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.


Introduction
Women's "performance and image-enhancing drug consumption" 1 is a growing phenomenon yet remains under-studied with much of the scholarly literature focused on men's consumption. Performance and image-enhancing drugs (PIEDs) commonly include anabolic androgenic steroids, antioestrogenic agents, beta agonists (e.g., clenbuterol), stimulants, human chorionic gonadotrophin, human growth hormone and other prohormones, various peptides and insulin (Larance et al., 2008). While research suggests that men consume PIEDs at much higher rates than women, the overall prevalence of consumption among women is unknown, with limited national or international data sources and few targeted studies. The most common anabolic-androgenic steroids used by women are thought to be Stanozolol and Oxandrolone (Abrahin et al., 2017;Ip et al., 2010). These may be preferred as they produce fewer effects classified as androgenic, often referred to as "virilization," and may be considered "milder" or "less masculine" by women consumers (Sverkesson et al., 2020). Research also suggests that women tend to consume different substances than men, such as ephedrine, clenbuterol, human growth hormone, human chorionic gonadotropin and peptides .
Historically, PIED consumption was thought to be mainly limited to women who participated in competitive bodybuilding and elite sport, although this may be changing (Jesperson, 2013). The increasing centrality of health optimization imperatives in medical paradigms (Keane, 2011) and contemporary life more generally, along with the normalization of gym and fitness cultures (Andreasson & Johansson, 2013;Sassatelli, 2010) and changing norms around feminine physique and body ideals (Dworkin & Wachs, 2009;Toffoletti & Thorpe, 2021) mean that more women are likely consuming PIEDs for general health and fitness purposes (Henning & Andreasson, 2021;Kotzé et al., 2020). Women use PIEDs for muscle growth, strength development, weight loss, improved healing or recovery from injury, and improvements in overall health function (Van Hout & Hearne, 2016). Preliminary data collected for a new study on women's substance consumption for fitness and strength-training has also identified that some PIEDs, for example, peptides and human growth hormone, have a wider uptake among women for broader health enhancement, wellbeing and wellness, and antiageing purposes (Petersen, 2018;Van Hout & Hearne, 2016). These substances, sometimes referred to as "supplements," are part of an emerging cosmeceutical market developing around the enhancement of health and skincare, weight loss and anti-ageing (Martin & Glaser, 2011;Van Hout & Hearne, 2016). As we discuss below, the uptake and mobilization of the same substances across different cultural sites of health optimization suggest the need to take a broader perspective on "enhancement" consumption. In contrast to the existing tendency to approach these practices in relation to legal, regulatory and public health risks and harms, this essay advances sociological research into substance consumption for fitness and strength-training by advocating for such consumption to be understood as synergistic with other gendered health optimization and enhancement imperatives.
To develop this line of thought, this essay draws on feminist scholar Suzanne Fraser's (2020) concept of ontopolitically-oriented research, developed after STS scholar John Law's work on the performative effects of method. Building on insights from Latour and Woolgar's (1979) influential ethnography of a scientific laboratory, Law argues that scientific practices do not simply describe a pre-existing reality, but rather identify and assemble particular relations, objects and entities into specific realities. Importantly, because scientific practices rely on and reproduce particular framings, they can only ever be sensitive to some forms and relations while necessarily excluding others. In this sense, scientific practices do not just describe a corresponding reality, they assemble specific relations, objects and phenomena into necessarily partial, contingent realities. The apparent stability of these realities is achieved in practice: through repeated enactments (or in Law's term's the ongoing practice of "crafting"), realities become sedimented and assume the appearance of stability, but they are always open to change. As Law (2004) argues: To talk of enactment, then, is to attend to the continuing practice of crafting. Enactment and crafting never stop, and realities depend upon their continued crafting-and perhaps by people, but more often (as Latour and Woolgar imply) in a combination of people, techniques, texts, architectural arrangements and natural phenomena (which are themselves enacted and re-enacted). (p. 56) In elaborating the concept of enactment Law proposes a relational and emergent understanding of reality-making, in which realities are produced through continuing practices of inscription and crafting. If we apply these insights to women's substance consumption for fitness and strength-training, it becomes possible to approach it as a socio-culturally constituted phenomenon with its own organizing logics, rather than as an intrinsically "risky" site of illicit drug consumption. Fraser's (2020Fraser's ( , 2022 concept of ontopolitically-oriented research is especially useful for our aim of rethinking women's consumption for fitness and strength-training, attending in particular to the role of research in shaping its existing connections and scope. Fraser (2020) proposes that it is possible to harness the recognition of the performative, emergent character of reality to inform a research practice that embraces the action of research methods in constituting realities. She encourages researchers to consider which realities we wish to "research into being" and to "formulate our aims, questions, datasets and analyses accordingly, unconstrained by untenable aspirations to neutrality" (p. 8). In elaborating how we might operationalize this "ontopolitically-oriented" approach to research, she advocates for careful attention to: 1) the methodological performativity of naming in constituting research objects; 2) the ontological politics of data generation, including who and how we recruit; 3) the limits of representation and attention to relevant dynamics and effects that might be obscured in dominant representations; 4) the contingency of units of study; and 5) our capacity to only ever enact partial worlds through our research. Given the limitations that we identify below in the existing literature on women's consumption-such as lack of methodological diversity, the gendering of women's agency, and the siloed enactment of substance consumption for fitness and strengthtraining as distinct from broader social and technological relations-these insights are instructive for the development of a critical research agenda on women's substance consumption for fitness and strength-training. Drawing on an interdisciplinary approach including critical drugs studies, gender studies and feminist sport sociology, our aim is to document a range of contemporary issues that require further research and methodological innovation, and in so doing present an agenda for future research that can attend to the complexity and diversity of women's substance consumption for fitness and strength-training.

