As researchers we are committed to incorporating into our activities the voices of those directly affected by research. Here we present some key comments collected to date for our research on performance and image-enhancing drugs, organised by topics. Future publications and presentations will be based on our interviews and the perspectives they elicited.

The accounts below were drawn from interviews conducted with Australian men living in cities and regional areas of Victoria, New South Wales, Queensland and Western Australia. The topics chosen represent only a small selection of the common themes that emerged in the interviews. The men interviewed expressed a range of views about performance and image-enhancing drugs and the role they have in their lives. Here we cover participants’ comments on how performance and image-enhancing drug consumption fits into their everyday lives, attitudes towards disclosure, relevant health concerns, experiences of accessing health care, and attitudes towards expertise (medical and otherwise) on performance and image-enhancing drugs.

Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added for clarity, e.g. ‘I want to maintain [my current level of consumption]’. Ellipses within square brackets –[…] – show where text has been removed in order to shorten the quote to include only relevant details. For example, ‘As long as I get my bloods done, I’m running PCTs [post-cycle therapies] and I’m not stupid with it. […] I’ve done a bit of research…like a little bit of research around it, I’m pretty confident I’ll be all right.’

PIED consumption and everyday life

Achievement

I do link it [my PIED consumption] in a lot with my weight training, so it’s always been around obviously improving myself at the gym, which improves my overall self-confidence, but it shows me, sort of in a way, that if I apply that same principle to other aspects of my life, I can use that to build on to reach goals in other areas, say employment and things.

(Richard, 25, Qld).

Looking good

I’ve always looked good, I’ve trained since I was 15 years of age … Being a gay man even, especially being a gay man as a matter of fact, it’s a very body beautiful culture out there and I learnt a long time ago that being a gay man muscled gives you like an incredible amount of choice … gay men are stupid over muscles. It’s like they see muscles and they go basically ga-ga and it’s like you can basically choose what you want.

(Ryan, 43, NSW).

Mental health

I suffer from anxiety. It’s been so bad in the past that I’ve not left the house for days on end because I have a little bit of social anxiety, and I notice within … I mean when you start taking steroids, it’s not like other drugs, it doesn’t hit you like a tonne of bricks all of a sudden. It’s like it just creeps [up] on you. You don’t even feel like a high or anything like that, but I notice within probably three or four days of my first couple of shots, that I start to feel a lot more confident, a lot more content within myself.

(Alex, 38, Qld).

Disclosure

Resisting stereotypes

Well, I’m not particularly open with my sort of steroid use, like if someone says, you know, ‘Are you using?’ I usually say, ‘Oh no, not really,’ or ‘I used to be, but…’ and it’s simply because there’s that connotation if you’re on steroids, then you’re angry or that you’re insecure about yourself or, you know, you’ve got some sort of body image issue, and I just don’t want that connotation put on me.

(Angelo, 35, NSW).

Stigma

It’s like a taboo subject. You know, like everyone’s in the gym and probably at least half the males in there are using performance-enhancing drugs, I reckon, and everyone’s using all different things […] but no one really says anything about it […] Injecting something into anyone’s muscle or using a needle, for one, would be the biggest taboo. People just can’t handle or they don’t like the idea of it, that it’s kind of like, I guess, it’s close to being a junkie.

(Ryan, 43, NSW).

Telling others

I’ve told a couple of people that I do it. No-one’s approached me unknowingly and asked me about it and I wouldn’t have a problem with them asking. I would be happy to tell them that I do. I don’t particularly like the kind of people that say they’re all natural, [when it is] very obvious what they’re doing. I’m not ashamed of doing it, I’m not doing it for … I don’t think the wrong reasons, so no it doesn’t make me feel bad at all.

(Kirk, 30, Qld).

Legal status

Well, it’s illegal to start with, so [it is] not really a good thing to kind of go on about. It’s funny because you’ll get the guys from work [who] will go out and get absolutely plastered after work on Friday, but if they found out that you injected something to go to the gym you’d be on the outer end, you’d be the one that, yeah, no one talked to any more. So it’s just that you’ve got to keep [it] quite close within certain circles and not something you discuss at large.

(James, 35, Vic).

