Image-enhancing Drugs Research Articles

Who Veridicts Health? Health Professional Discourses on Performance and Image-Enhancing Drugs (PIEDs), Health, and Masculinity

This article explores the ways in which Australian health professionals performatively constitute the relationships between performance and image-enhancing drugs (PIEDs), health, and masculinity. It draws on the work of Judith Butler, John Law and Bruno Latour to argue that interviews with health professionals stabilize PIEDs, somewhat paradoxically, as inherently dangerous substances that distort and damage “natural” bodies, and as important medical technologies that can reverse this damage when administered “legitimately.” On the basis of interviews with 20 Australian health professionals who, in the course of their work, encounter men who consume PIEDs, we identify some of the mechanisms through which PIED consumers are excluded from health services, and are sometimes enacted as difficult and deceitful. Rather than taking these as reflecting pre-existing truths about PIED consumers, we show how, when framed within the assumed authority of medical expertise, discourses of “the natural,” health and masculinity produce these realities. Through these entanglements, masculinity is performed as natural to the body, and self-guided, experimental and illicit consumption of drugs constitutes the consumer, his body and his masculinity as unnatural, deceptive, and inauthentic. We conclude by arguing that treating men who consume PIEDs as potential co-experts, acknowledging the uses of PIEDs, and having open discussions could improve health outcomes for this group. Such a move, we propose, might also intervene in the iterative practices that work to regulate so-called “real” and “authentic” masculinities to create more expansive possibilities for men.

Consuming 'God Juice': Using 'ethnopharmacological-connoisseurship' to situate trenbolone use and knowledge among image and performance enhancing drug communities.

Trenbolone, a potent anabolic-androgenic steroid (AAS), is used for its muscle growth benefits but poses significant health risks, including psychosocial issues. Existing research among humans is limited by lack of targeted investigation. This study addresses gaps in existing research by leveraging the ethnopharmacological expertise of trenbolone consumers. By engaging with the community's connoisseurship, we sought to enhance harm reduction strategies and foster collaboration between consumers, scholars and health practitioners. An international sample of trenbolone consumers (N = 30) were interviewed. Interviews explored trenbolone use, knowledge levels and harm reduction strategies. Analysis involved an iterative categorisation approach, incorporating the lead author's lived experience with trenbolone. Participants described trenbolone as both a physical enhancer and a source of psychological boosts, tempered by adverse effects such as emotional volatility and intrusive thoughts. Despite warnings about its dangers the drug's allure was amplified by social media and community visibility. Consumers spoke of a developing connoisseur-like knowledge about trenbolone through personal and shared experiences. Through this collective expertise, they developed harm reduction strategies such as conservative dosing and regular health monitoring. This study demonstrates the importance of integrating ethnopharmacological-connoisseurship from the image and performance enhancing drug community to develop a contextually relevant understanding of AAS use-trenbolone being one of these. By elevating community insights, we advocate for a collaborative approach to harm reduction. Ultimately, we call for partnerships between researchers, health professionals and consumers to enhance health and reduce harm in image and performance enhancing drug communities.

The ethics of enhancement among image and performance enhancing drug coaches

ABSTRACT This research examines image and performance-enhancing drug (IPED) use, specifically focusing on the emerging role of IPED coaches. Situating drug use within broader assemblage theory, we investigated how these coaches, often operating in an online context, function as enabling environments, influencing practices, and contributing to harm reduction in a broader social context within and for IPED communities. Ten IPED coaches were interviewed, with this work focusing on their legal, ethical, and moral considerations, risk assessment, and harm reduction strategies of their practices. We employed a critical realist approach, following flexible coding to identify and develop themes which were further framed an enabling environments framework. Coaches operated along an ethical tightrope, emphasising the conscious regulation of conduct within established norms and the nuanced assessment of risks aligned with individual goals and motivations. Power dynamics and responsibility concerns unfolded through the lens of collaborative decision-making, where trust emerged as an essential element of these relations within contextual risk assessments. IPED coaches play a role in harm reduction by fostering trust and informed decision-making, balancing clients’ goals with health considerations. These findings emphasise the potential for collaboration between IPED coaches and the health workforce to enhance health promotion and support within IPED communities.

