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Performance and Image Enhancing Drugs

27 February 2013

The use of performance and image enhancing drugs (PIEDs) by elite athletes has been a permanent story in the media since late last year. However, the Australian Crime Commission report stated that in addition to elite athletes using PIEDS, they are also being used by sub-elite athletes competing at various levels of competition. This is a good time to reflect on PIED use in Australia and think about how the associated harms can be limited.


The Australian Crime Commission report states that steroids, peptides and hormones are the most commonly used PIEDs by Australian athletes.

The 2010 National Drug Strategy Household Survey shows that recent use of steroids was low and stable at 0.3% or less, with lifetime use highest among those aged 20-29 years at 1.1%.

Anecdotal reports for Needle and Syring Programs services in NSW and QLD suggest increases in the number of people who inject PIEDs. In 2011, PIEDs injection increased from 2.4% in 2010 to 4.6% in 2011.

Recent data suggests that the Australian PIEDs market has expanded rapidly in recent years. There have been increased border seizures, with a 106% increase in the number of PIEDS detected at the Australian border between 2009-10 and 2010-11.

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. However, for professional athletes it is the advantage in physical strength and size that is the main reason for use.

Anabolic steroids— roids, gear, juice

Anabolic-androgenic steroids are derived from testosterone and can be administered both through injection and as a tablet. Steroids are used to treat medical conditions in humans thanks to the anabolic effects that assist in the growth and repair of muscle tissue. These are also the main reasons for illicit use. People who use PIEDS 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 problems


Peptides have become increasingly popular among professional and amateur athletes, due to fact that they are hard to detect as they are rapidly metabolised. Peptides stimulate the release of an increased level of human growth hormone, which has an important role in muscle and bone growth. Reported side effects of peptides include:

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


There are numerous hormones and hormone stimulating drugs in the PIEDs market. These include:

  • Growth hormones like AOD-9604, which has fat burning properties and is used by athletes to increase power to weight ratios. Currently undergoing clinical trials. AOD-9604 is not currently a World Anti-Doping Agency (WADA) prohibited substance.
  • Selective Androgen Receptor Modules (SARMs) appear to only act on anabolic receptors that cause tissue growth, unlike testosterone which acts on both anabolic and androgenic effects and are classed as a prohibited drug by WADA.
  • Insulin-like growth factors (IGF-1) are 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.
  • Mechano growth factor (MGF) is derived from IGF-1 and helps with tissue repair and adaptation. It is used mostly by bodybuilders and is on the WADA prohibited list.

Further information

Performance and Image Enhancing Drug fact sheets

  • Clenbuterol: Clenbuterol is classed as a 'beta-2 agonist' and its short-term effects are similar to stimulant drugs like amphetamine or ephedrine.
  • Creatine monohydrate: Creatine is a naturally occurring compound synthesised from amino acids by the kidneys and liver.
  • Erythropoietin (EPO): EPO is 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: Insulin may be illegally used in conjunction with anabolic steroids, in an attempt to increase muscle growth and definition.
Information you heard is intended as a general guide only. This audio is copyrighted by the Australian Drug Foundation. Visit for more