Interrogating the Category of Performance and Image-Enhancing Drugs
The first area we identify for future critical research on women's substance consumption for fitness and strength-training concerns the formulation of "PIEDs" as an object of study, including its implications for broader thinking around gender and enhancement effects. The ways in which substances are constituted as "drugs," in this case "performance and image-enhancing" drugs, has important epistemological and ontological effects (Fraser & Moore, 2011;Seear, 2013). Here, we take up Fraser's suggestion to consider the methodological performativity of naming in constituting research objects. The performativity of naming denotes how the act of naming helps to call the named object into being. Naming has definitional or ontological power: rather than simply describing a stable, anterior object, the process of naming helps to produce it, delimiting its contours and scope. As we mentioned earlier, the category of "PIEDs," traditionally defined, includes a wide range of substances, such as so-called "muscle" drugs (e.g., anabolic-androgenic steroids) and "image-enhancing" drugs (e.g., melanotan). Yet, despite references to PIEDs as an apparently stable, unified category, on further scrutiny it becomes clear that the boundaries of the category are contested and mutable: different drugs and consumption practices have been classified under its ambit, and these have changed over time. Van de Ven et al. (2019) describe some of these historical tensions in the constitution of PIEDs as a category, observing how the contextual boundaries of the category have shifted over the last two decades in relation to changing social concerns that the category PIEDs indexes: previously the category centered on "doping" in sport, but it has expanded to include the consumption of these drugs in other athletic and occupational settings. They write that "the main goals of these 'non-athletic' using groups is aesthetic modification, such as to lose weight or to increase muscle mass, and to a lesser extent, athletic enhancement" (p. 4). This shifting emphasis on motivations sometimes lead to a shuffling of terms in the title, for example, "image and performance enhancing" or "appearance and performance enhancing" drugs. However, recalling Fraser's point about the limits of representation, this discussion of nomenclature remains squarely focused on representation, driven by the question of how best to represent the motivations of those who use these substances. As such, these debates over nomenclature do not address the ontological effects and implications of naming. A critical approach to the construction of PIEDs prompts careful attention to the politics of the category itself and the modes of classification it authorizes. Following Foucault's (1982) notion of "dividing practice," we might usefully question how PIEDs is mobilized to set groups of people against each other by legitimizing certain consumption practices and delegitimizing or even stigmatizing others.
These foundational questions are rarely, if ever, considered in studies of PIEDs, yet they play a crucial role in defining the issues at stake and separating consumers into distinct categories with significant implications for policy and practice. One exception is Seear's (2013) paper on doping, where she argues that understandings of "doping" could be improved through an appreciation of the range of different actors that jointly produce drug "effects." Drawing on the concept of "intra-action" developed by feminist science studies scholar Karen Barad, Seear argues that "we would do well to consider more carefully the ways that policies, techniques, instruments, rules, and human and nonhuman actors as well as substances might intra-actively co-constitute doping effects" (p. 208, original emphasis). Exploring PIED consumption specifically, Latham and colleagues (2019) similarly argue that the category of performance and image-enhancing drugs is not merely descriptive but fundamentally political: The very term "performance and image-enhancing drugs" is, for instance, constituted in particularly gendered ways. Whilst we specify that our own work concerns men's PIED use, this is somewhat tautological as the category itself is constituted with and for men as its primary subject. (p. 151) This is a crucial observation, raising an issue that requires serious scholarly engagement: For whom and under what settings can substances be said to be "performance and image enhancing"? While the category of PIEDs purports to neutrally describe a category of substances or drug effects, a range of actors and relations are required to sustain this particular logic of enhancement.
