Size Matters

It's 9:30 a.m. on a recent Friday. Sunlight slants across Ocean Drive. Jason DiBiaso, his partner John, and another friend are shirtless and eating breakfast. Heaps of eggs, toast, bagels, and bacon will fuel Jason's and John's daily late-morning weightlifting session. All three men are, to use the vernacular, ripped -- bulging with musculature that would require a working knowledge of Latin for a full description.

John (a pseudonym), like a significant number of gay men living in Miami Beach, has a prescription for anabolic steroids. He injects testosterone regularly, and will do so every week for the rest of his life. For good reason. Some years ago he had surgery on his pituitary gland, a procedure that left his body unable to produce testosterone.

DiBiaso also uses anabolic steroids. He too has a prescription. But DiBiaso has no medically accepted reason for injecting his mix of Deca-Durabolin and testosterone cypionate. His reasons, by his own admission, are mostly aesthetic (though, as a model/actor, his sculpted physique has helped his career).

DiBiaso had been bulking up naturally, he says, ever since a gay-bashing experience a few years back in Coral Gables, in which two of his friends ended up hospitalized. "I felt I needed to be big enough to defend myself," he says. After a couple of years, the five-foot-eight DiBiaso went from 130 pounds to 155, then plateaued.

"At the same time, in the community -- not just the gay community but in Miami Beach as a whole -- steroids had become much more prevalent," DiBiaso continues. "In my social circle, at least half of my friends were using steroids. We're all vain gay men, so I figured what better way to keep yourself looking amazing? So, being the sheep that I am, I gave myself a cycle of steroids as my 40th birthday gift."

But that first batch of steroids, which DiBiaso brought back from Brazil, was a bust. All he ended up with was a sore posterior where he injected the stuff. He found another source, one who supplied a better product: an American doctor from out of town who has numerous HIV-positive patients to whom he regularly prescribes steroids. DiBiaso, who is HIV-negative, says this obliging doc has hooked him up with three "cycles" -- six- to twelve-week doses -- in the past year and a half.

DiBiaso, now up to a rock-solid 185, is ecstatic. "Steroids have transformed me," he gushes. "I'm astonished with the results. I've become a much more sought-after model."

In the Beach's gay male community, legal steroid use is widespread. The vast majority of users are HIV-positive. Doctors have prescribed steroids for AIDS patients throughout the Nineties to combat wasting syndrome, the debilitating, potentially deadly weight loss associated with advanced stages of the disease. Most HIV-positive men who are on steroids not only maintain their muscle mass, they are able -- with regular trips to the gym, of course -- to look healthier and more robust than when they were HIV-negative.

But recently, illegal steroid use among gay men has skyrocketed, transforming Miami Beach into a national epicenter for "cosmetic" steroid use. The drugs are no longer a matter of medical necessity but rather of attaining the perfect bod. While the steroid boom among gay men mirrors a similar pattern in the straight community, doctors fear that gay users are pumping up without heeding the potentially deadly side effects of heavy use. And gay pundits fret that the ascendancy of massive chiseled physiques is producing a drug-enhanced gay elite that disdains the less-sculpted citizens of the Queer Nation.

Steroids are cheating. Everything else that the average American knows about these drugs springs from that notion. Steroids make you bigger, stronger, faster. Get caught with traces of them in your urine and you will lose your Olympic medals. The word "steroids" even sees action as quickie metaphor. If you rerfer to something "on steroids," whether a car or a caterpillar, everybody knows you're talking about a jumbo version.

There are different kinds of steroids, though. Corticosteroids, for instance, are commonly used as anti-inflammatories. The most popular and notorious variety of steroid is anabolic, which works by enhancing the muscles' ability to grow and by suppressing their atrophy. Testosterone is a natural steroid. Flooding the body with this or its numerous synthetic cousins, in conjunction with strenuous exercise, allows users to build pounds of extra muscle in a matter of weeks.

