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Performance and image enhancing drugs

What are performance and image enhancing drugs (PIEDs)?

Types of PIEDs

Why do people use PIEDs?


Further information



What are performance and image enhancing drugs (PIEDs)?

Performance and image enhancing drugs (PIEDs) are substances taken by people with the intention of improving 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 body2.


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 market2. These include:

  • Growth hormones like AOD-9604, which has fat burning properties and is used by athletes to increase power-to-weight ratios2.
  • Selective Androgen Receptor Modules (SARMs) appear to only act on anabolic receptors that cause tissue (such as bone and muscle) growth2. These are classed as a prohibited drug by WADA3.
  • 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.3
  • Mechano 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.4 However, 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 injury4


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.

When injected, PIEDs have the additional harms associated with other injecting drug use, including infection, transmission of disease through needle sharing and other problems caused by incorrect injecting technique4.

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)
  • 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 cause2.

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.

Further information


Reducing the risks


  • Clenbuterol: classed as a 'beta-2 agonist' and its short-term effects are similar to stimulant drugs like amphetamine or ephedrine.
  • Creatine monohydrate: is a naturally occurring compound synthesised from amino acids by the kidneys and liver.
  • Erythropoietin (EPO): a naturally occurring hormone produced by cells in the kidneys that regulate the production of red blood cells in bone marrow.
  • Human chorionic gonadotrophin (hCG): when taken by males, hCG can stimulate the testes to produce testosterone rapidly.
  • Insulin-like growth factor (IGF-1): IGF-1 is a naturally occurring growth factor or hormone that stimulates many processes in the body.
  • Insulin: may be illegally used in conjunction with anabolic steroids, in an attempt to increase muscle growth and definition.
  • Steroids: synthetic hormones that imitate male sex hormones, specifically testosterone.


ADF SEARCH – Find further credible research and information on PIEDs.

ADIN – Find other credible websites and apps on PIEDs.


1. Larance, B., Degenhardt, L., Dillon, P. & Copeland, J. (2005). Use of performance and image enhancing drugs among men: A review. Technical Report No. 232. Sydney: National Drug and Alcohol Research Centre.

2. Australian Crime Commission. (2013). Organised crime and drugs in sport. Canberra: Australian Crime Commission.

3. World Anti-Doping Agency. (2014). The 2015 prohibited list: International standard. Montreal: World Anti-Doping Agency.

4. Larance, B., Degenhardt, L., Dillon, P. & Copeland, J. (2005). Rapid assessment of performance and image enhancing drugs (PIEDs) in New South Wales: Feasibility study. Sydney: National Drug and Alcohol Research Centre.


Last updated: 26 April 2016

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