For instance, as Latham and colleagues (2019) discuss, trans men use testosterone and other steroids in similar ways to non-trans men who use PIEDs, but the effects of their consumption is not generally categorized as "performance and image-enhancing." Consumed by differently sexed and gendered bodies, or mobilized in medical or healthcare settings, "PIEDs" are constituted as "hormones," with gender "transition" or "affirming" effects. Then again, for women, these substances can only be termed enhancing until a certain gender "threshold" has been exceeded, at which point the accumulation of muscle and "masculine"-coded side-effects disrupts the intelligibility of the female body and transgresses the normative ideals of the gender binary. In this context, the logic of performance and image enhancement falters due to the transgressive or threatening effects of these substances on intelligible gender performance. Put differently, PIEDs are no longer "imageenhancing" because they diminish rather than enhance normative femininity. Significantly, PIEDs are only PIEDs when consumed by non-trans men-this is a condition of their intelligibility, yet rarely explicitly acknowledged in research.
The non-trans male body is central to the formulation of "PIEDs" and underpins the technorationalist pharmacological logic that PIEDs are mere "enhancers" of already existing attributes or capacities (e.g., the muscled, male body). In contrast to this dominant view, Latham et al. (2019) argue that, like other enhancement practices engaged in by a wide range of subjects, PIED consumption should also be understood as a gender-enhancing technology "related to men's performance of masculinity" (p. 151, original emphasis). If we think about PIED consumption among non-trans women, trans men and women, and non-binary people, we can shift this definition slightly and argue that rather than "gender-enhancement," gender performativity is central to the ontology of PIEDs, regardless of who is consuming them. To foreground PIED consumption as intricately entangled with gendered practices and performances  (rather than as utilitarian or instrumental) is also to draw parallels with the many different forms of consumption, body work and other enhancement practices that gendered subjects are exhorted to take. For example, women engage in practices of drug consumption that might be understood as performance and image-enhancing, such as the use of weight-loss pills or depilatory creams, but these substances are generally excluded from the category of PIEDs as such practices are normalized for women through the social expectation to normatively perform femininity . Or, to provide a different example, Pienaar et al. (2020) and Moyle et al. (2020) both describe how LGBTQ consumers experiment with a range of drugs to enhance pleasure, facilitate sexual performance and transform gendered experiences, yet these practices are typically excluded from the remit of PIED consumption.
Taken together these analyses highlight the gendering and politics of the category PIEDs. In doing so, they invite a rethinking of the nomenclature of performance and image-enhancing drugs with greater sensitivity to the specificity of substances and effects, their variation and multiplicity across different gendered contexts of consumption, and connections to other "enhancement" practices. As we have just argued, the substances gathered under "PIEDs" do not objectively produce "enhancement" effects. Rather, as technologies of gender-as constitutive of, and inseparable from, gendered normsthey are productive of a multiplicity of gender expressions, embodiment styles and drugged effects. One important reason for rethinking their naming is to foreground these gendered coalitions and synergies so as to resist "trans exceptionalism," or what Heyes and Latham refer to as the "view that trans people are uniquely positioned with regard to gender norms" (2018, p. 174). By foregrounding non-trans men's consumption of steroids, for example, as gender enhancement, we can emphasize that it is not only trans people, or gender diverse persons, who are actively engaged in gender affirmation or transformation through drug and other enhancement practices, but all subjects.
For our purposes, the dismantling of PIEDs as a discrete object of study is also crucial for mapping points of connection across women's substance consumption practices in relation to health optimization and enhancement practices. In directing this alternative line of inquiry, we might usefully ask: What new practices and gendered subjects might emerge if we make the category of enhancement drug use more capacious? For example, how might other substances previously excluded from the category of "PIEDs," such as Botox and dermal filler, be productively analyzed alongside women's consumption of steroids and peptides? How is women's steroid or peptide consumption mobilized for new health enhancement goals, such as anti-ageing? What are the implications of gendered forms of "body work" for the pervasive and rapidly expanding culture of health optimization in Western neoliberal societies?

