{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:36:28Z","timestamp":1788759388218,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Issue<\/jats:title>\n                    <jats:p>Performance and image\u2010enhancing drug (PIED) use among women is a growing phenomenon, particularly within weight\u2010training populations. Despite increasing prevalence, research on the psychosocial factors involved in women's PIED use remains emergent and fragmented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach<\/jats:title>\n                    <jats:p>This systematic review of mixed methods studies uses an integrative approach to explore perspectives, motivations and psycho\u2010social factors associated with women's use of PIEDs within weight\u2010training populations. The review also investigates gendered experiences that may exist among women who use PIEDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Findings<\/jats:title>\n                    <jats:p>Following screening, 22 articles were included in the review and five key themes emerged from the analysis. Women's experiences with PIEDs were found to be significantly shaped by pressures to conform to societal beauty standards and gendered expectations. Unlike men, who often receive guidance from peer\u2010driven \u201cbro\u2010science\u201d, women navigate PIED use largely in isolation, which increases potential risks. The stigma surrounding PIED use in women, particularly related to side\u2010effects such as virilisation, further deters open discussions and engagement with healthcare services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>These findings highlight the importance of developing gender\u2010specific educational materials and harm\u2010reduction initiatives to address the unique challenges faced by women using PIEDs. Additionally, health services should be equipped to engage with this population in a non\u2010judgmental manner and offer tailored support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a clear need for further research into women's experiences with PIEDs. Gender\u2010sensitive approaches to education, prevention, and healthcare are essential to mitigating the risks associated with PIED use among women in weight\u2010training communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dar.70112","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T01:49:43Z","timestamp":1770428983000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Systematic Review Investigating the Psychosocial Factors Influencing Initiation, Use and Subjective Experience of Performance and Image\u2010Enhancing Drugs in Women Who Weight\u2010Train"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7353-1027","authenticated-orcid":false,"given":"Hannah C.","family":"Schuurs","sequence":"first","affiliation":[{"name":"School of Psychology The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Walter","sequence":"additional","affiliation":[{"name":"School of Psychology The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4550-8460","authenticated-orcid":false,"given":"Leanne","family":"Hides","sequence":"additional","affiliation":[{"name":"School of Psychology The University of Queensland  Brisbane Australia"},{"name":"National Centre for Youth Substance Use Research The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7971-4625","authenticated-orcid":false,"given":"Mair","family":"Underwood","sequence":"additional","affiliation":[{"name":"School of Social Science The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"B.Larance L.Degenhardt P.Dillon andJ.Copeland Use of Performance and Image Enhancing Drugs Among Men: A Review(2005)."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2021.126340"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494820973096"},{"key":"e_1_2_10_5_1","volume-title":"National Drug Strategy Household Survey 2019","author":"Health AIo, Welfare","year":"2020"},{"key":"e_1_2_10_6_1","volume-title":"National Drug Strategy Household Survey 2022\u20132023","author":"Health AIo, Welfare","year":"2024"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-021-00550-z"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.peh.2021.100197"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2023.08.179"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102876"},{"key":"e_1_2_10_11_1","volume-title":"Little Big Men: Bodybuilding Subculture and Gender Construction \/ Alan M. 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