The health effects of non-prescribed anabolic-androgenic steroid use: Findings from The Performance and image-enhancing drugs UseRS' Health (PUSH) audit.

To ascertain the adverse health outcomes experienced by those using prescribed testosterone and non-prescribed anabolic-androgenic steroids presenting to general practitioner (GP) clinics. Retrospective clinical audit from nine GP clinics in major metropolitan areas across three Australian states. Data included demographic and individual characteristics (age, sexuality, body mass index, smoking status and HIV status); performance and image-enhancing drug use (type, reasons for use, patient-reported adverse effects); and blood biochemistry measurements (lipid profiles, liver function tests and red blood cell tests). Adverse health outcomes included evidence of polycythaemia, hypertension, liver abnormalities and hypercholesterolemia. Three hundred men were identified as either using prescribed testosterone (66%; n = 197) or non-prescribed anabolic-androgenic steroids (AAS) (34%; n = 103). Individuals in the prescribed group were more likely to be older (p < 0.001), gay or bisexual (p < 0.001) and living with diagnosed HIV (p < 0.001) compared to individuals in the non-prescribed group. Abnormal liver function, polycythemia and gynecomastia were the top three adverse events experienced. When adjusting for age, sexuality, HIV status and smoking status, those who used non-prescribed AAS were more likely to experience any adverse event (aPR = 1.28; 95% CI 1.01-1.60; p = 0.038), hypertension (aPR = 1.86; 95% CI 1.19-2.91; p = 0.006) and liver abnormalities (aPR = 1.51; 95% CI 1.04-2.20; p = 0.030) compared to those using prescribed testosterone. For GPs who have clients who may be using, or who they suspect of using, AAS, these findings highlight the importance of not only exploring a patient's history of the adverse effects they have experienced, but that measuring for these other conditions may provide a more accurate clinical picture.

A hormonal side effect of anabolic steroids among a sample of Baghdad male bodybuilders

Anabolic-androgenic steroids (AAS) are used widely, but in illegal ways mostly by young men as performance-enhancing and image-enhancing drugs (IPED). long-term usage of AAS, usually in conjunction with other illegal substances, can have extremely detrimental impacts on the reproductive system. The primary goal of this study was to examine any possible detrimental effects of AAS on sex hormone levels, a liver and kidney function in individuals who frequent fitness centers in Iraq-Baghdad. In this research, there are 60 participants (20–37 years old); 30 athletes who visited the different gyms in Baghdad/ Iraq and used AAS such as testosterone, Boldenone, Cybontae, Deca Durabellin; and 30 athletes who did not take any synthetics hormones and serve as control. All participants answered the questionnaire form which included their age, the type of used AAS, when they started to take it, and the total usage number per week. The blood (5 ml) was drawn from every participant to separate the serum. The serum was used to measure some hormones (Testosterone, FSH, LH, prolactin and Estrodiol) and liver and kidney function parameters. The results showed a significantly lower level of testosterone and FSH in the AAS-users’ bodybuilding group compared to the control group. In comparison with the control group, there was a notable rise in the PRL level in the serum of AA users. However, when comparing the serum levels of LH and Estrodiol in the AAS-user group to those in the control group, no discernible variations were seen. AAS users had a significantly higher level of ALT and lower ALP than controls, although there is no difference in AST levels between the two groups. The creatine level was significantly higher in the AAS-user compared to the control group, but not urea. In conclusion, the effects of AAS and other supplements on sex hormones and kidney, liver function, and vary depending on how long they are used, with the effects of AAS being more pronounced. Therefore, there is a need for culturally sensitive measures to prevent steroid abuse among youth.