Gendering Agency and Risk
As addressed above, the gendered formation of PIEDs as an object of research has been largely invisible in the existing research. However, gender is notable in studies of women's substance consumption for fitness and strength-training through a focus on gendered harms and risks for women. For this reason, our second proposed research focus concerns the treatment of gender and agency to avoid reproducing totalizing notions of feminine vulnerability and passivity.
Before we move to analyzing this research, it is useful to briefly address the substantive body of feminist literature on women's bodybuilding (Boyle, 2005;Grogan et al., 2004;Heywood, 1998;Ian, 2001), and women's growing participation in strength training practices such as CrossFit and powerlifting (Brighton et al., 2020;Heywood, 2015;Nichols et al., 2021;Washington & Economides, 2016). Although this research corpus is not specifically focused on PIED consumption, it produces important insights into the gendered dimensions of muscle, with some studies noting the role of steroids in the performativity of gender (Boyle, 2005). However, steroids often form the backdrop to descriptions of bodybuilding culture, and are described as a "gender-threatening" technology, producing "freaky" and "mannish" bodies (Boyle, 2005;McGrath & Chanani-Hill, 2009).
Much feminist and cultural studies literature on women's bodybuilding has hinged on the question of whether women's extreme muscle-building constitutes feminist resistance or recuperation, subversion or reproduction, of traditionally defined feminine norms (Boyle, 2005;Grogan et al., 2004;Kotzé et al., 2020). As Schippert (2007) writes, and we tend to agree, scholarly work has demonstrated both to be the case. Following Fraser's call to attend to what might be obscured in dominant representations, an alternative line of inquiry is under what circumstances these shifts in the "dominant production and treatment of gendered bodies can occur and what implications [ . . . ] there might be for other situations where bodies are configured" (p. 156). Notably, an important factor in these shifts is the stigma that women bodybuilders experience, in which the cultivation of muscled bodies elicits almost constant social harassment and revulsion (Grogan, 2004;Schilling & Bunsell, 2009). Importantly, the muscled bodies of bodybuilders may not be characteristic of the bodies of a wider range of women who now use such substances outside of bodybuilding contexts. As Schippert (2007) writes, the hyper disciplined bodily practices of bodybuilders are organized around a complicated set of norms and "a genre of embodiment" not aimed at mass-conformity (p. 157). This raises the question of the gender norms that shape contemporary women's substance consumption for fitness and strength training, and the cultural changes these forms of consumption might be provoking in gendered embodiment and health optimization.
Knowledge of women's experiences of substance consumption for fitness and strength-training based on qualitative, empirical research is scarce, with few qualitative studies focused on non-bodybuilders' experiences. Andreasson and colleagues' work on female fitness "doping" has engaged with questions of gender and PIED consumption amid changing fitness practices (Andreasson & Henning, 2021;Andreasson & Johansson, 2013, 2020, 2021. Johansson's (2020, 2021) research on female fitness "doping" draws on online forum data and six qualitative interviews with Swedish women who use PIEDs. Tracking broader changes in women's fitness practices and gendered bodily ideals, they argue that greater involvement in general gym and fitness cultures may lead to a "habituation process" through which consumers' growing ambitions and heavier training schedules lead to the increasing normalization and acceptance of PIEDs. They also argue that the "gender of muscularity is gradually changing and idealised notions of female muscularities are becoming more acceptable" (Andreasson & Johansson, 2020, p. 336). Reflecting the position reached in feminist research on bodybuilding, they suggest that the cultivation of muscular femininities grants women consumers freedom of gender expression and transgression, despite wanting to be read as normatively feminine. Consistent with research on men who consume PIEDs (e.g., Latham et al., 2019), they observe that women's PIED consumption is embedded in a range of other everyday practices requiring consistent work and effort, such as diet, training, and other lifestyle practices.
Aside from this work, gender predominantly features in the literature through a focus on side-effects and risk. The potential for virilization or "masculinizing" side-effects features in almost all research on women's consumption (Havnes et al., 2021;Huang & Basaria, 2018). Studies suggest that women are concerned about becoming "too" muscular, developing excessive body hair, clitoral enlargement, voice deepening, changes to the menstrual cycle and increased libido (Abrahin et al., 2017;Börjesson et al., 2021;Sverlersspm et al., 2020;Van Hout & Hearne, 2016). One of only a few qualitative studies conducted with women focuses on virilization effects. Ainsworth et al. (2022) describe participants' concerns about changes to their body and side-effects on fertility and body image while using steroids. Another study focuses specifically on the experience of gendered and sexual effects to argue that women "are at risk of developing irreversible masculinizing effects" (Havnes et al., 2021, p. 1). From the perspective of the ontological politics of data generation, a key question is why these changes are formulated as health risks? Schippert (2007) observes that there is a widely professed "concern" regarding women's consumption of steroids and various "health" risks. However, it is unclear on what grounds "lower voices, hairy faces or bodies, and even a greater than average clitoris" constitutes a health risk (p. 162). They argue that the "perceived danger" might be "more accurately described as women posing the 'health' risk of transgressing gender" (p. 162). Unlike men, the dangerous aspect of steroid consumption for women is not that they are seen to be "cheating" (i.e., gaining an unfair competitive advantage), rather, that "these women might become "too much like men" (p. 162).
