to celebrating the differences that make us all quite interesting," DiBiaso says in measured tones. "It's assimilation versus individuality."
DiBiaso also hammers Signorile's condemnation of Circuit Parties. "He perceives that scene as all these out-of-control boys who just go from party to party to party to party to party," DiBiaso says. "My contention is that these are responsible men who have substantial-enough jobs and incomes that they can afford to attend these parties."