Background: Women comprise a minority of performance and image-enhancing drug (PIED) consumers, with use linked to undesirable side effects. Preliminary work suggests that many women have little knowledge of what substances they are using, with males close to them involved in their use. This study aimed to explore women's motivations for PIED use; to examine the negative health experiences related to use; and to understand how interpersonal relationships facilitate their use. Method: Women who had used PIEDs were invited to participate in an online survey (N = 28) and/or interview (N = 10). Open-text survey and interview data were analyzed using content and thematic analyses, respectively. Results: There were three key areas (motivations, health experience, role of third parties) within which 12 theme categories were developed from the survey data. There were three overarching themes developed from interviews that expanded on these data: socializing women's use, facilitating women's use, and PIEDs exacerbating existing issues. Conclusion: The findings substantiate the nuanced gender dynamics of women's PIED use, challenging stereotypes and revealing the complexity of their motivations and experiences. While women's reasons for PIED use may share some semblance with men's, there is a less comprehensive understanding of the physical and psychosocial impacts of these drugs. To empower women and destigmatize PIED use, interventions focusing on substance literacy and stigma management are crucial. Future research should explore these interventions’ effectiveness in promoting women's well-being and autonomy.