Background Increased utilisation of needle–syringe programs (NSP) by men who inject performance and image-enhancing drugs (PIEDs) has been reported. While fewer in number, people who inject PIEDs possess distinct service and knowledge needs compared to other NSP clients. Methods Using standardised data from 26 NSP outlets through the Queensland NSP Minimum Data Set (QNSPMDS), trends in occasions of services among males intending to inject PIEDs were assessed using multilevel mixed-effects negative binomial regression, adjusting for month, year, and age, and clustering by site. Results Compared to 2007, PIEDs-related occasions of service increased from 2008 until 2013 (3% and 13% of all occasions of service involving males in 2007 and 2015, respectively). While accounting for the fewest occasions of service, the Northern region experienced the greatest rate of occasion of service increase (2015 IRR 7.46, 95% CI:6.11,9.12). Similarly higher rates were seen among males aged <35 years. Interventions were provided at 55% of occasions of service; most commonly safe equipment disposal (23%), and blood-borne virus (9%) and safe injecting/vein-care (9%) education. Conclusion NSP settings provide an opportunity to engage with this unique population, providing important education on injection-related injuries and diseases, including blood-borne viruses, and greater linkage to primary care.