“More drugs means more stress on my body”: exploring enhancement and health among elite strength athletes who use performance and image enhancing drugs

Existing data reveals prevalent performance and image-enhancing drug (PIED) use in specific global regions and higher rates among athletes, however, research on performance-enhancement experiences among elite untested athletes is lacking. Drawing on conceptual frameworks that emphasize the intersection of context and practice, this research aims to gain insights into the subjective perspectives, motivations, and challenges faced by athletes in managing and optimizing their performance while using PIEDs. In-depth interviews were conducted with seventeen strength sports athletes, including powerlifters and bodybuilders, who had competed at national and/or international levels within untested federations. Thematic analysis was employed to examine the interview data within a social constructivist ontology. Findings revealed that PIEDs have dual roles as tools for enhanced recovery and heightened training stress, a delicate balance that aligns with Foucault’s notion of self-transformation through technological advancements. These substances exerted power beyond consumption events with long-term psychological effects such as anxiety and irrational behavior emerging as key concerns. Peers with lived experience were key actors in the relationship between responsible drug management, however, the need for informed guidance was acknowledged. Non-human actors, notably biometric data tracking, played a pivotal role in guiding substance consumption. The study underscores the need for further research and tailored frameworks to support the health and well-being of athletes in this domain while addressing the broader implications of PIED use in public health discourse. Specifically, this study highlights the significance of integrating lived experiences and social contexts, emphasizing the need for nuanced harm-reduction strategies in this space.