Exercise and the use of image- and performance-enhancing drugs within the gym environment

Among the image- and performance-enhancing drugs (IPEDs), anabolic-androgenic steroids (AAS) are now a global public health issue. Once confined to sporting arenas and competitive bodybuilding, they have now reached an increasingly image-conscious general population. In addition to the well-documented evidence of physical harm caused by AAS, there is emerging evidence that in sustained high doses they affect the structure and functioning of the brain. For some of the newer drugs the potential long-term impact is unknown. The risks to health are compounded by polypharmacy, high levels of injecting, and variable product content and contamination resulting from the illicit market. Responses to the issue (i.e., the level and implementation of regulations, education and preventive activities, and treatment and harm reduction) vary. However, there are few data to inform the development of effective interventions, and there is a clear need to develop the evidence base, which requires effective engagement with drug-using populations