Management of patients using anabolic androgenic steroids and other performance and image enhancing drugs (including peptides): A harm reduction approach

Performance and image enhancing drugs (PIEDs) include a diverse range of substances used to improve physical performance, muscle mass or appearance. While historically associated with elite sport and bodybuilding, use has expanded to broader populations. Most PIEDs used outside clinical settings are non-prescribed and obtained through informal or online markets, creating additional health risks.

This article aims to support general practitioners (GPs) in engaging with patients who use anabolic androgenic steroids and other PIEDs and to outline practical harm reduction strategies for monitoring and managing associated health risks.

People who use anabolic androgenic steroids and other PIEDs might be reluctant to disclose use because of stigma, fear of judgement or concerns about confidentiality. A non-judgemental, harm reduction approach can facilitate disclosure and enable clinicians to provide appropriate monitoring, screening and education, as well as reduce potential harms by supporting safer practices and managing adverse effects.