Experiences of Healthcare Support and Access Among Women Who Use Performance and Image-Enhancing Drugs

Women who use performance and image-enhancing drugs (PIED) face distinct health risks, yet little is known about how they engage with healthcare or seek support. This study explored how women who use PIEDs navigate healthcare, with a focus on engagement, disclosure and stigma.

An interpretative phenomenological analysis was undertaken, involving semi-structured interviews with nine women with current/historical experience of PIED use, and engagement in regular weight training. Interviews explored health monitoring, support-seeking, and experiences with healthcare services and providers in the context of their PIED use.

Participants described healthcare experiences ranging from respectful, supportive care to dismissal, judgement and clinical uncertainty. Three interrelated themes were identified: (i) participants' proactive engagement in health monitoring and healthcare to manage risks associated with PIED use; (ii) systemic barriers and knowledge gaps within healthcare, which made appropriate care difficult to access and navigate and, at times, shifted the burden of expertise onto participants within clinical encounters; and (iii) the importance of non-judgemental care, with stigma and fear of judgement shaping disclosure, trust and help-seeking.

This study provides an in-depth qualitative account of how women who use PIEDs engage with and navigate healthcare. Despite strong health motivation and proactive risk management, participants often encountered structural and interpersonal barriers to care. Respectful, non-judgemental interactions were central to positive healthcare engagement and sometimes more influential than clinical expertise alone. Findings highlight the need for improved professional education and gender-sensitive, harm-reduction-oriented resources to support women who use PIEDs.