While anabolic steroids do have limited medical applications -- in addition to treating HIV-related wasting, anabolics are sometimes used to treat certain kinds of anemia -- they are used mostly to bulk up. Not long ago these drugs were the dirty little secret of a relatively small group of hard-core weightlifters, bodybuilders, and other athletes. Steadily, though, they have become ever more widely available, almost always illegally.

In the 1993 National Household Survey on drug use, nearly one million people reported using the drugs. In 1996 a survey by the National Institute on Drug Abuse found that 1.9 percent of high school seniors reported using them.

Anabolic steroids are manufactured worldwide. Generally, the highest-quality brands are made domestically and in Europe and are available only by prescription. The active black market for steroids in the United States provides anything from prescription-quality drugs to veterinary preparations. "It is extremely easy to obtain steroids on the black market," remarks Dr. Harrison Pope, a researcher with the Community Epidemiology Workgroup at McLean Hospital in Boston.

Steroids of varying qualities are also legally available without a prescription throughout Central and South America. Pope, who has studied steroid use for nearly fifteen years, says that many users who can't obtain a prescription in the United States will either purchase steroids abroad and smuggle them back in or order them through the mail from foreign sources. Since the drugs are relatively cheap (a six- to twelve-week cycle runs from $300 to $600) and are legal in those countries, the postal option is low-risk.

Steroids are not a high priority for law enforcement. Seldom do agencies target anyone solely for dealing steroids. Lt. Michael Auch of the Miami Beach Police Department's narcotics division recalls only five steroid busts within the past two years.

When FBI and DEA agents arrested John A. Velasquez in May, possession of steroids with intent to distribute was among the less serious charges against the part owner of the Miami Beach restaurant Cafe Prima Pasta. The major ones concerned money laundering and conspiracy to sell Ecstasy (MDMA), which is a Schedule I drug under federal law. The Ecstasy-related charges against the restaurateur carry maximum penalties of twenty years in prison. Steroids are a Schedule III drug; maximum sentence for distribution is five years. Mere possession (without a prescription) carries a maximum one-year federal sentence. All of these penalties have been in effect since 1990.

The prospect of jail time keeps almost everyone involved with the underground steroid trade mum, at least about the particulars of how they get their cycles. As with many such subcultures, the steroid-use crowd has a wealth of Websites at its disposal, many of which are extremely detailed about the combinations (called "stacks") that produce optimal effects. Deca-Durabolin for bulk, Winstrol-V for cut, Equipoise for hardening, and so on.

Pope says discussions about such specific effects are mostly myth. "They all basically work the same way," he says. "There are all kinds of underground theories, underground gurus, but the bottom line is that it probably doesn't make much difference. The only consistent thing I can tell you is that the more you take, the bigger you get."

Steroids also carry with them a raft of side effects. The short-term physical side effects vary considerably and are usually minor: acne, growth of body hair, loss of hair on the head, gynecomastia (a buildup of fat behind the nipples known as "bitch tits" among users, gay and straight), and increased libido, sometimes made more irksome by another side effect: impotence. Decreased sperm count and testicular shrinkage always result. ("That's for the straight boys to worry about," quips DiBiaso.) Heavy, long-term steroid use can cause liver problems (occasionally even cancer) and accelerates hardening of the arteries, increasing the risk of heart attack or stroke.

The most consistent, immediate, and dangerous side effect is psychological, Pope stresses. At least half of all users report irritability and mood changes. Some ten percent, Pope adds, experience aggression and flares of temper. The medical term for this phenomenon is hypomania. In popular culture, it's called "'roid rage." Pope says he has served as an expert witness in "a dozen cases" where a man with no history of violence killed someone while on anabolic steroids.

"These kinds of personality changes are idiosyncratic; we don't know who is more vulnerable to them or why," Pope says. "It's a gamble."

The airy, mirrored, second-floor Washington Avenue gym called Crunch (formerly Club Body Tech) is about half full, a mixed crowd of men and women, gay and straight, buff and not so buff. This 20,000-square-foot space is where Jason DiBiaso and John hone their physiques. As LifeCycles whir and weights clank, the pair disclose what they call their "beauty secrets."

