Performance and image enhancing drugs (PIEDs)

Performance and image enhancing drugs (PIEDs) are taken by people who wish to improve their physical appearance and/or enhance their strength and sporting performance.

Possible benefits include increasing the size and definition of muscles, reducing body fat, increasing strength/endurance and helping the body recover from injury. These benefits can increase a user’s confidence and self-esteem which may lead to them becoming psychologically dependent on these drugs.

The most widely used type of PIED are anabolic steroids however this group also includes peptides and hormones such as androstenedione, human growth hormone, erythropoietin, diuretics, and various stimulants

Peptides work by stimulating the release of human growth hormone, which has an important role in muscle and bone growth. Peptides have become increasingly popular among athletes as they are hard to detect due to how quickly they are absorbed by the body. Reported side effects include water retention, numbness in the hands and feet and increased tiredness. However, because many synthetic peptides are not approved for human use it is difficult to know exactly what their harms may be.

There are numerous artificial hormones and hormone stimulating drugs available 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.
  • Selective Androgen Receptor Modules (SARMs) which appear to act on anabolic receptors that cause tissue (such as bone and muscle) growth.
  • Insulin-like growth factors (IGF-1) used for muscle growth and the development of cartilage and bone.
  • Mechano growth factor (MGF) which is derived from IGF-1 and helps with tissue repair and adaptation.

Anabolic steroids

Anabolic steroids, Roids, Steroids, Juice

Anabolic steroids are by far the biggest group of PIEDs. They are a group of hormones which occur naturally in the body. They are responsible for growth, physical development and functioning of reproductive organs. In men the main hormone is testosterone which is also responsible for masculine features such as the growth of body hair and the deeper voice. Anabolic steroids also have a building effect on the body and increase muscle tissue.


Anabolic steroids have a limited medical use in the UK, mainly in the treatment of anaemia. They are not to be confused with corticosteroids which are commonly used for a number of medical conditions.

Anabolic steroids are used non-medically by bodybuilders, athletes and other sports people. They may come in tablet form and be taken orally, or in liquid form and prepared for injection.


According to Home Office statistics, anabolic steroids were used by 0.2% of 16-59 year olds and 0.3% of 16-24 year olds in 2018/19 in the last year.  


Use of performance enhancing drugs has been going on ever since the Olympic Games of ancient Greece. Anabolic steroids were first used by athletes in the mid 1950s and by the 1960s their use was widespread.

They were banned by the International Olympic Committee in the 1970s, but this didn’t stop their use and in the 1980s doping became a big issue at the Olympic games and other sporting events. Drug testing came into many sports and a number of famous athletes failed tests and were banned from competing. As drug testing became more sophisticated new ways were found to avoid being found positive.

The law

Anabolic steroids are Prescription Only drugs under the Medicines Act. They can only be sold by a pharmacist on the presentation of a doctor’s prescription.

Anabolic steroids are also class C drugs under the Misuse of Drugs Act. It is not an offence to possess anabolic steroids for personal use as long as they are in a medicinal form and are not counterfeit. It is an offence to supply them. The maximum sentence for supplying or producing steroids is 14 years, a fine or both.

In practice maximum sentences are rarely given out and the police will only arrest for steroid possession if they can prove the drugs are not prescribed by a doctor. For more information please see the sentencing page on the Release website.


Although medical experts disagree, on balance it seems that taking anabolic steroids combined with intensive training and a high protein diet builds body weight and increases the size of muscles. They also often make users feel more aggressive and competitive and better able to perform strenuous physical activity.

There are reports of regular users becoming physically violent and sexually abusive in a fit of so called ‘roid rage’. But whether those involved had violent tendencies in the first place is unclear.

“When you hear about steroid users getting into fights because of the drugs, they are mainly idiots. They are the idiots of society who want to cause trouble and steroids allow them to become even bigger idiots.”

Quoted in Korkia and Stimson Anabolic Steroids use in Great Britain 1993.

Users often take steroids in multiple combinations and at much higher doses than would be prescribed medically – this is called stacking. They may also take courses of steroids, known as cycles, which last between 4 and 12 weeks. Steroids can also be taken by stacking and cycling, this is known as pyramiding. This starts with a low dose (one or a combination), then the dose is increased over time up to a maximum dose. After, there is a rest period where none are taken and then the cycle starts again.

Some of the main risks of steroid use include:

  • Liver abnormalities and a rare form of hepatitis.
  • Hypertension – steroids encourage the body to retain water and raise blood pressure.
  • HIV and other infections if users inject and share injecting equipment.
  • Stunted growth in young people.
  • Changes in male reproductive system. Sperm output and quality is reduced and can take 6 months to return to normal. Sex drive may at first increase but then be lowered. Some men have also experienced over-development of their breast tissue.
  • Acne
  • Whilst not regarded as drugs of physical dependence regular steroid use can lead to psychological dependence when the user is convinced they cannot perform well without being on drugs. Some users say they feel lacking in energy and depressed after stopping steroids and continue to use them rather than face these symptoms.

Changes in the female body

Women report increased sex drive, menstrual problems and enlarged clitoris. They also run the risk of developing ‘masculine’ features such as growth of facial and body hair, deepening of the voice and decreased breast size. Once these happen they are usually irreversible even when steroid use stops.

Problems such as sleep disorders, confusion, depression and paranoia may also be experienced. These tend to lessen once steroid use is stopped.

“When I started I felt like superwoman. I felt I had superhuman strength and could run faster than ever. I was right and everyone else was wrong. This high feeling went on for about a month. Then I found I couldn’t sleep and I felt really tired. I started drinking like I never have before. And I started to be violent towards friends. One time I screamed at my sister and punched her in the face. And I’m not normally a violent person”.

Counterfeit drugs

Many PIEDs sold in gyms are counterfeit or designed for veterinary use. Counterfeit PIEDs pose additional risks. Many are made without the controls of legitimate drugs, and so vary in purity and also safety. Like most illicit drugs, you can never be sure of what is in them. Because PIED users often inject their drugs, sometimes in large quantities over a long period of time, they bypass their body’s natural defences to impurities and infections and run considerable risks. Counterfeits also vary in strength, which again can affect the safety of short and long-term use.

Harm reduction

It is important to give the body a break from steroids after using them, especially in a cycle.

Injecting is the most dangerous way of taking drugs. A big dose may be taken in one go and injecting can lead to serious infection, especially hepatitis and HIV if injecting equipment is shared so clean equipment should always be used.

Updated February 2022