A study of women who use performance- and image-enhancing drugs (PIEDs) such as steroids and peptides suggests healthcare has not kept pace, with most research on the topic focused on men.
University of Queensland School of Psychology PhD candidate Hannah Schuurs led qualitative interviews with women using PIEDs, primarily to enhance their body composition, physical appearance or sporting performance.
“We interviewed 9 women who use PIEDs about how they managed their health throughout their PIED use,” Ms Schuurs said.
“They reported difficulty accessing reliable information and a lack of clinical expertise and formal healthcare support.
“This has been a male-dominated area of research for a long time, so there are significant gaps in understanding women’s healthcare needs.
“The study participants were all active in self-monitoring – tracking changes in their bodies and actively sought formal healthcare support.
“But they found it hard to access comprehensive blood and hormone testing, or clinicians who were familiar with the unique health concerns associated with women’s PIED use.”
Study participant Kate* described her interaction with GPs:
“They have no knowledge of PIEDs… I was open [about PIED use], but they didn’t even know.”
Ms Schuurs said the women felt they had to fill gaps in medical knowledge.
“The participants had spent considerable time educating themselves about PIEDs and their risks and found they were often educating their healthcare providers, rather than receiving guidance tailored to their circumstances,” she said.
“Structural and systemic barriers shifted a disproportionate level of responsibility for harm reduction and care coordination onto the women themselves.”
The study found a strong motivator for healthcare support and self-monitoring practices was the women’s awareness of sex-specific risks of PIEDs, including hormonal disruption and virilisation – when masculine physical traits develop due to high levels of androgens.
However, Ms Schuurs said the women interviewed did not necessarily expect healthcare professionals to have all the answers.
“Participants were often understanding of gaps in clinical knowledge, provided they were met with openness and a willingness to work collaboratively,” she said.
“They emphasised that respectful, non-judgemental healthcare relationships were just as important as technical expertise.”
Study participant Elle* described the importance of finding a trusted doctor.
“I found a really good GP who’s worked with a lot of sportspeople, and he did a lot of blood testing for me… He was really open about it… And he never judges.”
Ms Schuurs said the findings challenged dominant stereotypes of people who use PIEDs, which often characterised them as uneducated, or indifferent to their health.
“The participants actively managed their health and navigated stigma, uncertainty and gaps within healthcare,” she said.
“We need healthcare responses that are collaborative rather than judgemental, as those narratives can oversimplify people’s experiences and make it harder for them to seek support.”
Ms Schuurs said the research showed PIED use could be embedded within broader goals relating to health, wellbeing, performance and self-management.
“Better understanding women’s experiences is critical if we want healthcare systems to respond effectively and ensure women can access the support they need,” she said.
“There is a real opportunity to improve education, clinical guidance and support for healthcare professionals in this space, that values and draws from the lived experience of women themselves.”
Read the research in Drug and Alcohol Review.
*Pseudonyms have been assigned for anonymity
Collaboration and acknowledgements
The study was supervised by Dr Zoe Walter from the School of Psychology, Professor Leanne Hides from the National Centre for Youth Substance Use Research and Dr Mair Underwood from the School of Social Science.