DiBiaso, in his baseball cap, black tank top, and baggy pants, offers this nugget while waiting his turn for a pulley contraption that isolates the biceps: The upside of a relationship like his and John's is that you can shave each other's backs in the shower. This practice becomes increasingly necessary if one or both of you are using steroids.

John likes to begin his workouts with some abdominal exercise. A massage therapist, he speaks at length about the anatomy of the abdominal muscle ("The 'six-pack' is just one big muscle") and the best way to isolate it. Six-foot-four, John is a very big dude with a lot of definition. He grimaces as he bends his six-pack to his will.

"It feels like you're going to puke, doesn't it?" he says as he finishes his set. "If I know I'm going out that night, I don't do as much on the abs. Because I know I'll be dancing with my shirt off, and I'll be tensing up my abs the whole time."

As John and DiBiaso move through today's regimen (back and biceps), they offer a running commentary on those sharing the gym with them.

Whop! Whop! A lanky man in red sweatpants is delivering low roundhouse kicks to the heavy punching bag in the corner. "You know someone's straight if they're at the punching bag," DiBiaso mutters. "They've got something to prove.

"You see that guy in the black tank top?" he asks, indicating a tanned, bulging man doing military presses. "He takes steroids. This guy over here in the white tank top? He's natural." DiBiaso isn't guessing; he knows both men, at least in passing. But he maintains that there is a certain look to the musculature, especially the increased size and definition around the neck and shoulders, that tells him if someone is "juicing" or not. Some of the heavier users, he notes, tend to look puffy.

His own use, he emphasizes, has been extremely modest. He knows what the side effects are, and one of his goals is "to be kind to my liver.... It's when the mental image of your body is really at odds with physical reality that people run the risk of real abuse," he says. "I know someone who I am convinced is going to kill himself. He's six-foot, he's 245, and he wants to get to 260. At 260 he's going to want to get to 280. At 280 he's going to want to get to 300. Somewhere along the line he's going to fry his liver, and all hell is going to break loose. It's like any other drug. It can become an addiction."

Dr. Alberto Canas sees both faces of the Miami Beach steroid scene. More than half his practice consists of HIV-positive patients, and he prescribes steroids (or the vastly more expensive human growth hormone -- $21,000 per three-month cycle) to many of them as part of their drug regimens. He estimates that he gives steroids to about one-third of his patients, and believes that this proportion is representative of treatment for the roughly one million HIV-positive people in the United States.

Canas, a handsome man in his late thirties with plenty of gray in his dark brown hair, also knows all about the burgeoning population of HIV-negative steroid users. He dunks a slice of tuna into soy sauce and glances out Sushi Rock's front window.

"There goes one now," he murmurs as a massive man on a bicycle zips past on Collins Avenue.

Canas, like many other doctors who treat HIV patients, believes that steroids stave off the ravages of wasting syndrome. Yes, there are side effects, but irritability and the possibility of liver problems in five years pale in comparison to watching a patient's body eat itself within a matter of months. "For the most part, in the HIV-positive patient the benefits far outweigh the risks," he says.

Still, as with so many other treatments for the symptoms of HIV, the unknowns outweigh the knowns when it comes to gauging the effectiveness of steroids. Steve Fallon, director of education at CenterOne, a nonprofit HIV/AIDS service center in Fort Lauderdale, says that neither steroids nor human growth hormone has been unequivocally proven to help keep AIDS patients alive.

"A lot of gay HIV-positive men develop a more muscular physique, but it's not completely understood if that's a hedge against wasting," Fallon cautions. "The jury is still out. Has there been a major surge in getting on steroids? Yes. Are HIV doctors reluctant to tell their patients that there's no proof? Probably."

Canas is more worried about the consequences of steroid use among the HIV-negative. "We don't really know what the long-term effects of steroids are," he admits. "There are problems that can happen immediately."

