<p>This article examines women’s accounts of using performance and image-enhancing drugs in the context of fitness and strength-training. It explicitly engages in a mode of feminist knowledge production to rethink the harms women experience as a feature of epistemic injustice and gendered discrimination rather than personal inability, consumption or drug effects alone. Drawing on theorisations of epistemic agency and injustice (Fricker, 2007; Haraway, 1988) alongside 10 qualitative interviews with women who use substances for strength-training in Melbourne, Australia, we attend to the social and political features of drug consumption, and women’s accounts of bodily transformation and harms. Women overwhelmingly described consumption in relation to enhanced autonomy, with substances functioning as technologies of self-realisation within domestic and work responsibilities and gendered relations of power, as well as a route to enhanced social lives. In contrast to epistemically authoritative discourses in which women have little knowledge of the substances they are consuming and knowingly downplay the potential for side effects, our participants possessed detailed forms of knowledge and skill, and actively sought to monitor and prevent side effects, including virilisation, in the absence of reliable, gender-sensitive health information and healthcare. The most pressing forms of harm women experienced were gender-related stigma and discrimination, and insufficient gender-specific healthcare, related, in part, to epistemic exclusion and injustice in research and healthcare. By prioritising women’s accounts and attending to embodiment and social practices, our analysis complicates normative knowledge claims about women’s risk, coercion and pathologies, and suggests new epistemic resources for understanding women’s consumption as socially and materially meaningful, and enhancement harm reduction more broadly.</p>