Performance and Image Enhancing Drug Use Among Australian Women: The Role of Interpersonal Relationships in Facilitating Use

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.

‘The general concept is a safer use approach’: how image and performance enhancing drug coaches negotiate safety through community care

Background Drug coaches are a novel extension of traditional personal trainers who play a significant role providing support and shaping drug-related behaviours for people who use image and performance enhancing drugs (IPEDs). They constitute a critical domain for everyday risk management, where substance use, and its associated harms are influenced by social exchange. This study investigated how IPED coaches negotiate safety within the community through the provision of their services and the partnerships they form with clients. Method Ten IPED coaches, selected through purposive sampling, engaged in semi-structured interviews (32–57 minutes in length) exploring the way in which they operate in their field of practice. Iterative inductive analysis was applied to the transcripts, enhanced by discussions among researchers and an independent coder. Results The findings are organised under three categories, revealing the nuanced strategies and identities of IPED coaches, emphasising harm reduction and optimising ‘gains’ in IPED use. These coaches play a significant role in harm reduction, wielding their ‘chemical capital’ and lived experience to integrate nuanced harm reduction strategies into their partnerships with clients. Conclusion Embodying a model of peer-driven knowledge exchange and emphasising open and inclusive discourse IPED coaches offer a vehicle toward integrated harm reduction strategies.

'Insulin is super dangerous if you don't know what you're doing': Situating the risks of insulin within the image and performance enhancing drug community.

Insulin is an essential treatment within diabetes management; however, it takes on a role of enhancement within image and performance enhancing drug (IPED) communities due to its anabolic effects. This study sought to provide insight into how IPED users perceive and manage the risks linked to insulin. We conducted semi-structured interviews with 10 individuals from Australia and United Kingdom who used insulin as part of their IPED protocols. The analysis followed an iterative categorisation approach and applied the lens of situated rationality theory. The decision to incorporate insulin was influenced by peers' experiences and preferences. Participants highlighted the risks and responsibilities associated with insulin use, emphasising the need for precise lifestyle habits. They recognised the potential dangers and called for comprehensive harm reduction strategies within IPED communities to respond to such concerns. Some participants expressed reluctance to discuss insulin openly, underlining the importance of education and awareness to mitigate health risks associated with underground and uninformed use. While people who use IPEDs demonstrate awareness of the risks associated with insulin, their practices of routinisation moderate these risks within the context of IPED use. Silence as a risk-reduction strategy highlights vulnerabilities among certain prospective users, while the hierarchical structure of IPED use establishes expertise and status within the community. Reconsidering insulin risks entails reframing harm reduction messages to better match the social dynamics of IPED communities. Closer ties between IPED communities can enhance support accessibility, particularly through peers, who, with their firsthand knowledge, can offer tailored guidance.

Masculine enhancement as health or pathology: gender and optimisation discourses in health promotion materials on performance and image-enhancing drugs (PIEDs)

ABSTRACT The consumption of performance and image-enhancing drugs (PIEDs) is commonly pathologised in public health discourse as stemming from an unhealthy relationship to masculinity, and is often framed as intrinsically ‘risky’ and fundamentally at odds with ‘good health’. This article examines Australian health promotion materials on PIEDs to analyse their role in shaping notions of good health, normal gender and appropriate self-improvement. To do so, it draws on the work of Butler, Law and Latour to consider how these materials co-constitute men and their health, often in problematic ways. First, we examine the ways in which PIEDs are constituted via a politics of the ‘natural’, then consider how the health promotion materials on PIEDs participate in the regulation of appropriate, healthy masculinity, and conclude by examining how adolescent masculinity is co-constituted with PIEDs. We observe a key tension between health promotion’s avowed interest in improvement and optimisation and its treatment of PIED consumers as aberrant, vulnerable and insecure subjects whose drive to enhance and optimise is characterised by pathology and addiction. We conclude by arguing that health promotion materials on PIEDs fail to acknowledge the exceedingly normative character of enhancement practices in contemporary society.

