An international survey of image and performance enhancing drug coaches’ practices and services

Background: In the absence of governmental harm reduction support, the image and performance enhancing drug (IPED) community has developed its own strategies to mitigate drug-related risks, including the emergence of IPED coaches who provide guidance on drug use. Existing studies on IPED coaching are predominantly qualitative, with small, Western-based samples. Methods: This study employed a quantitative, cross-sectional survey to explore the lived experiences of forty-one IPED coaches from diverse global contexts, to examine IPED consumption, related harms, and the scope of coaching services they offer. Results: Coaches reported use of a wide range of injectable and oral steroids, alongside ancillary substances. Coaching practices varied considerably, with client numbers ranging from 0 to over 70. Service provision included bloodwork advice, analysis, and in some cases, drug supply. Conclusion: Findings demonstrate substantial heterogeneity in IPED coaching practices, providing a foundation for the development of a typology that distinguishes informed, evidence-aligned guidance from misinformed or potentially harmful practices within the community.