“No pain, no gainz”? Performance and image-enhancing drugs, health effects and information seeking

Abstract

Background: A range of indicators point to an international increase in the prevalence of performance and image-enhancing drugs (PIEDs) use, predominantly among young men. Attention to PIEDs-related benefits, adverse health effects, information and health service access are needed. Methods: A cross-sectional survey of 605 men who inject PIEDs was conducted at nine primary needle and syringe programme locations across five local health districts in Sydney. Results: Among anabolic–androgenic steroids (AAS) users (n =  564), anger, rage or irritability (27%, 95%CI: 23.4–30.6) and sexual or genital problems (26.4%, 95%CI: 22.9–30.0) were the most commonly reported adverse health effects. Taking regular, longer breaks between AAS cycles were associated with reduced reports of some adverse effects. Approaching two-thirds of participants had told a doctor about using PIEDs (63.1%, 95%CI: 59.1–67.1). However, as length of time since first injecting PIEDs increased, participants’ perceptions of doctors as reliable information sources decreased (rho = −0.10, p = 0.04). Reliance on lay information sources was very common, particularly among people who spoke languages other than English. Conclusions: This study supports providing information on cycle lengths and break periods as part of standard PIEDs-related harm reduction guidelines. Safe injecting and dosage education through peer networks or steroid clinics may be useful strategies.

Keywords:

• Injection drug use
• needle-exchange programmes
• health care
• performance and image-enhancing drugs
• anabolic–androgenic steroids

Acknowledgements

The authors wish to thank all study participants and acknowledge the generous advice and encouragement given by NSP staff and NSW Harm Reduction Programme Managers, in particular Julie Page, Sasha Kaplan, Felicity Sheaves and Gary Gahan; and Dr Jenny Iversen, the Drug and Alcohol Multicultural Education Centre’s Research Subcommittee and Alison Jaworski.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Supplementary material available online