Big business: The private sector market for image and performance enhancing drug harm reduction in the UK

This article draws on three mutually independent ethnographic studies to explore the private sector market for image and performance enhancing drug (IPED) harm reduction in the UK, specifically examining (1) steroid accessory supplements; (2) blood testing services; and (3) bloodletting services. After contextualising the work with a discussion of IPED use and harm reduction and the substantial growth of the global health and fitness industry, each private sector provision is critically interrogated with the following questions in mind: what is the role and utility of these services compared to public sector provision? Why has the private sector begun to deliver IPED harm reduction products and services in the UK? And how does this provision relate to the health and fitness industry more broadly? The paper concludes with some reflections about the future direction of IPED harm reduction, the importance of community-led services, and the need to think innovatively if we are to best protect users’ health and wellbeing.

“More drugs means more stress on my body”: exploring enhancement and health among elite strength athletes who use performance and image enhancing drugs

Existing data reveals prevalent performance and image-enhancing drug (PIED) use in specific global regions and higher rates among athletes, however, research on performance-enhancement experiences among elite untested athletes is lacking. Drawing on conceptual frameworks that emphasize the intersection of context and practice, this research aims to gain insights into the subjective perspectives, motivations, and challenges faced by athletes in managing and optimizing their performance while using PIEDs. In-depth interviews were conducted with seventeen strength sports athletes, including powerlifters and bodybuilders, who had competed at national and/or international levels within untested federations. Thematic analysis was employed to examine the interview data within a social constructivist ontology. Findings revealed that PIEDs have dual roles as tools for enhanced recovery and heightened training stress, a delicate balance that aligns with Foucault’s notion of self-transformation through technological advancements. These substances exerted power beyond consumption events with long-term psychological effects such as anxiety and irrational behavior emerging as key concerns. Peers with lived experience were key actors in the relationship between responsible drug management, however, the need for informed guidance was acknowledged. Non-human actors, notably biometric data tracking, played a pivotal role in guiding substance consumption. The study underscores the need for further research and tailored frameworks to support the health and well-being of athletes in this domain while addressing the broader implications of PIED use in public health discourse. Specifically, this study highlights the significance of integrating lived experiences and social contexts, emphasizing the need for nuanced harm-reduction strategies in this space.

Investigating the methods and characteristics of the trafficking of performance and image enhancing drugs in Australia.

Using case law, the aims of this study were to document the methods for trafficking of performance and image-enhancing drugs (PIED) into Australia, and the characteristics of individuals and groups involved. Data was collected from judges' sentencing comments. Searches were conducted using the Australasian Legal Information Institute database across all states in Australia, for the period of January 2010 to December 2021. After removing duplicates and cases which did not meet the inclusion criteria, 31 cases were included in the analysis. Across the 31 cases, 37 individuals were named as being involved in the supply and/or trafficking of PIEDs, with three cases involving an unknown number of individuals. One case named four actors involved in the supply and/or trafficking of PIEDs, three cases involved three actors, four cases involved two actors and 17 cases involved one actor. In 20 of the 31 cases, individuals operated alone. Over half (19 of the 37) of the individuals were health professionals. The majority (n = 17) of cases involved prescription as the method of acquisition, while seven cases involved the importation of PIEDs. The small number of cases identified, with the majority involving only a single actor, and half of the cases involving those in the medical profession. The findings suggest that discrete occurrences of trafficking involves individuals or small groups that do not appear to be linked to large-scale networks or networks involving the supply and trafficking of other illicit substances.

