NDARC Technical Report No. 232 (2005)


Although physical training remains the primary way of changing and developing appearance, there is a range of substances being used by some to enhance the effects of training. Performance and Image Enhancing Drugs (PIEDs) refer to substances that are generally used to enhance muscle growth ('anabolic' effects) or to reduce body fat ('catabolic effects'). The expected benefits of using these types of substances range from increasing the size and definition of muscles, reducing water retention and body fat, to increasing physical strength and endurance (Bahrke & Yesalis, 2004). The major substances of concern are human and veterinary anabolicandrogenic steroids (AAS), growth hormone, other reproductive hormones, diuretics, stimulants, beta-2 agonists (e.g. clenbuterol), creatine monohydrate, and hormones such as insulin and thyroxine (Henry-Edwards, 2004). The most commonly used PIEDs are AAS.

The widespread use of the term 'performance and image enhancing drugs' (PIEDs) has evolved over the last 5 years in Australia. Originally, 'performance-enhancing drugs' (PEDs) was the term used to describe the range of substances that could have performance benefits for athletes. 'PEDs' is a term that is still widely used in the US, even where there is no direct link to competitive sports. Several Australian reports have identified that the use of AAS and related substances affect not only the sporting sector, but also a wider cross-section of the Australian community (Australian Olympic Committee, 2000; Henry-Edwards, 2004; Henry-Edwards, Ali, Bisshop, Gordon, & Hall, 1999). Accordingly, the use of the term 'PIEDs' has become the preferred term in Australian policy.

The present paper focuses primarily on the non-sporting use of PIEDs. Although athletes might be the most visible group (due to media attention) it has been hypothesised that they are actually the smallest group of PIEDs users (Bahrke & Yesalis, 2004; Shapiro, 1994). Other groups of PIEDs users have been identified in the literature including medical users, body image users, occupational users, and adolescents (Henry-Edwards, 2004; Peters, Copeland, Dillon, & Beel, 1997).

Use of PIEDs often occurs without medical supervision, and in amounts that greatly exceed recommended therapeutic doses. Assessing the health risks can be difficult as users often take complex combinations of drugs. While a small proportion of PIEDs are prescribed by a doctor for therapeutic reasons, many of the substances used in Australia are believed to be obtained and used illicitly, and there is an active black market for PIEDs (Australian Crime Commission,

Citation: Larance, B., Degenhardt, L., Dillon, P. and Copeland, J. (2005), Use of performance and image enhancing drugs among men: a review. Sydney: National Drug and Alcohol Research Centre.



Briony Larance, Louisa Degenhardt, Paul Dillon, Jan Copeland
Date Commenced
09 Sep 2005
Resource Type
Technical Reports