Women's use of performance and image-enhancing drugs (PIEDs) carries a distinct set of risks to men, and yet little is known about their impact on female bodies, a University of Queensland study has found.
Risks to women include virilising effects, hormonal disruption and changes to menstrual and reproductive health, the report published in the Drug and Alcohol Review says.
However, even the most recent clinical guidelines on PIEDs were focused on research that had been done on men, one of the report's authors said.
"The research has centred on men's experiences and what this means for men's health and the benefits we associate with men," UQ research officer Hannah Schuurs told AAP.
"There might be one line about the fact that 'yes, women use these and might experience things differently', but women's experiences seem to just be dismissed."
Ms Schuurs has worked in the fitness industry and noticed men were more open about their use than women, who stayed silent due to stigma, she said.
Performance-enhancing substances are used to enhance body composition or sporting performance and are often associated with bodybuilders, who may access them illicitly.
Social media wellness trends have led to increasing peptide use outside of the bodybuilding world, with influencers promoting substances online to their followers.
The research found women felt they were dismissed or judged by health professionals, while being proactive in seeking to manage risks to their own health, and often faced "systemic barriers and knowledge gaps".
Responsibility for harm reduction and care coordination was being shifted onto the women themselves, rather than clinicians, the study said.
Nine women who had used PIEDs from Australia, the US and Canada were interviewed, under the condition of anonymity, with many reporting facing stigma from doctors.
An Australian bodybuilder, aged in her 30s, had her own systems in place to manage her health, including requesting routine blood tests.
"You will do damage if you don't monitor … I do my blood pressure every couple of days, resting heart rate all the time, my blood glucose," she said.
Another competitive bodybuilder felt "a lot of stigma" and when she asked for blood tests in Australia the doctor did not request hormone profiles because she was competing.
"I think the doctor just assumed that maybe I was on the PIEDs or something and it skewed it for whatever reason," she said.
Ms Schuurs hoped the study reinforced the importance of women's lived experiences, and called for health professionals to build a better rapport with their patients and ask questions about substances without stigma or judgment.
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