Is the use of performance and image enhancing drugs (PIEDs) in women an issue of concern? The findings from a stakeholder consultation

ObjectivesThere is limited research into the use of performance and image enhancing drugs 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 performance and image enhancing drug use in regulated and unregulated sport settings. DesignQualitative interviews. MethodsThirty-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. ResultsThirty-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 performance and image enhancing drug 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 performance and image enhancing drug use’. ConclusionsPerformance and image enhancing drug 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 performance and image enhancing drug use. The environments in which performance and image enhancing drug use occurs can impact individual decisions of women and eventuate in significant and long-lasting physical and psychological harms.

Gendered perspectives on women’s anabolic–androgenic steroid (AAS) usage practices

BackgroundThe masculinizing effects from anabolic–androgenic steroid (AAS) appear to be different between men and women, leading to calls for more gender-specific information regarding women and AAS use. This study sought to gather perspectives from both men and women on the unique challenges surrounding women’s use of AAS, irrespective of their personal use. Secondly, the study interrogated how women’s AAS practices differ from those of men specifically.MethodsThe data presented in this paper come from a subsample of participants who participated in a larger study investigating women and performance and image enhancing drug (PIED) use in Australia. Participants were included in the current analysis if they were: (i) males or females who competed with or coached female strength athletes using AAS and (ii) female and male strength athletes who used AAS. The final sample comprised 21 participants of which there was a proportion of males (n = 7) and females (n = 7) using AAS.ResultsWomen’s choices in AAS selection were predominantly around oral compounds (e.g. Oxandrolone) as well as other PIEDs (e.g. Clenbuterol). Some women report the use of injectable AAS represents a change in the profile of the typical female user as it reportedly comes alongside drastic physical and psychological changes.ConclusionsThe unique challenges facing women who use AAS are largely isolation and stigma, with little evidence-based practice or education being available to them online or through peer-groups. Future work may consider piloting harm reduction strategies that may be co-designed with this group.

Impact of harm reduction practice on the use of non-prescribed performance and image-enhancing drugs (PIEDs): The PUSH! Audit

The PUSH! Audit was a cross-sectional study performed from May 2019 to May 2021. With each audit submitted, general practitioners (GPs) were asked about the impact of their engagement with their patients. In all, 144 audit responses were collected, with 81.6% ofaudits showing a change in behaviour. The changes noted were better monitoring (71.3%), treatment of adverse effects (64.4%), modified use (44.4%) and stopped use (12.2%). This study asking GPs about outcomes with each of theirpatients using non-prescribed PIEDs has shown significant changes in behaviour. There has been no previous work done to evaluate the potential impact of such engagement. The findings of this exploratory study of the PUSH! Audit suggest harm reduction for people who use non-prescribed PIEDs when engaged with GPclinics.

'My mind pretty much went to mush': A qualitative exploration of trenbolone in the performance and image enhancing drug community.

There are a variety of harms associated with anabolic-androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users. As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16). Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS-using peers and family members of users reported the readily observable effect of trenbolone. Users should be cognisant of the potential for significant harms and health-care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users.

Do you get what you see? The illicit doping market in Denmark - an analysis of performance and image enhancing drugs seized by the police over a one-year period.

This study examines doping products seized by the police in three regional police districts in Denmark from December 2019 to December 2020. The products, often referred to as performance and image-enhancing drugs (PIEDs), are described in relation to the country of origin, manufacturing company and the active pharmaceutical ingredient (API) stated on the packaging vs. the one identified by subsequent chemical analysis. The study also includes a description of the degree of professionalism by which the products appear according to EU requirements. A total of 764 products were seized during the study period. The products originate from 37 countries, mainly located in Asia (37%), Europe (23%), and North America (13%). 193 different manufacturing companies could be identified from the product packaging. The most frequent compound class was the androgenic anabolic steroids, found in 60% of the products. In 25-34% of the products, either no or an incorrect active pharmaceutical ingredient, relative to the one stated on the product, was found. However, only 7-10% contain either no API or a compound from a different compound class than the one stated. Most products had a professional appearance fulfilling most EU requirements for packaging information. The study shows that many different companies supply PIEDs to the Danish market and that counterfeit and substandard products are widespread. Many products do, however, appear professional to the user giving an impression of a high-quality product. Although many products are substandard, they most often contain an API from the same compound class as the one labeled.

