Based on the one-on-one interactions Butters and Jimmy have had on the show, they seem to be good friends. In " Krazy Kripples ," Butters was the only person who went to see Jimmy's comedy show instead of Christopher Reeve's public appearance. In " Erection Day ," Jimmy came to Butters for advice on his erection problems, expressing that Butters is the only one he can tell who won't make fun of him for it. The two were also seen sitting together at Cartman's AIDS benefit in " Tonsil Trouble ". During Season Fifteen's episode " 1% " Jimmy and Butters form the 99% club to protest the Presidential Fitness Test results. They stand outside and picket the President's Council on Fitness, Sports & Nutrition, Colorado Division Regional Office, only the media believe they are protesting the Red Robin Restaurant. In " Funnybot ," Butters is the only person in the audience who was clapping and cheering Jimmy while everybody else was asleep. In " Going Native ," Butters reveals that he doesn't find Jimmy's jokes funny. In " A Nightmare on Face Time ," the two are seen trick-or-treating together.
There was some controversy surrounding "Up the Down Steroid" and the 2005 film The Ringer , as both feature the same plot: someone pretending to be disabled in order to compete in the Special Olympics.  The Ringer was written and filmed months before this episode was aired, although, The Ringer was not released to the public until after this episode aired. According to the episode's DVD audio commentary, series co-creators Trey Parker and Matt Stone did not think that they ripped off The Ringer , since the idea to them did not seem hard to come up with, and they did not even think it was big enough for a twenty-minute episode let alone a two-hour film.  In the opening scene, the boys are playing the same "Investigative Reports with Bill Kurtis " funtime game as they did in the season two episode " Cartman Joins NAMBLA ". 
The novel is epistolary ; aside from opening and closing chapters consisting entirely of dialogue the story is told through memos from the office, fragments of notes dropped in the trash can, essays handed in to be graded, lesson plans, suggestions dropped in the class suggestion box, and most often by inter-classroom notes that are a dialogue between Sylvia and an older teacher. Sylvia also writes letters to a friend from college who chose to get married and start a family rather than pursuing a career. The letters serve as a recap and summary of key events in the book, and offer a portrait of women's roles and responsibilities in American society in the mid-1960s.