Objectives There is limited research into the use of performance and image enhancing drugs (PIEDs) among women who participate in sport, despite evidence that women do use these substances and experience related harms. The aim of this project is to capture stakeholder perspectives on the current research, policy, and practice landscape in Australia regarding women's PIED use in regulated and unregulated sport settings.

Design Qualitative interviews.

Methods Thirty-two semi-structured interviews were conducted online with stakeholders from Australia between September and December 2021. Interviews ranged between 15 and 90 min in duration. Data were imported into the NVivo (Version 12) platform and analysed using thematic analysis.

Results Thirty-two participants (20 females and 12 males) who held a variety of roles (e.g., coach/strength coaches, gym owners, anti-doping agents, athletes) were interviewed. Fourteen participants reported PIED use. There were four overarching themes generated from the data: ‘participation in untested sports’; ‘environmental factors driving use’; ‘individual rationalisation’; and, ‘the dark side of PIED use’.

Conclusions PIED use was identified as an issue of concern for women competing in non-elite strength and power-based sports. Of particular concern is the influence of unqualified advice from third parties (i.e., coaches and partners) regarding PIED use. The environments in which PIED use occurs can impact individual decisions of women and eventuate in significant and long-lasting physical and psychological harms.