Women using performance-enhancing drugs face major gaps in healthcare support

Women using PIEDs reported difficulty accessing reliable information, testing and clinical expertise, according to a qualitative study.

Researchers interviewed nine women who used performance- and image-enhancing drugs, primarily to enhance body composition, physical appearance or sporting performance.

Participants reported problems accessing comprehensive blood and hormone testing and finding clinicians familiar with health concerns linked to women’s use of these drugs.

This has been a male-dominated area of research for a long time, so there are significant gaps in understanding women’s health care needs.

The research, led by University of Queensland School of Psychology PhD candidate Hannah Schuurs, explored how the women managed their health while using PIEDs, which include substances such as steroids and peptides.

Schuurs said: “We interviewed nine women who use PIEDs about how they managed their health throughout their PIED use.

“They reported difficulty accessing reliable information and a lack of clinical expertise and formal health care support.

“The study participants were all active in self-monitoring, tracking changes in their bodies, and actively sought formal health care 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.”

The study found participants spent considerable time educating themselves about the drugs and their potential risks.

“They often found themselves educating healthcare professionals rather than receiving guidance tailored to their circumstances.

Schuurs said: “The participants had spent considerable time educating themselves about PIEDs and their risks and found they were often educating their health care providers, rather than receiving guidance tailored to their circumstances.”

“Structural and systemic barriers shifted a disproportionate level of responsibility for harm reduction and care coordination onto the women themselves.”

Participants were also aware of sex-specific risks, including hormonal disruption and virilisation. Virilisation is when masculine physical traits develop due to high levels of androgens.

However, the women did not necessarily expect healthcare professionals to have all the answers.

Schuurs said: “Participants were often understanding of gaps in clinical knowledge, provided they were met with openness and a willingness to work collaboratively.

“They emphasised that respectful, nonjudgmental health care relationships were just as important as technical expertise.”

The findings also challenged stereotypes that people using PIEDs are uneducated or indifferent to their health.

Participants reported actively managing their health while navigating stigma, uncertainty and gaps in healthcare.

Schuurs said: “The participants actively managed their health and navigated stigma, uncertainty and gaps within health care.”

“We need health care responses that are collaborative rather than judgmental, as those narratives can oversimplify people’s experiences and make it harder for them to seek support.”

She said the research showed PIED use could form part of wider goals relating to health, wellbeing, performance and self-management.

Schuurs said: “Better understanding women’s experiences is critical if we want health care systems to respond effectively and ensure women can access the support they need.”

“There is a real opportunity to improve education, clinical guidance and support for health care professionals in this space that values and draws from the lived experience of women themselves.”