The second main way that gender features in this research is in relation to "initiation" experiences, that is, how women are "introduced" to PIEDs. Recent research suggests that women commonly begin using steroids and associated substances through the advice and guidance of male partners, friends and coaches (Gibbs et al., 2022;Havnes et al., 2021). Given that social relationships are known to shape initiation experiences and harm reduction practices in other drug consumption settings (Fraser, 2013), it is unsurprising that some women learn about and begin using steroids in sexual or training partnerships. While this dynamic deserves some consideration, especially in relation to the development of health information and harm reduction advice, particular care should be taken in how women's agency is conceived, given the gendering of risk we identify above. As we noted earlier, muscular and substance-consuming women are all too often judged as excessive for their bodily practices. Research that foregrounds women's decision-making solely in relation to male influence risks enacting women in line with traditional gendered stereotypes of feminine passivity, and as overly vulnerable to men's advances, with limited agency. Linear accounts of coercion or pressure are highly gendered, usually drawing on notions of hegemonic masculinity, which inadvertently downplay the agency of women who are constituted as relatively passive. Given that women express pragmatic reasons for using steroids (Henning & Andreasson, 2021), research should be sensitive to the various forces and constraints that shape their decision-making and experiences.
In line with Fraser's focus on the ontological politics of data generation, we argue that future research should examine the formulation of risk and agency in research on women's experiences of substance consumption for fitness and strength-training, given that the practice of research actively shapes research subjects and realities. While women's health concerns are important, the current emphasis on virilization may also be related to the politics of data generation (Fraser, 2020). When studies are designed to explore women's experiences of "masculinizing, gonadal and sexual effects" (Havnes et al., 2021), negative health effects or "risks," they obscure other priorities, concerns or experiences that women may value. Further complicating the matter is that much of the existing research analyses online fora and websites, rather than the situated and context-specific accounts of women's whole lives. Given the stigmatization PIED consumers report experiencing in healthcare settings (Fraser et al., 2020), online sites often operate as key resources for information-seeking and advice, meaning that health concerns and side-effects may tend to be captured more than other experiences. In our view, the gendering of women's consumption is yet to be adequately explored-the scholarly focus on reproductive and hormonal effects has limited our understanding of the ways in which gender shapes substance consumption in this context. Our survey of the current literature indicates the need for nuanced, feminist research grounded in women's experiences to generate a stronger knowledge base about the range of women's substance consumption practices for fitness and strength-training, and the social and gendered norms that shape consumption.

Cultural Contexts of Consumption: Health Optimization and Enhancement
Our third suggested area for research is a focus on the political, social and cultural contexts of women's consumption, especially in relation to broader changes in biomedicalization, pharmaceuticalization and health optimization. This agenda draws on Fraser's third provocation to attend to the limits of representation, insofar as we are identifying relevant cultural dynamics that have hitherto been largely ignored in the literature. One cultural shift we noted previously relates to changes in gym and fitness cultures that have influenced new muscular feminine bodily ideals and normalized strength-training and related physical practices. The rise of female bodybuilding in the 1980s facilitated the recognition of muscular and defined female bodies within bodybuilding and public discourse more broadly (Andreasson & Johansson, 2021). Fitness culture in the 1990s also gradually shifted from being a male-dominated enterprise into a "commercialised industry" that targeted and included women (Andreasson & Henning, 2021, p. 2). With women's strength training gaining popularity, the highly muscular and vascular female body has become more normalized and desirable (Andreasson & Johannson, 2020). As other scholars have noted, this new feminine body ideal is evident in media slogans such as "strong is the new skinny" and the cultural ascension of weightlifting and strengthtraining in popular culture Nichols et al., 2021). It has been argued that these shifts in female muscularity and body ideals may contribute to the consumption of substances and supplements for fitness training Van Hout & Hearne, 2016). While the normalization of fitness culture and muscularity for women is an important starting point for interpreting these shifts, a number of other significant cultural changes also warrant attention if we are to develop a fuller, more nuanced understanding of women's substance consumption practices.