Health issues

Medications and other drug consumption

I know that when I was first inquiring about PrEP [HIV pre-exposure prophylaxis] and, you know, whether or not you were suitable for it, one of the things they did say was, you know, ‘Are you on any sort of medication?’ and I said, ‘Well, I am using steroids right now,’ and, you know, they said, ‘Oh okay. Well, you know, PrEP…being on PrEP, there’s more potential issues with liver damage, with kidney damage, with bone density, so you being on steroids could potentially affect those sort of factors.’ So, you know, so far I haven’t had any sort of feedback that I’m having any liver or kidney damage, but it’s definitely one thing that they considered when I was starting off with PrEP.

(Angelo, 35, NSW).

Coming off

[I try] to maintain the same level of training, but it’s hard because after probably a month or maybe towards, after three weeks that you stop, you start to feel […] your body’s natural testosterone levels have declined and your body’s not producing as much because it’s getting it artificially. So then all of a sudden, you’re not getting anything come into your body artificially, your testosterone levels are down here, so then you start to become lethargic and tired and grumpy and you don’t feel like training as much. So trying to, yeah, trying to find that balance during that period is difficult.

(Joshua, NSW, 46).

Fertility

That’s the only real issue […] that I’d ever be worried about, but I mean how I look at it, I mean there are like pros that do ridiculous amounts more gear than I do and if I was to compare to dudes like that, I’m [doing] next to nothing, you know, and they still manage to be able to come back and have kids. As long as I get my bloods done, I’m running PCTs [post-cycle therapies] and I’m not stupid with it. […] I’ve done a bit of research…like a little bit of research around it. I’m pretty confident I’ll be all right. As long as I don’t suppress it for like years at a time, I think it should be okay. That’s why I think it’s important to have those off cycles so my body can get back to the point where it can produce natural testosterone itself. 

(Richard, 25, Qld).

Accessing healthcare

GP attitudes

But the judgement you get from the doctors, and I feel like as soon as you tell them what you’re doing […] they don’t care as much or they sort of judge you straight away. So, yeah, I haven’t really had…I’ve obviously told them that I have been doing steroids, but I’ve never had the conversation about injecting or anything past basically me just telling them I’ve been doing steroids.

(Nathan, 26, Qld).

NSP (needle exchange) access

It’s free, no questions asked. You just go in there and say, ‘I want a, you know, box of 3 mL syringes, 21 pins, the alcohol wipes,’ and they just give you a box of everything. He takes your age, your Indigenous status and whether it’s for performance-enhancing use or whatever, and that’s it. And then it’s all…so there’s no reason you should be getting stuff off other people or ever sharing or anything like that. So I’ve never really worried about it [hepatitis C] because I’ve always, I guess, trusted in the fact that the things I get from the places are sterile and obviously, like, all good.

(Richard, 25, Qld).

Non-judgmental approaches

[The needle exchange is] actually quite welcoming. Yeah, I really like the people behind the counter. They’re non-judgmental and they understand that we come in here to try and keep it clean, keep it healthy and they understand they’re providing a service and I think it’s a really good system.

(Kirk, 30, Qld).

Learning about PIEDs and their effects

Medical knowledge and support

So ideally I would like all performance drug users to be in an open dialogue with a doctor, general practitioner or a specialist, preferably to a specialist if they could get referred that far and if it wasn’t already understood by [the] individual user, then ideally those specialists would teach them or at least inform them of the requirements.

(Arnold, 24, Qld).

Academic research

When I first started out, I actually would go on to Google Scholar and, yeah, I just looked at every research paper that I could because, of course, yeah, you have a look through the forums, but it’s just a bunch of ‘bro-science’ on there. Everyone’s an expert because their older brother told them something, so yeah, I actually decided to go and have a look at the studies and, yeah, see what the actual results are and were, like how they affected the body, why they worked the way they did, what were the side effects.

(Joel, 26, Qld).

Forums

[I visit] forums, learning what other people did as well, but then the problem with forums is it’s not fact, it’s just what other people say. Even if there’s ten people that say, ‘Oh yeah, do this and this,’ what happens if all those ten people have got the wrong information?

(Jake, 24, Qld).