In-Sample Stability of 52 Performance- and Image-Enhancing Drug Biomarkers in Wastewater

Wastewater analysis shows promise in tracking community use of performance- and image-enhancing drugs, yet their post-sampling stability remains unknown. To understand and minimize post-sampling analyte degradation, knowledge of stability and optimal preservation methods is essential. A selection of 52 performance-enhancing substance biomarkers relevant to sports doping and image enhancement were subjected to a series of stability experiments in wastewater, testing several conditions including two pretreatments, filtered and unfiltered, and three sample preservation methods, unpreserved, sodium metabisulfite addition, and hydrochloric acid addition to pH 2, and were assessed at three temperatures, 22, 4, and −20 °C, for up to 200 days. Results indicated that the optimum preservation techniques were filtration, with or without preservatives, and acidification to pH 2 without filtration, with the times to 50% transformation indicating that the majority had medium (40–160%) to high (80–120%) stability at 4 °C for up to 92 days and at −20 °C for up to 200 days. A typical sample collection and archiving scenario was assumed and evaluated for each biomarker using an interactive calculator made available online from this study. This study provides, for the first time, post-sampling/archiving stability assessments for 52 biomarkers of performance- and image-enhancing drugs in wastewater for six pretreatment methods.

Rethinking Women’s “Performance and Image-Enhancing Drug Consumption”: An Agenda for Ontopolitically-Oriented Research

Women’s “performance and image-enhancing drug consumption” is a growing phenomenon yet remains an under-studied area of research. This essay reviews the existing literature on women’s consumption and draws on Fraser’s concept of ontopolitically-oriented research to develop an agenda for future research. Ontopolitically-oriented research applies insights from Science and Technology Studies (STS) to consider the ontological politics of research practices, that is, the realities they enact and foreclose. We argue that the current focus in the existing literature on a limited set of methods and issues risks obscuring the diverse meanings and practices of women’s substance consumption for fitness and strength-training, and genders agency in ways that further entrench assumptions of women’s vulnerability and passivity. We consider issues pertaining to the nomenclature of performance and image-enhancing drugs, the gendering of agency in formulations of “health” risks and initiation experiences, and the need to understand women’s consumption practices in relation to broader cultural changes in health optimization and digital fitness cultures. We argue that ontopolitically-oriented research into women’s substance consumption for fitness and strength-training requires greater methodological diversity and attention to the politics of data generation. It should aim to constitute women’s experiences through terms, connections and coalitions that expand our understandings of women’s agency, and the gendered and social contexts of enhancement practices.

Men, bodywork, health and the potentiality of performance and image-enhancing drugs

ABSTRACT In a qualitative study on masculinity, embodiment and sexuality, we interviewed men who were recreational gym-goers about their bodywork practices in Melbourne, Australia. We also asked whether the men had used performance and image-enhancing drugs (PIEDs) as an adjunct to their bodywork practices. While none had used PIEDs, all were considering, or had considered, using them. We found that participants held varying opinions on PIED use and those who used them. The literature on PIEDs noted men’s concerns with body appearance and health and focused largely on individual problematic use, but non-users were not mentioned. A second issue in the literature focused on social influences on PIED use, but again with no mention of non-users. Discussion on risk reduction as a public health response did not mention non-users either. This paper, therefore, reports on non-users’ thoughts on, regular exposure to, and considerations of PIEDs and other men who use them. We propose that PIEDs might more usefully be understood as an everyday, if contradictory, consideration within most men’s bodywork and health practices. We argue that PIEDs constitute a discursive practice exposing a potentiality that engages non-users also and this requires new health promotion approaches.