Abstract
<title>Abstract</title> <p> <bold>Background</bold> : Women who use image and performance enhancing drugs (IPEDs) experience unique health risks compared to their male counterparts (e.g., voice deepening, virilisation). Although a small number of qualitative studies exist, there is limited quantitative data regarding how women who use IPEDs navigate healthcare systems, or how their harm reduction practices compare with men. This study aimed to investigate gender‑based differences in healthcare access and IPED‑related harm‑reduction practices in a large international sample. <bold>Methods:</bold> Data for this study were sourced from the 2024 Global Drug Survey (GDS) and included 1366 men and 134 women. Descriptive statistics were used to explore socio-demographic information. Chi-square analyses were used to explore gender-based differences in barriers to healthcare access and harm reduction practices. <bold>Results:</bold> 3.7% ( <italic>n</italic> = 5) of women reported difficulties engaging with healthcare. Women experienced significantly fewer difficulties than men accessing GPs, hospitals and pharmacies (all χ²s > 2.96, all <italic>p</italic> s ≤ .05). GPs were the service with which both men (17.2%, <italic>n</italic> = 235) and women (3.0%, <italic>n</italic> = 4) most frequently reported difficulty accessing. Men were significantly more likely to report using laboratory testing to check product purity (13.0% vs. 3.7%; χ²(1) = 9.70, <italic>p</italic> = .002). No significant gender differences were observed for home test use (7.0% vs. 3.0%; χ²(1) = 3.11 <italic>p</italic> = .07). <bold>Conclusion:</bold> Women reported fewer difficulties than men when engaging with health services. Despite comparable access to care, women who use face a deficit of gender‑specific harm reduction support, underscoring the need for women‑centred AAS interventions. </p>