He's seen mood swings result even from the carefully measured doses he gives his HIV-positive patients. "I have had people tell me, people I was treating for wasting, 'When I was on that cycle, doc, I was picking fights with my boyfriend left and right. Can we maybe try a lower dose?' These side effects are definitely real."

Canas also worries about the interaction between steroids and other drugs, legal and illegal. "Anything else that can also effect your liver, like alcohol, may cause additive damage," Canas says. "Also, weightlifting sends your blood pressure very high. If you're also doing any other kind of stimulant, like cocaine or crystal meth, you could stroke out. That's kind of indirect, but there's the potential."

The social consequences among gay men can also be severe.
"What happened was, all of a sudden you saw people who weren't doing so well at one point becoming Adonises," Canas recounts, between bites of California roll. "It's human nature to be competitive. I have a lot of patients, HIV-negative guys, who will say, 'How can I get steroids? It's not fair that I can't get them just because I'm negative.'"

He says he's had to give the same speech over and over: "Right now, if you're negative, it's not accepted medical practice to get steroids. And not legal. I don't prescribe anabolic steroids to anyone who doesn't have a chronic wasting disease."

Canas says it's impossible to quantify the illicit steroid use among gay men, in Miami Beach or anywhere else. It's all guess work at this point.

"The gym I work out in is a gay gym," says Fallon. "I was talking to somebody there, and I guessed that maybe twenty percent of the guys there were on steroids. He laughed at me and told me it was way more."

Canas is aware of the possibility that his patients might try to pass prescribed steroids along in the black market. "That's one of my biggest fears," he admits. "I do try to administer injectables within the office. But sometimes people will travel, spend summers on Fire Island or whatnot. I have to give them what they need to self-inject."

Self-injectors to whom he has not issued prescriptions also show up for treatment, and it's not a pretty sight. "I've treated people for abscesses that have formed, which is basically a big collection of pus under the skin where they inject themselves," he says.

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."

Signorile places South Beach at the top of his list for steroid use among gay men, saying that it beats out even West Hollywood in California and Chelsea in New York City. "In New York, L.A., and Miami, in certain gyms, 75 to 85 percent of the men are using steroids," he estimates. This environment has produced another party phenomenon that Signorile denounces: Miami Beach Hardbodies, a group that organizes sex parties timed to coincide with Circuit Parties here and elsewhere, and with major holidays. The message currently on the voice mail of Miami Beach Hardbodies goes like this: "Miami Beach Hardbodies has a strict door policy. Muscle guys only. That means hard, solid pecs and six-pack abs. Expect to take your shirt off to prove it. If you don't measure up, you don't get in."

To Signorile, that sums up everything that's wrong with the rise in steroid use among gay men. "These guys are already dealing with self-esteem issues, feeling less than other people," Signorile says. "To come into an environment where you have to prove masculinity like that is very damaging. It plays out badly in many men, who can become incredibly depressed."

Depression is not the only response of nonjuicing gay men, though. "Among those that are not using, it has evolved into the stereotypical joke in a way," says one gay Miami Beach resident who asked not to be named. "Are those really their pecs or implants? Do they really do 500 situps or do they take steroids? I don't know if catty is the best word, but there's definitely a lot of sarcasm."

This man and other anonymous sources also pointed to DiBiaso as one of the organizers of Miami Beach Hardbodies. DiBiaso would not confirm this but, speaking as an unabashed steroid-user, he defends such events from doomsayers like Signorile.

"I think the lady doth protest too much," he says archly of the writer. "If someone doesn't allow you in, you find a way to demonize them in order to justify your nonparticipation. And that's essentially what he's done. And I think his view has been very harmful to the gay community at large, because he factionalizes and divides a community that can survive only through unity. By being such a divisive element, he panders to those whose self-esteem is not what it could be or should be. And offers them a scapegoat as to why they feel the way you do."

"Michelangelo's very bitter," adds John, in a croaking imitation of gay actor Harvey Fierstein. "She went to a party and no one wanted to fuck her." DiBiaso bursts into laughter.


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