Non-athletic global consumption of performance-enhancing substances (PES), generally in anabolic androgen steroids (AAS) or selective androgen receptor modulators (SARMs) and fat-dissolving drugs such as clenbuterol, is a broadening health issue far beyond the highest levels of sport. This paper recontextualizes doping as a complex public health issue, which is promoted by misinformation systems, poorly regulated online marketplaces, social media intervention, and regulatory gaps. Translating epidemiological data, toxicological investigations, and media coverage into its inferences, it shows how PES has become widespread among young people, females, and recreational fitness men and women populations and depicts specific trends of physiological harm, mental illness, and extremely high pressure on healthcare delivery systems. The paper also criticizes the moralization of the use of PES by stating that there should be a transition to a public health model that acknowledges structural vulnerabilities and information asymmetries. The necessity of addressing the issue through multi-tiered interventions can be supported by comparing it with other challenges related to public health, such as opioid and tobacco use. They are intercontinental policy transformations, the control of digital platforms, educational prevention, gender-responsive outreach, and consumer authentication technologies. This paper has sought to help design a new discourse around the Doping phenomenon, one that will promote informed, fair, and prevention methods to a health pandemic that continues to escalate.
KeywordsDopingPublic HealthMisinformation
Sagoe, D., Molde, H., Andreassen, C.S., Torsheim, T. and Pallesen, S. (2014) The Global Epidemiology of Anabolic-Androgenic Steroid Use: A Meta-Analysis and Meta-Regression Analysis. Annals of Epidemiology , 24, 383-398. https://doi.org/10.1016/j.annepidem.2014.01.009
Piatkowski, T., Whiteside, B., Robertson, J., Henning, A., Lau, E.H.Y. and Dunn, M. (2024) What Is the Prevalence of Anabolic‐Androgenic Steroid Use among Women? A Systematic Review. Addiction , 119, 2088-2100. https://doi.org/10.1111/add.16643
Mingxing, L. and Yanfei, Y. (2025) Adverse Effects of Anabolic Androgenic Steroid Abuse in Athletes and Physically Active Individuals: A Systematic Review and Meta-analysis. Substance Use & Misuse , 60, 873-887. https://doi.org/10.1080/10826084.2025.2460986
Gestsdottir, S., Kristjansdottir, H., Sigurdsson, H. and Sigfusdottir, I.D. (2020) Prevalence, Mental Health and Substance Use of Anabolic Steroid Users: A Population-Based Study on Young Individuals. Scandinavian Journal of Public Health , 49, 555-562. https://doi.org/10.1177/1403494820973096
Fink, J., Schoenfeld, B.J., Hackney, A.C., Matsumoto, M., Maekawa, T., Nakazato, K., et al . (2018) Anabolic-Androgenic Steroids: Procurement and Administration Practices of Doping Athletes. The Physician and Sportsmedicine , 47, 10-14. https://doi.org/10.1080/00913847.2018.1526626
Mccomb, S.E. (2023) The Slim-Thick Ideal: Its Impact on Women’s Body Image and Eating, Exercise, and Body Modification Behaviours. https://yorkspace.library.yorku.ca/items/fa69db51-68a6-4d36-958a-c8f05f13d0e7
Rothstein, M.A., Wilbanks, J.T., Beskow, L.M., Brelsford, K.M., Brothers, K.B., Doerr, M., et al . (2020) Unregulated Health Research Using Mobile Devices: Ethical Considerations and Policy Recommendations. Journal of Law , Medicine & Ethics , 48, 196-226. https://doi.org/10.1177/1073110520917047
Adhikari, B. and Agrawal, A. (2013) Understanding the Social and Ecological Outcomes of PES Projects: A Review and an Analysis. Conservation and Society , 11, 359-374. https://doi.org/10.4103/0972-4923.125748
Nieschlag, E. and Vorona, E. (2015) Doping with Anabolic Androgenic Steroids (AAS): Adverse Effects on Non-Reproductive Organs and Functions. Reviews in Endocrine and Metabolic Disorders , 16, 199-211. https://doi.org/10.1007/s11154-015-9320-5
