A performance enhancing substance (PES) is any compound consumed for the purpose of improving appearance or athletic performance (Siegmund, NASN Sch Nurse 37:263–269, 2022). The rate of PES use in adolescence is on the rise, making school-based interventions even more important. Providers need to be aware of PESs and their potential side effects to identify inappropriate use and develop educational programming to prevent the initiation of use.