The first development we outline here is that of health optimization, which is closely linked to transformations in biomedicine. Social theorist Nikolas Rose (2007) argues that contemporary biomedicine has transformed contemporary life through its reformulation of health and citizenship imperatives. Biomedicine is no longer focused solely on treatment, or constrained by "the poles of health and illness," but increasingly geared toward health enhancement and optimization (p. 6). For Rose, contemporary biomedicine produces "technologies of optimisation," engaged with the "biological reengineering of vitality" on a newly articulated molecular level (p. 16). Biomedicalization has changed contemporary understandings of the body, with its capacities no longer circumscribed by organic life but instead rendered flexible and open to transformation (Coveney et al., 2011). This shift means individuals are invited to consider "their embodied selves as open to modification in new ways and hence to acquire further obligations for the responsible self-management of their biological and somatic experience" (Rose, 2007, p. 81).
Within the context of women's fitness and strength training, few attempts have been made to connect women's substance consumption to broader transformations in contemporary biopolitics and health optimization. One example is Marianne Raakilde Jespersen's (2013) work exploring an online community's reflection of women's PIED use in recreation sports, which explicitly connects performance enhancement in sport to twenty-first century health optimization imperatives to perform, evolve, expand and enhance. She argues that in a "culture of optimisation" we tend to celebrate initiatives that increase outcomes and make processes more efficient and effective (p. 201). However, as she notes, this is not the case for understandings of drug consumption, which conversely incite ethical debates about fairness and "natural" advantage. An important consideration for future research on enhancement drug research is the affective relations and mechanisms by which health optimization imperatives work and are sustained. Health aspirations and practices are not always driven by explicit desires for health and self-improvement but rather by contrary and conflicting attachments to things, norms, institutions and ideals that ultimately may constrain agency (Berlant, 2011). While scholars of sport have engaged affect theory to explore how exercising women are moved by feeling, affect and desire (Toffoletti & Thorpe, 2021), to date, the affective registers of women's substance consumption practices in the context of fitness and strength-training remain underexplored.
Sociological research on biomedical enhancement has explored these connections in more detail, with Conrad and Potter (2004) characterizing biomedical enhancement as a "genre of selfimprovement." They make useful connections between drugs, surgery and other medical interventions aimed at improving the mind, body or performance. Exploring the case of human growth hormone, they track its use as a biomedical solution to the social "problems" of shortness, ageing and athletic edge. Key to their analysis is the concept of medicalization (Conrad, 2007), the process by which a particular issue comes to be understood in medical terms as a "problem" amenable to medical intervention or treatment. Through their analysis they identify three dimensions of biomedical enhancement associated with processes of medicalization: normalization, repair and performance edge, and note the blurred boundary between treatment and enhancement in contemporary biomedicine. Focusing on the medical management of sleeplessness as "insomnia," Coveney et al. (2011) argue that the concept of pharmaceuticalization (which may occur without medical authority) may be more analytically useful than medicalization in tracing how cognitive-enhancing drugs are shaping cognition and the relations between contemporary subjects in a techno-scientific era of pharmaceuticalization. According to their account, pharmaceuticalization extends beyond the domain of the medical or medicalised to include the diverse processes by which human conditions and capacities are transformed into opportunities for pharmaceutical intervention. This distinction is important for our purpose as it captures the use of drugs for "lifestyle, augmentation or enhancement purposes (among 'healthy' people)," offering a lens for understanding the social, cultural and technoscientific forces shaping the contemporary imperatives of health optimization and enhancement (Coveney et al., 2011, p. 711).
Finally, although not usually considered within the remit of PIEDs, it may be productive to consider the social dimensions of women's substance consumption for fitness and strength-training amid other gendered biomedical enhancement practices, such as beauty and cosmetic practices. Although it is beyond the scope of this essay to address this scholarship fully, feminist research has illuminated the gendered dimensions of women's body work and the cultural significance of such practices for configurations of gender relations (Bordo, 2004;Fraser, 2003;Pitts-Taylor, 2007). Future research in this area would benefit from addressing the context of broader socio-cultural imperatives in relation to beauty and enhancement that invite women to engage with their bodies in historically and culturally specific ways.
