Performance & image enhancing drugs

Syringe and ampule

Last published: November 22, 2023

What are performance and image enhancing drugs (PIEDs)?

Performance and image enhancing drugs (PIEDs) are substances taken by people with the intention of changing their physical appearance and to enhance their sporting performance.

Types of PIEDs

Anabolic steroids – ‘roids, gear, juice

Anabolic-androgenic steroids are synthetic hormones that imitate male sex hormones, specifically testosterone. They can be taken either as an injection or as a tablet. Steroids are used due to their anabolic effects that assist in the growth and repair of muscle tissue.1


Peptides stimulate the release of human growth hormone, which has an important role in muscle and bone growth. Peptides have become increasingly popular among professional and amateur athletes as they are hard to detect due to how quickly they are absorbed by the body.2


Hormones are chemicals released by the body. For example, the pituitary gland naturally releases growth hormone which tells bones and muscles to grow and repair. There are numerous artificial hormones and hormone stimulating drugs available in the PIEDs market.2 These include:

  • Growth hormones like AOD-9604, which has fat burning properties and is used by athletes to increase power-to-weight ratios.2
  • Selective Androgen Receptor Modules (SARMs) appear to only act on anabolic receptors that cause tissue (such as bone and muscle) growth.2 These are classed as a prohibited drug by World Anti-Doping Agency (WADA).3
  • Insulin-like growth factors (IGF-1) is a hormone produced by the liver, necessary for cell growth in the body. It is used for muscle growth and the development of cartilage and bone.2 This substance is a prohibited substance according to the WADA list.3Mechano growth factor (MGF) is derived from IGF-1 and helps with tissue repair and adaptation.2 It is used mostly by bodybuilders and is on the WADA prohibited list.3

Why do people use PIEDs?

For most people who use PIEDs, body image is the main motivation for use. Due to desirable effects on physique, and improved self-esteem and confidence, people who use these drugs can develop a psychological dependence. 4However, for professional athletes it is the advantage in physical strength and size that is the main reason for use.

The expected benefits of using these substances may include:

  • Increasing the size and definition of muscles
  • Reducing water retention
  • Reducing body fat
  • Increasing strength and endurance
  • helping the body recover quicker from injury.


There is no safe level of drug use. Use of any drug always carries some risk – even medications can produce unwanted side effects. It is important to be careful when taking any type of drug.

The harms associated with PIEDs, depend on the type of drug being used: different categories of drugs have different harms, though there are a few shared harms.

If PIEDs are injected, there is an increased risk of:

  • Tetanus
  • Infection
  • Vein or skin damage

If sharing needles with other people, there is an increased risk of:

  • Hepatitis B
  • Hepatitis C
  • HIV and AIDS.

People who use steroids should be aware of a number of negative physical, psychological and behavioural side effects including:

  • Acne
  • High blood pressure
  • Liver and heart problems
  • Gynaecomastia (growth of breast tissue in men)
  • Hair loss
  • Increased aggression and irritability (‘roid rage’)
  • Depression
  • Shrinking testicles and prostate problems4

Reported side effects of peptides and hormones include:

  • Water retention
  • Numbness of the hands and feet
  • Increased tiredness

As a number of synthetic peptide hormones are experimental or not yet approved for human use, it is difficult to pinpoint the specific harms they may cause.2

It is important to note that many of these drugs do have legitimate, medical uses when they are prescribed and supervised by a medical professional.

Mixing PIEDs and other drugs

Annabolic steroids + stimulants; can impair athletic performance and increase the risk of heart palpitations and high blood pressure.5

Use of more than one drug or type of drug consumed at the same time is called polydrug use.6 More on Polydrug use ‘Polydrug use’ is a term for the use of more than one drug or type of drug at the same time or one after another.7 Polydrug use can involve both illicit drugs and legal substances, such as alcohol and medications.

Getting help

If your use of PIEDs is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about a loved one, you can find help and support.

Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs

Help and Support Services search

Find a service in your local area from our list. Simply add your location or postcode and filter by service type to quickly discover help near you.

If you're looking for other information or support options, send us an email at


Not sure what you are looking for?
Try our intuitive Path2Help tool and be matched with support information and services tailored to you.

Find out more
Image of a woman walking through a maze

It is illegal to manufacture, import, possess, use or supply steroids without a prescription or medical practitioner licence. The penalties for illegally administering steroids varies for every Australian state and territory.8

It is also against the law to inject another person with steroids, or for them to self-administer,with out a prescription.

Medical practitioners can only prescribe steroids for legitimate medical reasons.8

Steroid use is banned in competitive sport. Testing positive for steroids can result in fines, suspensions or permanent bans.9

See also, drugs and the law.

  • According to the Australian Crime Commission the number of steroid seizures at our borders has increased 14% from 3,155 in 2018-19 to 3,584 in 2019-20.10
  • The Australian Needle and Syringe Program survey found that performance and image enhancing drugs were reported as the last drug injected by between 4% to 6% of respondents over the period 2016 to 2020.1
  1. Larance B Degenhardt L Dillon P Copeland J. Use of performance and image enhancing drugs among men: A review. Sydney National Drug and Alcohol Research Centre; 2005.
  2. Australian Crime Commission. Organised Crime and Drugs in Sport Australian Crime Commission; 2013.
  3. World Anti-Doping Agency. World Anti-Doping Guide International Standard Prohibited List Montreal: World Anti-Doping Agency; 2021.
  4. Larance B Degenhardt L Dillon P Copeland J. Rapid assessment of performance and image enhancing drugs (PIEDs) in New South Wales: Feasibility study. National Drug and Alcohol Research Centre 2005.
  5. Mayo Clinic. Performance-enhancing drugs: Know the risks 2020 [19.11.2021].
  6. Darke S, Lappin, J. & Farrell, M. The Clinician's Guide to Illicit Drugs. United Kingdom: Silverback Publishing 2019.
  7. World Health Organisation. Lexicon of Alcohol and Drug Terms. World Health Organisation; 1994.
  8. Australian Government Department of Health. Performance and Image Enhancing Drugs What you need to know [cited 22.10.2021].
  9. Therapeutic Goods Administration (TGA). Performance and image enhancing drugs 2019 [25.10.2021].
  10. Australian Criminal Intelligence Committee. Illicit Drug Data Report 2019-20. 2021.
  11. Heard S Iversen J Maher L. Australian Needle Syringe Program Survey National Data Report 2016-2020: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Kirby Institute, UNSW Sydney; 2021.


acne, assist growth and repair of muscle, assist in bone growthincrease strength and endurance, depression, gynaecomastia, hair loss, increased aggression, increase strength and endurance, prostate problems, recover from injury, reduce body fat, shrinking testicles


gear, juice, roids