Research has documented the harms associated with performance and image enhancing drug (PIED) use and lack of disclosure of use to healthcare providers (HCPs). Given that the relationship between HCPs and PIED consumers plays an important role in harm reduction, research is required to understand the barriers and facilitators for consumers to engage in help-seeking. This qualitative study explored the attitudes around current harm reduction frameworks for PIED consumers in Australia. Interviews were conducted with identified key stakeholders, who included a variety of PIED consumers as well as HCPs who come into frequent contact with PIED consumers. All participants were asked questions regarding the key barriers and facilitators for PIED consumers to help-seek, and how to best increase engagement among PIED consumers with HCPs. HCPs in Australia are calling for education around PIEDs, which is reflected as a ‘therapeutic barrier’ by consumers. This barrier represents an ongoing need to upskill HCPs in working with PIED consumers. Our data also showed a ‘safe space’ dynamic among peer-consumers in this space. Optimising harm reduction frameworks requires more synergy between peers and needle and syringe programs (NSPs), which remain safe and trusted environments for PIED consumers. We recommend harm reduction frameworks be strengthened through an increase in, and leveraging of, peer-led education programs.