Off-label GLP-1 weight-loss medicine use among online bodybuilders: Folk pharmacology, risk and harm reduction

Turnock, LA ORCID: 0000-0002-4928-1945, Hearne, E, Germain, J ORCID: 0000-0002-9890-3798, Hirst, M ORCID: 0009-0004-3907-811X, Townshend, HD ORCID: 0000-0003-1963-6351 and Lazuras, L ORCID: 0000-0002-5075-9029 (2025) Off-label GLP-1 weight-loss medicine use among online bodybuilders: Folk pharmacology, risk and harm reduction. International Journal of Drug Policy, 142. ISSN 0955-3959

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Abstract

Background: GLP-1 medicines (e.g. Semaglutide; Tirzepatide) are diabetes medicines that have recently been approved for weight loss purposes. These drugs are increasingly common, with many users accessing these medicines for off-label lifestyle-oriented purposes. While recent research has explored increased interest in these drugs, to date no studies have explored their use in bodybuilding cultures. With bodybuilders often at the forefront of experimental drug use, and diffusing knowledge of drugs to other populations, this research examines bodybuilders’ understandings of use and risk of GLP-1 medicines, and community approaches to harm reduction. Methods: This research adopted a netnographic approach, exploring 12,392 unique posts from 160 threads across two popular bodybuilding forums. Qualitative thematic analysis of posts was undertaken. Findings: Bodybuilders frequently undertook experimental approaches to GLP use, including ‘stacking’ multiple compounds and ‘cycling’ between them, presenting risk. GLPs’ utility for bodybuilding was questioned by some owing to their muscle-wastage effects, but many bodybuilders combined them with anabolic-androgenic steroids (AAS) to off-set these side-effects. In addition to their weight-loss properties, many users discussed the drugs’ anti-ageing properties, and older men appear to be a significant emerging user population. While displacing potentially dangerous fat burners in bodybuilders’ folk pharmacologies, GLPs nonetheless presented risks of hypoglycaemia when combined with AAS, and broader harms. Harm reduction information was frequently shared in forum spaces as part of bodybuilders’ communal folk pharmacology, but some enabling behaviours likely to heighten risk were also identified. Discussion: We examine the likely implications of these findings for public health, with particular reference to the practices of ‘cycling’ and ‘stacking’ GLP medicines and the risk this presents, particularly when combined with drugs such as AAS and far burners. We discuss the need for harm reduction services such as drug testing services, and the need for healthcare professionals to be aware of anti-ageing motivations for use among older men. Continued research into novel GLP use is needed.

Item Type:	Article
Uncontrolled Keywords:	Humans; Weight Loss; Health Knowledge, Attitudes, Practice; Harm Reduction; Weight Lifting; Internet; Male; Glucagon-Like Peptide 1; Off-Label Use; Bodybuilding; Folk pharmacology; GLP-1; Netnography; Semaglutide; Weight-loss medicine; Humans; Harm Reduction; Off-Label Use; Weight Loss; Glucagon-Like Peptide 1; Weight Lifting; Male; Health Knowledge, Attitudes, Practice; Internet; 4407 Policy and Administration; 4206 Public Health; 42 Health Sciences; 44 Human Society; Prevention; 5.1 Pharmaceuticals; Generic health relevance; 3 Good Health and Well Being; Humans; Harm Reduction; Off-Label Use; Weight Loss; Glucagon-Like Peptide 1; Weight Lifting; Male; Health Knowledge, Attitudes, Practice; Internet; 11 Medical and Health Sciences; 16 Studies in Human Society; 17 Psychology and Cognitive Sciences; Substance Abuse; 4206 Public health; 4407 Policy and administration
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine > RC1200 Sports Medicine R Medicine > RS Pharmacy and materia medica
Divisions:	Public and Allied Health
Publisher:	Elsevier BV
Date of acceptance:	15 May 2025
Date of first compliant Open Access:	1 September 2025
Date Deposited:	01 Sep 2025 11:06
Last Modified:	01 Sep 2025 11:15
DOI or ID number:	10.1016/j.drugpo.2025.104854
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27043

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