Experiences of healthcare support and access among women who use performance and image-enhancing drugs

A new study led by NCYSUR Postdoctoral Research Fellow Hannah Schuurs, undertaken as part of her PhD research in UQ’s School of Psychology, provides one of the first in-depth examinations of healthcare access and support among women who use performance and image-enhancing drugs (PIEDs). Published in Drug and Alcohol Review, the study challenges persistent assumptions about who uses these substances and how women understand, negotiate and manage their health.

PIEDs encompass a diverse range of substances used to alter body composition, appearance, strength, recovery or sporting performance. Although anabolic-androgenic steroids are the most widely recognised, the category also includes selective androgen receptor modulators (SARMs), stimulants, weight-loss drugs, peptides and other hormones.

PIED use is increasingly relevant to youth AOD research and practice. Australian secondary-school data indicate that approximately one in 50 young people aged 12-17 used PIEDs in the previous year. Young women may also encounter a widening range of substances, including peptides and weight-loss drugs, through online fitness, appearance and wellness cultures not always recognised as conventional drug-use environments. However, reliable data on their use, experiences and support needs remain limited.

Research and clinical guidance have focused overwhelmingly on male physiology and men’s experiences. Consequently, comparatively little is known about women’s patterns of PIED use, health concerns or experiences of seeking professional support. Women’s experiences are also frequently interpreted through assumptions about femininity, appearance and reproductive risk, rather than understood on their own terms.

The study used interpretative phenomenological analysis, drawing on semi-structured, in-depth interviews with nine women who regularly engaged in weight training and had current or previous experience of PIED use. Participants described markedly varied healthcare experiences, ranging from collaborative, non-judgemental care to encounters characterised by dismissal, stigma and clinical uncertainty.

Importantly, participants were not indifferent to the potential risks of PIED use. They closely monitored bodily changes, sought blood and hormone testing, researched the substances they used and actively pursued professional healthcare support. Their accounts complicate common portrayals of people who use PIEDs as reckless, poorly informed or unconcerned about their health.

Accessing appropriate care, however, was often difficult and labour-intensive. Some participants struggled to identify clinicians with sufficient knowledge of PIEDs or the confidence to advise on concerns specific to women, including hormonal disruption, menstrual and reproductive health, and the potentially irreversible effects of androgen exposure. Several found themselves explaining substances, monitoring practices and potential harms to their healthcare providers.

Gaps in research and clinical knowledge therefore generated a distinctly gendered burden of responsibility. Women were required not only to manage the potential risks of their own substance use, but also to locate appropriate services, evaluate sometimes-conflicting information and help clinicians navigate an area in which formal guidance remains limited.

This finding resonates with broader AOD scholarship showing that women who use substances are often expected to demonstrate particular responsibility, self-control and concern for health to resist gendered judgements. Participants performed considerable practical and moral labour to establish themselves as informed, responsible and legitimate recipients of care. Access to appropriate healthcare should not depend on women successfully proving those qualities.

The findings also demonstrate that technical expertise was only one component of a constructive healthcare encounter. Participants did not necessarily expect every clinician to possess specialist knowledge of the rapidly evolving PIED market. Instead, they valued practitioners who acknowledged the limits of their knowledge while remaining open, respectful and willing to work collaboratively.

These relational dimensions have important implications for harm reduction. Anticipated judgement and previous experiences of dismissal sometimes made participants more cautious about disclosing their PIED use. Incomplete disclosure can leave clinicians without information needed to interpret symptoms, select appropriate investigations and provide informed care. Stigma can therefore directly constrain the conditions under which harm reduction becomes possible.

For young women, early experiences with healthcare may be especially influential in shaping whether they feel able to disclose substance use and seek support in the future. Conversely, respectful responses provide opportunities for early engagement and harm reduction before patterns of use or associated health concerns become more established.

The study identifies a pressing need for professional education and gender- and youth-responsive clinical resources. Existing Australian guidance for general practitioners is derived largely from research involving men and contains limited information about women’s specific healthcare needs. Treating male evidence as the clinical default risks leaving women responsible for navigating the consequences of their exclusion from the research base.

These limitations may become increasingly consequential as peptides and other emerging substances become more visible and accessible online. Young people may encounter these products through social media, influencers and online vendors, often alongside claims about muscle growth, fat loss, recovery or appearance. The rapidly evolving market reinforces the need for youth AOD research capable of identifying emerging patterns and informing credible, non-judgemental responses.

The publication has attracted substantial public and professional attention. The findings were featured by UQ News and subsequently covered by MJA Insight+, extending the research to a national medical audience. Their implications for AOD practice will also be discussed in the upcoming Insight webinar, Jumping through hoops: Healthcare and women’s performance and image-enhancing drug use, on 7 October 2026.

Rather than approaching women’s PIED use solely through risk, pathology or appearance, the study positions women as knowledgeable and active participants in their healthcare. Gender-responsive care requires attention to how gender shapes whose knowledge is recognised, whose concerns are taken seriously and who is expected to carry responsibility for reducing harm. For young women, early access to informed, respectful care may establish trust and create opportunities for harm reduction across the life course.

The article, “Experiences of healthcare support and access among women who use performance and image-enhancing drugs,” was authored by Hannah C. Schuurs, Zoe Walter, Leanne Hides and Mair Underwood and is available in Drug and Alcohol Review.

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