Antonopoulos, G.A. and Hall, A. (2016) ‘Gain with No Pain’: Anabolic-Androgenic Steroids Trafficking in the Uk. European Journal of Criminology , 13, 696-713. https://doi.org/10.1177/1477370816633261
Landy, J.F., Walco, D.K. and Bartels, D.M. (2017) What’s Wrong with Using Steroids? Exploring whether and Why People Oppose the Use of Performance Enhancing Drugs. Journal of Personality and Social Psychology , 113, 377-392. https://doi.org/10.1037/pspa0000089
Milano, G., Chiappini, S., Mattioli, F., Martelli, A. and Schifano, F. (2018) β‐2 Agonists as Misusing Drugs? Assessment of Both Clenbuterol‐ and Salbutamol‐Related European Medicines Agency Pharmacovigilance Database Reports. Basic & Clinical Pharmacology & Toxicology , 123, 182-187. https://doi.org/10.1111/bcpt.12991
Hilkens, L., Cruyff, M., Woertman, L., Benjamins, J. and Evers, C. (2021) Social Media, Body Image and Resistance Training: Creating the Perfect ‘Me’ with Dietary Supplements, Anabolic Steroids and Sarm’s. Sports Medicine - Open , 7, Article No. 81. https://doi.org/10.1186/s40798-021-00371-1
Brennan, R.J. (2017) Imposed versus Affect-Based Resistance Training Intensities on Adherence, Session Affect, Session Perceived Exertion, and Intrinsic Motivation Measures during a Six-Week Program in Novice Female Lifters 2017. Master’s Theses, State University of New York College. https://digitalcommons.cortland.edu/theses/40
Piacentino, D., Sani, G., Kotzalidis, G.D., Cappelletti, S., Longo, L., Rizzato, S., et al . (2022) Anabolic Androgenic Steroids Used as Performance and Image Enhancing Drugs in Professional and Amateur Athletes: Toxicological and Psychopathological Findings. Human Psychopharmacology , 37, e2815. https://doi.org/10.1002/hup.2815
Brennan, B.P., Kanayama, G. and Pope, H.G. (2013) Performance‐Enhancing Drugs on the Web: A Growing Public‐Health Issue. The American Journal on Addictions , 22, 158-161. https://doi.org/10.1111/j.1521-0391.2013.00311.x
Taylor, J. (2016) BBC NEWS. Steroids Sold Illegally via Facebook, BBC Investigation Finds.
Gibbs, N. (2023) #Sponseredathlete: The Marketing of Image and Performance Enhancing Drugs on Facebook and Instagram. Trends in Organized Crime . https://link.springer.com/10.1007/s12117-023-09491-4 https://doi.org/10.1007/s12117-023-09491-4
Coomber, R., Pavlidis, A., Santos, G.H., Wilde, M., Schmidt, W. and Redshaw, C. (2014) The Supply of Steroids and Other Performance and Image Enhancing Drugs (PIEDs) in One English City: Fakes, Counterfeits, Supplier Trust, Common Beliefs and Access. Performance Enhancement & Health , 3, 135-144. https://doi.org/10.1016/j.peh.2015.10.004
Cordaro, F.G., Lombardo, S. and Cosentino, M. (2011) Selling Androgenic Anabolic Steroids by the Pound: Identification and Analysis of Popular Websites on the Internet. Scandinavian Journal of Medicine & Science in Sports , 21, e247-e259. https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2010.01263.x https://doi.org/10.1111/j.1600-0838.2010.01263.x
Fabresse, N., Gheddar, L., Kintz, P., Knapp, A., Larabi, I.A. and Alvarez, J. (2021) Analysis of Pharmaceutical Products and Dietary Supplements Seized from the Black Market among Bodybuilders. Forensic Science International , 322, Article 110771. https://doi.org/10.1016/j.forsciint.2021.110771
King, L.A., McDermott, S.D., Jickells, S. and Negrusz, A. (2008) Drugs of Abuse. Clarke ’ s Analytical Forensic Toxicology , 3, 45-48.
Missoum, I. and Benmestoura, M.A. (2023) The Role of E-Commerce in the Development of Foreign Trade. PhD Thesis, Ibn Khaldoun University. http://dspace.univ-tiaret.dz/handle/123456789/13877
Vainio, O. (2024) Social Media Influencers’ Discourse on Steroids: Role Models or Cautionary Tales?
