One drawback to Brennan’s study is that, unlike Kouri’s, there was evidence of attempted deception. Several people had to be excluded from the non-users’ group because they were either definitely on steroids (they failed the urine test), or probably on steroids (in the researchers’ words, they had “implausibly high muscularity and low body fat despite denial of AAS use”). However, even if a couple of users slipped in, they probably didn’t skew the data too much. The sample size for nonusers was big enough (131 people) that a few bad apples wouldn’t spoil the whole bunch, and the researchers were excluding suspiciously jacked people anyways, so if a few users did slip in, they apparently weren’t swole enough to raise any red flags.
“There’s this drumbeat that muscularity equals masculinity, and so we’re seeing more and more young men with muscle dysmorphia,” says Pope. The consequences of this kind of thinking can be dangerous. As more and more men hit the gym in the hopes of transforming themselves into the Rock, many are also turning to anabolic steroids to achieve the muscle mass they associate with masculinity. Up to 4 million Americans—nearly all of them male—have tried steroids at some point, according to Pope’s recent research .
Treatment of muscle dysmorphia can be stymied by a patient's unawareness that the preoccupation is disordered or by avoidance of treatment.  Scientific research on treatment of muscle dysmorphia is limited, the evidence largely in case reports and anecdotes,  and no specific protocols have been validated.  Still, evidence supports the efficacy of family-based therapy , cognitive behavioural therapy , and pharmacotherapy with selective serotonin reuptake inhibitors .   Also limited is research on prognosis of the untreated.