Performance enhancing drug use increasing in women

A study of women who use performance and image-enhancing drugs (PIEDs) has found healthcare support from GP’s has not kept up with their increasing use.

University of Queensland School of Psychology research officer Hannah Schuurs said women are using PIEDs to enhance body composition, physical appearance or sporting performance, despite being illegal to use without a prescription.

“These women were coming in with so much knowledge, which is really contrary to the stereotype that often exists around people who use these substances, that they're reckless or ill-informed,” she said.

“Most of the participants said that they did really have a desire for professional healthcare support throughout using PIEDs.”

“For some it was that seeing a GP regularly meant that they were able to access things like blood tests, hormone tests, and just have that monitoring. They were maybe able to give them a bit more tailored harm reduction advice.”

“That doesn't necessarily mean promising every risk can be eliminated. It just means being able to provide accurate information, take women's experiences seriously and make it possible for them to continue seeking care without that fear that they're just going to be shamed or dismissed.”

Women left out of the research

Ms Schuurs decided to do this research for her PhD as it has traditionally been such a male-dominated area of research, leading to significant gaps in understanding the impact of PIEDs on women’s bodies.

She conducted qualitative interviews with nine women who use PIEDs mainly to enhance their body composition, physical appearance or sporting performance.

“I think that's one of the other really concerning aspects about how research hasn't kept up with women who use PIEDs, because we are seeing that the effects really can be quite different. The risks can be different between sexes,” she said.

“That's been this big misconception for a really long time that these substances are taken by male athletes, male bodybuilders, and that women just didn't take them.”

“But the emerging evidence does suggest that women are taking them and that seems to be increasing.”

The study found women were self-monitoring or seeking health support on the sex-specific risks of PIED’s, such as hormonal disruption and virilisation — when masculine physical traits develop because of high levels of androgens.

More awarenesses needed from doctors

Ms Schuurs said while respondents wanted support they didn’t expect doctors to have all the answers, and that it was reasonable for doctors to have some confusion about PIED’s as the term covers such a broad range of substances.

“Often the term PIEDS and steroids are used interchangeably, but that's not quite accurate,” Ms Schuurs said.

“Anabolic androgenic steroids are the form of PIED that we know the most about. That's a class of substances and probably the form that GPs might encounter the most because it does seem like they're taken the most.”

“But there's also a lot of other classes that fall within that PIED label, like stimulants, peptides, which are gaining traction at the moment, basically it's this huge variety of substances that generally do have medical purposes, but the majority of their use we're seeing is occurring illicitly.”

Ms Schuurs said doctors needed more awareness about PIEDs, particularly as peptide use increases. She is presenting a webinar for the clinical training arm of Queensland Health on October 7 about clinical healthcare implications in this space.

"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,” she said.

“I think the participants did feel quite confident in their abilities to manage a lot of the risks but still did see an important place for GPs and healthcare professionals in general in that system of monitoring their health.”

“I think first and foremost, it begins with non-judgmental and gender responsive care.”

“I think in terms of clinicians training, clinicians probably do need a bit more practical guidance on how to actually ask about PIED use, how to discuss some of the uncertainty and relevant monitoring that might be associated, and some of those concerns that are more specific to women."

“Also, probably some clearer referral pathways when there might be specialist advice needed.”

She said this would overcome what the women described as a difficulty accessing reliable information, because of a lack of clinical expertise and formal healthcare support.