Geyer, H., Schänzer, W. and Thevis, M. (2014) Anabolic Agents: Recent Strategies for Their Detection and Protection from Inadvertent Doping. British Journal of Sports Medicine , 48, 820-826. https://doi.org/10.1136/bjsports-2014-093526
Alnuqaydan, A.M. (2024) The Dark Side of Beauty: An In-Depth Analysis of the Health Hazards and Toxicological Impact of Synthetic Cosmetics and Personal Care Products. Frontiers in Public Health , 12, Article 1439027. https://doi.org/10.3389/fpubh.2024.1439027
Nicholls, A.R., Cope, E., Bailey, R., Koenen, K., Dumon, D., Theodorou, N.C., et al . (2017) Children’s First Experience of Taking Anabolic-Androgenic Steroids Can Occur before Their 10th Birthday: A Systematic Review Identifying 9 Factors That Predicted Doping among Young People. Frontiers in Psychology , 8, Article 1015. https://doi.org/10.3389/fpsyg.2017.01015
Galli, F., Palombi, T., Mallia, L., Chirico, A., Zandonai, T., Alivernini, F., et al . (2021) Promoting Media Literacy Online: An Intervention on Performance and Appearance Enhancement Substances with Sport High School Students. International Journal of Environmental Research and Public Health , 18, Article 5596. https://doi.org/10.3390/ijerph18115596
Piatkowski, T., Robertson, J., Lamon, S. and Dunn, M. (2023) Gendered Perspectives on Women’s Anabolic-Androgenic Steroid (AAS) Usage Practices. Harm Reduction Journal , 20, Article No. 56. https://doi.org/10.1186/s12954-023-00786-x
Pereira, E., Moyses, S.J., Ignácio, S.A., Mendes, D.K., Silva, D.S.D.A., Carneiro, E., et al . (2019) Prevalence and Profile of Users and Non-Users of Anabolic Steroids among Resistance Training Practitioners. BMC Public Health , 19, Article No. 1650. https://doi.org/10.1186/s12889-019-8004-6
Solimini, R., Rotolo, M.C., Mastrobattista, L., Mortali, C., Minutillo, A., Pichini, S., et al . (2017) Hepatotoxicity Associated with Illicit Use of Anabolic Androgenic Steroids in Doping. European Review for Medical and Pharmacological Sciences , 21, 7-16.
Windfeld‐Mathiasen, J., Christoffersen, T., Strand, N.A.W., Dalhoff, K., Andersen, J.T. and Horwitz, H. (2022) Psychiatric Morbidity among Men Using Anabolic Steroids. Depression and Anxiety , 39, 805-812. https://doi.org/10.1002/da.23287
Paquette, C.E., Syvertsen, J.L. and Pollini, R.A. (2018) Stigma at Every Turn: Health Services Experiences among People Who Inject Drugs. International Journal of Drug Policy , 57, 104-110. https://doi.org/10.1016/j.drugpo.2018.04.004
De Sanctis, V., Soliman, A., Fiscina, B., Elsedfy, H., Elalaily, R., Yassin, M., et al . (2014) Endocrine Check-up in Adolescents and Indications for Referral: A Guide for Health Care Providers. Indian Journal of Endocrinology and Metabolism , 18, S26-S38. https://doi.org/10.4103/2230-8210.145055
Lisco, G., Giagulli, V.A., Iovino, M., Zupo, R., Guastamacchia, E., De Pergola, G., et al . (2022) Endocrine System Dysfunction and Chronic Heart Failure: A Clinical Perspective. Endocrine , 75, 360-376. https://doi.org/10.1007/s12020-021-02912-w
Lazo-Porras, M., Liu, H., Ouyang, M., Yin, X., Malavera, A., Bressan, T., et al . (2022) Process Evaluation of Complex Interventions in Non-Communicable and Neglected Tropical Diseases in Low-and Middle-Income Countries: A Scoping Review. BMJ Open , 12, e057597. https://doi.org/10.1136/bmjopen-2021-057597
Hill, S.A. and Waring, W.S. (2019) Pharmacological Effects and Safety Monitoring of Anabolic Androgenic Steroid Use: Differing Perceptions between Users and Healthcare Professionals. Therapeutic Advances in Drug Safety , 10, 1-10. https://doi.org/10.1177/2042098619855291
Bewley, A. and Dermatology Working Group (2008) Expert Consensus: Time for a Change in the Way We Advise Our Patients to Use Topical Corticosteroids. British Journal of Dermatology , 158, 917-920. https://doi.org/10.1111/j.1365-2133.2008.08479.x
Brennan, R., Wells, J.S.G. and Van Hout, M.C. (2018) “Raw Juicing”—An Online Study of the Home Manufacture of Anabolic Androgenic Steroids (AAS) for Injection in Contemporary Performance and Image Enhancement (PIED) Culture. Performance Enhancement & Health , 6, 21-27. https://doi.org/10.1016/j.peh.2017.11.001
Newman, H.J.H., Nyhagen, L. and Thurnell-Read, T. (2025) Moral, Health, and Aesthetic Risks: Performance-Enhancing Drug Use and the Culture of Silence in the UK Strongwoman Community. Qualitative Research in Sport , Exercise and Health , 17, 173-188. https://doi.org/10.1080/2159676X.2024.2440448
Hughes, A. (2024) More than Muscle: Steroid Handbooks and Bodybuilding Subculture, 1981-1989. PhD Thesis, University of Guelph.
