Performance and Image Enhancing Drugs: Factsheet

What are Performance and Image Enhancing Drugs?

Performance and image-enhancing drugs are substances that are used to try to enhance a person’s appearance or physical abilities, either by growing muscle or reducing body fat.

The main substances that are used for this purpose are:

• Human and animal anabolic and androgenic steroids
• Human growth hormone
• Other reproductive hormones
• Diuretics

How many young people have tried Performance and Image Enhancing Drugs?

According to the 2022-2023 Australian secondary schools’ survey, 1 in 50 young people (2%) aged 12-17 used performance or image-enhancing drugs in the past year.

The 2022-2023 National Drug Strategy Household survey reported that less than 0.2% of people aged 14 and older used steroids in the past year.

What are the effects of Performance and Image Enhancing Drugs?

Initially, performance and image-enhancing drugs can cause mood changes, such as euphoria (intense feelings of happiness), increased confidence and self-esteem, more energy and motivation to exercise. People who use these drugs feel less tired and may have trouble sleeping. Libido (interest in sex) commonly increases but can decrease.

Performance and image enhancing drugs can cause problems when competing in sporting competitions. Many of the substances are banned because of the health risks involved, the shame it brings to sport as a whole, and in order to encourage fair competition. For these reasons, use of performance and image enhancing drugs can result in disqualification from competition, as well as harming an athlete’s long-term sporting career and reputation.

The effects of performance and image enhancing drugs can be physical or psychological, as listed in the table below.

Evidence Base

This factsheet was developed following expert review by researchers at the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney, the National Drug & Alcohol Research Centre at the University of New South Wales, and the National Drug Research Institute at Curtin University.

Sources

1. Scully, M., Koh, I., Bain, E., Wakefield, M., & Durkin, S. (2023). ASSAD 2022–2023: Australian secondary school students’ use of alcohol and other substances. Cancer Council Victoria.
2. Momaya, A., Fawal, M., & Estes, R. (2015). Performance-enhancing substances in sports: a review of the literature. Sports
   Med, 45(4), 517-531. doi:10.1007/s40279-015-0308-9
3. Sagoe, D., Andreassen, C.S., and Pallesen, S. (2014). The aetiology and trajectory of anabolicandrogenic steroid use
   initiation: a systematic review and synthesis of qualitative research. Substance Abuse Treatment, Prevention, and Policy,
   9(27).
4. Larance, B., Degenhardt, L., Dillon, P., Copeland, J. (2005). Use of performance and image enhancing drugs among men: A
   review. National Drug and Alcohol Research Centre Technical Report 232.
5. Bird, S. R., Goebel, C., Burke, L. M., & Greaves, R. F. (2016). Doping in sport and exercise: anabolic, ergogenic, health and
   clinical issues. Ann Clin Biochem, 53(Pt 2), 196-221. doi:10.1177/0004563215609952
6. White, V. & Williams, T. (2016). Australian secondary school students’ use of tobacco, alcohol, and over the counter and
   illicit substances in 2014. Report prepared for the Drug Strategy Branch, Australian Government Department of Health by
   the Centre for Behavioural Research in Cancer, Cancer Council, Victoria.
7. Australian Institute of Health and Welfare (2023). 2022-2023 National Drug Strategy Household Survey Report. AIHW: Canberra.
8. Corrigan, B. (1996). Anabolic steroids and the mind. The Medical Journal of Australia, 165(4).
9. Pope, H. G., Jr., Wood, R. I., Rogol, A., Nyberg, F., Bowers, L., & Bhasin, S. (2014). Adverse health consequences of
   performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev, 35(3), 341-375. doi:10.1210/er.2013-
   1058
10. Kanayama, G., Hudson, J. I., & Pope, H. G., Jr. (2008). Long-term psychiatric and medical consequences of anabolic-
     androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend, 98(1-2), 1-12. doi:10.1016/j.
    drugalcdep.2008.05.004
11. van Amsterdam, J., Opperhuizen, A., & Hartgens, F. (2010). Adverse health effects of anabolic-androgenic steroids. Regul
    Toxicol Pharmacol, 57(1), 117-123. doi:10.1016/j.yrtph.2010.02.001
12. Ip, E. J., Lu, Debbie H., Barnett, Mitchell J., Tenerowicz, Michael J., Vo, Justin C., Perry, Paul J. (2012). Psychological and
    Physical Impact of Anabolic-Androgenic Steroid Dependence. Pharmacotherapy: The Journal of Human Pharmacology and
    Drug Therapy, 32(10), 1875-9114. doi:10.1002/j.1875-9114.2012.01123
13. Kam, P. C. A. Y., M. (2005). Anabolic steroid abuse: physiological and anaesthetic considerations. Anaesthesia, 60, 685-692.
14. Larance, B., Degenhardt, L., Copeland, J., & Dillon, P. (2008). Injecting risk behaviour and related harm among men who use
    performance- and image-enhancing drugs. Drug Alcohol Rev, 27(6), 679-686. doi:10.1080/09595230802392568
15. Hope, V. D., McVeigh, J., Marongiu, A., Evans-Brown, M., Smith, J., Kimergard, A., . . . Ncube, F. (2015). Injection site infections
    and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking.
    Epidemiol Infect, 143(1), 132-140. doi:10.1017/S0950268814000727
16. Evans-Brown, M., McVeigh, J., Perkins, C. and Bellis, M.A. (2012). Human Enhancement Drugs: The Emerging Challenges to
    Public Health. (E. Clark Ed.). Great Britain: Centre for Public Health, North West Public Health Observatory.
17. Brennan, R., Wells, J. S., & Van Hout, M. C. (2016). The injecting use of image and performance-enhancing drugs (IPED) in
    the general population: a systematic review. Health Soc Care Community. doi:10.1111/hsc.12326