Returning to Fraser's question about we constitute objects of study, we suggest there is much to be gained by considering women's substance consumption for fitness and strength-training through its connections to health optimization and biomedical enhancement. Occurring within a consumption landscape geared toward self-management, bodily enhancement, health optimization and anti-ageing, such practices should be understood as connected to and synergistic with a suite of health optimization practices that all contemporary health citizens are enrolled in, rather than a symptom of deficit or passivity or individual psychopathologies, such as body image disorder. Research that recognizes this consumption as inseparable from a wider range of contemporary health optimization practices avoids the impulse to pathologize women as disordered or abnormally invested in the body.

Digital Practices and Networked Bodies
The fourth key area for critical social analysis that we propose is women's engagement in digital cultures and its effects on embodiment, substance consumption and digitally mediated fitness experiences (Toffoletti & Thorpe, 2021). To date, women's social media and digital practices have largely been overlooked in research on women's substance consumption for fitness and strength training.
Concomitantly, studies of women's social media practices have paid surprisingly little attention to substance consumption as it relates to online body-work, self-presentation and health optimization. Returning to Fraser's conceptualization of ontopolitically-oriented research as engaged with the actions and agency of material objects, we suggest that research should consider women's digitally mediated fitness practices.
Importantly, while not focused on social media per se, a small but emerging body of research has explored women's efforts to access information, address health concerns and mitigate health risks through engagement in online fora and websites. In Sverkersson et al.'s (2020) study of women's participation in an online forum, participants describe how they engage in planning and researching before beginning PIED regimes. Women members sought advice about dosage, regimes, and the experiences of other women, which as other research has shown is often impeded by interference under the guise of advice from men (Jespersen, 2013). In their analysis of discussions of the synthetic growth hormone CJC-1296 across various bodybuilding websites, Van Hout and Hearne (2016) similarly found that women had a desire for informed decision-making, and for information on the effects of substances on hormones and contraception. While online spaces constitute an important source of information and advice for healthcare consumers, men's uninvited participation in womenonly fora contributed to the masculinization of online spaces, diminishing opportunities for honest and respectful communication centered on women's concerns (Henning & Andreasson, 2021). While the existing qualitative literature provides useful insights into women's online information-seeking practices, little is known about how other digital encounters shape women's body-work practices, relationships and embodiment.
Social media has become an important site for women to visually document the process of becoming stronger and fitter, and as a result to forge new bodily and subjective identifications. Explorations of online fit femininities identify various ways in which digital media engagements shape women's desires for their bodies, their presentation and body-work practices (Camacho-Miñano et al., 2019;Rich, 2018). For example, Riley and Evans (2018) discuss the "before and after" fitness selfie in the context of a postfeminist "transformation imperative." They suggest that women's desire for bodily transformation is an effect of an intensifying transformative imperative that position women as responsibilized agents and affirm new feminine norms of body display on social media. Importantly, women's documentation of fitness, physical practices and bodies in online cultures is also shaped by cultural and religious norms (Rahbari, 2019). In non-Western digital cultures, resistance is explored not only in relation to patriarchal and masculinist norms, but to the religious and cultural norms that enact appropriate feminine embodiment and styles of presentation. For example, Kavasoglu and Koca (2022) note that for Turkish women, criticisms around muscularity are shaped not only by sexism but by religio-conservative ideals that frame the display of the body as a transgression of social and religious expectations for women to remain concealed and docile.
In a 2021 article, feminist sociologists of sport Toffoletti and Thorpe suggest that embodiment, as it is expressed and experienced through digital media, generates multiple affective orientations toward the body. These orientations-which include pleasure, pride, vulnerability, disgust and shame-open up space for new bodily identifications and attachments (Toffoletti & Thorpe, 2021). In arguing that digital practices capacitate active and desiring bodies through affective encounters, they suggest researchers pay greater attention to the networked dimensions of women's body work and "the affective forces that compel gendered bodies to move, act and respond, and the agentic capacities they generate" (2021, p. 7). Similarly, in a study of women's powerlifting on Instagram Nichols et al. (2021) approach the digital mediation of gendered subjectivities as affective assemblages. Using feminist new materialist frameworks, they trace how "powerlifting emerges [through digital encounters] as a moving-desiring set of practices that demonstrates possibilities for intervention into narrow articulations of desired femininity" (p. 16). In a related analysis of women who use Instagram to post and interact with digital fitness content, Reade (2021) observes that "various body parts, objects, platform functionalities and discourses come together to create affective encounters" between women using social media for fitness inspiration (p. 535).