Harvey, O. (2020) Male Anabolic Androgenic Steroid-Users: A Mixed-Methods Study. The Voice of the AAS-User. PhD Thesis, Bournemouth University. http://eprints.bournemouth.ac.uk/34446/
Blanco, C., Wiley, T.R.A., Lloyd, J.J., Lopez, M.F. and Volkow, N.D. (2020) America’s Opioid Crisis: The Need for an Integrated Public Health Approach. Translational Psychiatry , 10, Article No. 167. https://doi.org/10.1038/s41398-020-0847-1
Pope, H.G., Wood, R.I., Rogol, A., Nyberg, F., Bowers, L. and Bhasin, S. (2013) Adverse Health Consequences of Performance-Enhancing Drugs: An Endocrine Society Scientific Statement. Endocrine Reviews , 35, 341-375. https://doi.org/10.1210/er.2013-1058
Taylor, J.L., Johnson, S., Cruz, R., Gray, J.R., Schiff, D. and Bagley, S.M. (2021) Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings: Harm Reduction in Outpatient Addiction Treatment. Journal of General Internal Medicine , 36, 3810-3819. https://doi.org/10.1007/s11606-021-06904-4
Abdel-Tawab, M. (2017) Do We Need Plant Food Supplements? A Critical Examination of Quality, Safety, Efficacy, and Necessity for a New Regulatory Framework. Planta Medica , 84, 372-393. https://doi.org/10.1055/s-0043-123764
Rycyk, M.T. (2010) Dietary Supplements and the DSHEA of 1994: Is Reform Needed to Ensure Safety? PhD Thesis, University of Georgia. http://getd.libs.uga.edu/pdfs/rycyk_matthew_t_201005_ms.pdf
Mine, Y. and Young, D. (2009) Regulation of Natural Health Products in Canada. Food Science and Technology Research , 15, 459-468. https://doi.org/10.3136/fstr.15.459
Traver, N.A. (2023) Dietary Suspects: Extracting the Truth from Dietary Supplements with a Standardized Federal Testing Seal. Arizona State Law Jour nal , 55, 767-811.
Labuda, J., Barek, J., Gajdosechova, Z., Goenaga-Infante, H., Johnston, L.J., Mester, Z., et al . (2023) Analytical Chemistry of Engineered Nanomaterials: Part 1. Scope, Regulation, Legislation, and Metrology (IUPAC Technical Report). Pure and Applied Chemistry , 95, 133-163. https://doi.org/10.1515/pac-2021-1001
Nilsson, S., Baigi, A., Marklund, B. and Fridlund, B. (2001) Trends in the Misuse of Androgenic Anabolic Steroids among Boys 16?17 Years Old in a Primary Health Care Area in Sweden. Scandinavian Journal of Primary Health Care , 19, 181-182. https://doi.org/10.1080/028134301316982423
NSF International (2022) Certified for Sport® App | Certified for Sport®. https://www.nsfsport.com/news-resources/certified-for-sport-app.php
Azca, R.M., Hidayati, N. and Zahra, N. (2025) How Product Attributes, Halal Certification, and Labdoor Certification Affect Purchasing Decisions for Whey Protein Supplements? Dialektika : Jurnal Ekonomi dan Ilmu Sosial , 10, 161-174. https://doi.org/10.36636/dialektika.v10i1.5619
McCann, M.A. (2005) Dietary Supplement Labeling: Cognitive Biases, Market Manipulation & Consumer Choice. American Journal of Law & Medicine , 31, 215-268. https://doi.org/10.1177/009885880503100204
Prove It, App Store (2025) Prove It—Supplement Scanner. https://apps.apple.com/us/app/prove-it-supplement-scanner/id6740288836
Kalaivani, R., Gopinath, M., Kumar, S. and Surya, P.R. (2024) Fake Food Product Detection Using Block Chain Technology. International Research Journal on Adv anced Science Hub , 6, 82-87. https://doi.org/10.47392/irjash.2024.015