Other Performance and Image Enhancing Drugs (PIEDs) – printable pdf

Non-prescribed medications are used within the bodybuilding community. The intention of their use is to counteract the side effects inherent in AAS use. The side effects these other PIEDs cause is an inescapable irony. They are used outside of their intended therapeutic applications.

 You are urged to read the manufacturers Patient Information Leaflets (PIL), with particular attentions to the side effects, warnings and cautions within.

Click on the medication’s underlined generic name to open the PIL. Click back icon to return to page.

The following is not an endorsement for the use of any of these medications for performance and image enhancing purposes.

Vitruvian Man provides specialist health advice and monitoring – not suggestions for drug regimes. It is, however, a judicious acknowledgement that non- prescribed medication use exists. Within this context, Vitruvian Man aims to provide authoritative information to minimise harm and reduce risk by promoting informed decisions.

“You pays your money and you takes your choice”

Aldous Huxley, author of Brave New World


Post Cycle Therapy Drugs

A regime to “kick-start” the Hypothalamus Pituitary Testicular Axis (HPTA) into increasing natural testosterone production which will have reduced during the steroid cycle. This is commonly attempted with varying results, through the use of the following drugs;

  • HCG; mimics Luteinising Hormone (LH), a hormone in the HPTA cascade produced by the pituitary gland, to stimulate the testes to produce testosterone.

Human Chorionic Gonadotrophin (HCG) HCG

  • Clomid and Tamoxifen; both are anti-oestrogens. They inhibit oestrogen feedback to the hypothalamus resulting in the pituitary being “instructed” to produce more Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH), therefore “instructing” the testes to produce more testosterone. HCG and Clomid are medically used in the treatment of female fertility. Tamoxifen is for breast cancer and can be prescribed off-license for breast pain.

Clomid Clomifene citrate

Nolvadex – American brand name Tamoxifen

Aromatase Inhibitors

These medications are commonly used to stop the conversion of testosterone to oestrogen via the aromatase enzyme. They differ from Selective Estrogen Receptor Modifiers (SERMs – tamoxifen, for example) by stopping the aromatase enzyme working rather than blocking the oestrogen receptors to prevent circulating oestrogen exerting it’s effects. AI’s, over time, result in undesirable changes in blood lipid profiles and bone density.

Arimidex anastrozole

Aromasin exemestane

Evista raloxifene

Faslodex fulvestrant

“Letro” Femara letrozole



Technically an anabolic steroid. Mesterolone binds to the aromatase enzyme as well as the Sex Hormone Binding Globulin (SHBG). This is reported to increase bio available free testosterone, support libido and help prevent gynaecomastia.

Pro-viron mesterolone


Reductase Inhibitors

Excess testosterone reduces (converts) via the 5 – alpha Reductase enzyme to dihydrotestosterone (DHT). DHT has a high affinity to androgen receptors in the prostate, scalp and skin leading to prostate enlargement, male pattern baldness and acne. All other androgens cause these side effect too, not exclusively DHT.

Some steroids are derivatives of DHT with the intention of producing a non-aromatising product.

The following medications are 5 – alpha Reductase inhibitors used to stop/reduce the conversion of testosterone to DHT. Impotence is a frequently occurring side effect of Reductase inhibitors.

Proscar finasteride

Avodart dutasteride



Certain non-aromatasable steroids,  19 – norandrogens (Deca, for example) – and Trenbolone in particular – can result in gynaecomastia like symptoms by increasing progesterone. They also reduce libido and delayed ejaculation as a result of increased prolactin levels. The following medications are used to address this. The intention being to increase dopamine, thereby inhibiting prolactin secretion. They’re medically used in the treatment of Parkinson’s disease and have significant side effect profiles when misused.

“Bromo” bromocriptine

“Caber” cabergoline

“Prami” pramipexole


Human Growth Hormone

Used as an adjunct to a mass cycle as it promotes cellular protein synthesis. More frequently used as part of a dieting regime, as it stimulates lipid metabolism. Lipid profile testing is recommended as HGH increases plasma fatty acids (triglycerides). In the manufacturers Summary of Product Characteristics, a thyroid function test is recommended to assess for any pre-existing hypothyroidism.

HGH in high quantities or durations will result in growth of internal organs and bones, particularly in the face hands and feet.

Insulin resistance with progression to type II diabetes is possible due to impaired glucose tolerance.

Paradoxically, large doses can initially lead to hypoglycaemia (low blood sugars) as it is converted to Insulin like Growth Factor -1 in the liver, then hyperglycaemia (high blood sugars). Glucose testing recommended.

“GH” somatropin



Insulin like Growth factor, as the name suggests, acts similarly to insulin and can dramatically reduce blood sugars to dangerous levels. Like insulin, IGF-1 can promote fat storage.

“IGF -1 mecasermin



Extremely dangerous. It is reported to be used – and not without risk – with growth hormone (which can raise blood sugar levels). Insulin is non-specific to where it shuttles nutrients from the blood stream. Not just into skeletal muscle but also fat cells.

It will dramatically drop blood sugar levels. This can result (and regrettably has) in loss of consciousness, coma and death.

Actrapid Insulin


Thyroid Medication

Most frequently used to increase metabolism to aid fat loss. Also reported to be often used concurrently with HGH, due to the increased conversion of T4 to T3 by HGH. It is of note that this is the normal physiological pathway in thyroxine production anyway. It is not a recommended practice as it will suppress natural Thyroid Stimulating Hormone (TSH).

Acute overdoses of thyroid medications can be lethal. T3 is considerably more potent than T4.

“T3” Cytomel – American brand name liothyronine

“T4” Thyroxine levo thyroxine



Acne, at time severe, is a common side effect of AAS use. Roaccutane’s side effect profile is considerable and will also worsen other AAS side effects such as deranged lipids, liver function, blood cells and mental health.

Blood donation must be avoided during – and for at least one month after – this medication.

This raises dilemmas as many AAS users choose to donate blood regularly to reduce their raised (AAS induced) haematocrit levels.

Roaccutane isotretinion


Erythropoietins (EPO)

Used to increase red blood cell production. The intention being to increase the capacity of the blood to deliver oxygen to the muscles, improving endurance and vascularity.

Can lead to hypertensive crisis and siezures. As with AAS use, can dangerously raise red blood cell concentrations. Used medically for anaemias in chronic renal failure

“EPO” Eprex Epoetin


There is currently no UK medical precribing literature on this tanning product, despite it’s increasing popularity.

It is not a prescribable product and no Summary of Product Characteristics or Patient Information Leaflets are available.

The following link to http://www.siedsinfo.co.uk/profile_melanotan.html offers valuable information. This website comes with Vitruvian Man recommendation and can be accessed in full from the “Useful Links” page on this website.



AAS use, particularly highly androgenic steroids (testosterone esters and Dianabol to name but two), can result in water retention through the artificial imbalances of hormones and electrolytes (sodium, for example). Competing bodybuilders use diuretics to shed “excess water” to improve muscle definition. Unfortunately so do a few aspiring bodybuilders who mistake water retention for simply being a bit fat.

Diuretics are dangerous. They can induce life threatening levels of dehydration and electrolyte imbalances – which cause cardiac arrhythmias – and death.

Aldactone spironolactone

Lasix furosemide


For available tests and prices see Tests and Fees


This page has been created in appreciation to the generosity of  Vitruvian Man’s valued clients who’ve shared their experiences. Thanks also to those of you who – in your hundreds –  have spoken frankly and candidly with me in the Needle Exchange Programme where I also work as the Anabolic Steroid Lead. You all know who you are.


Vitruvian Man – Squaring the circle of men’s health