Returning to Fraser et al.'s (2022) fourth feature of ontopolitically-oriented research, recognition of "the contingency of units of study" (p. 347), we ask what might be gained from approaching women's substance consumption practices as relationally produced through a network of phenomena, including new technologies and digital practices. According to Fraser, one benefit of this approach is to shift the analytic focus from the standard unit of study-the discrete, anterior object or individual-to attend instead to relations (between subjects, objects, technologies, practices and much more), seeing these as constitutive of realities. Understanding women's substance consumption as a contingent phenomenon, made in its encounters with other phenomena (themselves contingent and co-constituted) generates new insights into otherwise overlooked actors such as gender, social media, fitness cultures and affective orientations to the body.
New theoretical developments in feminist studies of sport and the body are promising in this regard, as they understand digital media as sites for the co-constitution of gendered bodies through materialdiscursive assemblages of human and non-human forces (Thorpe et al., 2020). These online dynamics produce new actions and experiences of the body, as well as understandings of human agency, power and politics (Lupton, 2018). In recognizing that embodiment is materialized through vital interactions of human, non-human, technological, cultural and biological forces, this line of inquiry expands possibilities for understanding women's relationships to their bodies, substance consumption practices, health optimization and digital fitness in the current moment. Building on these developments in feminist studies of sport, research on women's substance consumption in the context of digitally mediated fitness experiences could ask: How does substance consumption shape digital body work practices? How do social media and digital practices contribute to or transform contemporary enhancement and optimization imperatives? How does the use of illicit substances shape gendered enactments of "proper femininity" and affective orientations to the body?

Conclusion
This article has reviewed the existing literature on women's substance consumption for fitness and strength-training with a view to identifying issues requiring further research and methodological innovation. We have drawn inspiration from Fraser's work on ontopolitically-oriented research to outline a research agenda oriented to the realities that we research into being. First, we have argued for a reconsideration of the nomenclature of performance and image-enhancing drugs that takes into account the variation and multiplicity of substances and effects across different gendered contexts of consumption. In its current formulation, the category of PIEDs invites the narrow study of non-trans men's fitness practices and downplays the ways in which PIED consumption is a gendered practice, implicated in the expression and transformation of gender. This has significant effects for how we consider other subjects' consumption practices (e.g., as somehow uniquely related to gender) and limits how we might understand and approach women's consumption. In light of this critique, we call for alternative language that centers specific substances (e.g., steroids, human growth hormones, peptides) and practices (e.g., strength training, bodybuilding, health improvement) instead of reifying the presumed effects of substances ("performance and image enhancement"). Second, we observed a tendency in much of the existing research to focus on gendered risk and harm, with the virilizing effects of some women's substance consumption constituted in terms of "health risks." Related to this, women's "initiation" experiences are described in terms of peer pressure from sexual and training partners, which risks reinforcing dominant stereotypes of women as passive and vulnerable, and overlooking other dynamic forces that shape initiation experiences. Third, we argued for a greater focus on the connections between women's substance consumption practices for fitness and strength training and contemporary health optimization imperatives that enact enhancement and self-improvement as foundational citizenship practices. Finally, we have suggested attending to the role of digital and technological practices in women's substance consumption. Of central importance is the need for critical social research attuned to the various meanings and understandings of consumption, consumption practices and settings, connections with new technologies (e.g., fitness apps and tracking devices) and digital practices, and transformations in the self, embodiment and social relations that substances engender.
While this set of interlinked concerns is not exhaustive, we have thought ontopolitically about research aims and methods to develop a research agenda oriented to the diverse personal and social forces that shape women's substance consumption for fitness and strength training. When conceived of conventionally, PIED research has historically obscured women, in part because the foundational unit of study (non-trans men) has excluded women's bodies, interests and practices, and simultaneously reproduced a narrow focus on sexual characteristics and women's vulnerability to men. As our analysis suggests, a more capacious, ontopolitically-oriented approach has the potential to enact many other "partial worlds" (Fraser et al., 2022, p. 355) that jointly produce women's enhancement consumption. These partial worlds require diverse and innovative methods that can attune more closely to the cultural, gendered and social relations imbricated in this phenomenon, including changes in biomedicine, health optimization, health and wellness, digitally mediated fitness cultures and other enhancement practices. Of course, these set of issues are just a beginning. Pursuing the questions raised in this article is an important step toward challenging dominant assumptions about substance consumption in sport and fitness contexts that limit understandings of women's motivations, experiences and agency. Moreover, widening our frame of vision through the ontopolitically-oriented research agenda proposed here, can support a richer understanding of the complexity and diversity of women's substance consumption to inform policy developments and debates.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.