How bodybuilders, many on steroids, risk their bodies and brains

Creating a physique that can win at the highest level of professional bodybuilding requires superhuman self-discipline, intense training and genetic good fortune. Increasingly, say the people familiar with the culture and its consequences, it cannot be done without illicit drugs and a willingness to push a body to — or past — its limits.

More than a dozen scientists, trainers, judges and competitors interviewed for this report said that just earning a pro card, an amateur’s ticket to the pro ranks, is very difficult without anabolic steroids. Winning a marquee title drug-free? Several people laughed at the question.

“Impossible,” said Harrison Pope, one of the country’s leading anabolic-steroid researchers.

The behemoths who win the best-known and most lucrative titles barely resemble the iconic, classically muscled champions of the past, such as Arnold Schwarzenegger, who won the sport’s premiere title, Mr. Olympia, seven times between 1970 and 1980.

“Arnold Schwarzenegger would not win today,” said Brad Schoenfeld, a professor at Lehman College in New York and author of several books on bodybuilding and muscle growth. “He would not even get a pro card.”

LEFT: Arnold Schwarzenegger during the filming of “Pumping Iron,” amid his streak of Mr. Olympia victories in the 1970s. (George Butler/Contact Press Images) RIGHT: Mamdouh “Big Ramy” Elssbiay competing in 2020. He has won the title of Mr. Olympia the past two years. (Frank Jansky/Icon Sportswire/AP)

Although bodybuilders spend years lifting weights and honing each muscle, they don’t need to demonstrate strength for the judges beyond the ability to hold poses onstage.

They only need to look strong.

Some competitors — and a growing legion of young, mostly male admirers — chase that look by diving into a reckless pharmacological game of whack-a-mole that insiders say has grown more intense and dangerous as sheer size has trumped the “Greek god” ideal of previous generations.

They stack various steroids and other muscle-building drugs, then add in compounds intended to burn fat, blunt appetite or sap water from below the skin. They might counteract the worst side effects with another arsenal of medications, vitamins and supplements.

The result can be outlandish physiques that appear indestructible but are often quite fragile.

The price: Chaos within

Some drugs commonly used by bodybuilders can cause immediate illness and even death. Steroids, barring a rare reaction, are not among them. But large doses can cause hormonal upheaval in nearly every major system in the body.

“Steroids get sort of a break when in fact they are an illicit drug like any other,” Pope said. “And like lots of other drugs, if they’re used in small quantities, their effects are relatively modest, and if they’re used in larger quantities, for longer, their effects become increasingly dangerous.”

The long-term ramifications are just beginning to be understood, in large part because scientists cannot ethically give large doses of illegal drugs to volunteers in clinical trials.

Even if they could, there is no standard regimen to test.

Bodybuilders choose their own combinations of drugs, supplements and dosages, often based on word of mouth, internet influencers or recommendations from a coach or dealer. Buyers don’t always know what they’re getting, because fake and contaminated products abound in the underground supply chain, several trainers and bodybuilders said.

But as the people who began using large doses of steroids and other performance-enhancing drugs in the 1980s and 1990s reach middle age and beyond, the consequences are becoming clearer, especially in the heart, the reproductive system and the brain.

The training: Hours in the gym

Heavy lifting is the go-to exercise for building muscle. Top bodybuilders usually spend about two hours a day in the gym — sometimes more — five or six days a week, not counting hours choreographing and practicing posing routines that will show off their best assets to the judges.

They need near-perfect lifting mechanics, said New Jersey trainer Juan Pla, a former natural bodybuilder. Lifters with poor technique can suffer shoulder, neck, lower-back and quad injuries, and even tennis elbow.

Tendon tears are common among steroid users, said several trainers and muscle specialists. Typically, tendons and muscles grow together, like matched sets. But steroids can cause muscles to grow too big for their tendons to support.

“That’s when you attempt some diabolically heavy lift and you just rip a bicep tendon or you rip a pectoralis muscle‚” Phillips said. “There’s all kinds of disgusting things that happen.”

A 2015 study of bodybuilders done in Pope’s lab found that upper-body tendon injuries are more common in steroid users than in nonusers, possibly because steroids disproportionately grow muscle in the arms and torso.

To shore up their connective tissue, steroid users might inject extra growth hormone on top of what their pituitary glands typically pump out.

Growth hormone strengthens collagen in tendons and decreases fat. But it isn’t terribly selective about what it enlarges, and doses that are greater than the body normally produces can cause overgrown bones in the face, hands and feet, an enlarged heart and increased risk of heart failure, irregular heart rhythms, sleep apnea and colon cancer.

High doses can also cause water retention in the midsection and may enlarge other organs, contributing to “roid belly,” in which a competitor has a distended abdomen under six-pack abs, said Schoenfeld, the muscle growth researcher.

Some bodybuilders take Viagra before a workout thinking that greater blood flow will improve their muscle gain. (It probably doesn’t.) Others say it increases the “pump,” when muscle cells swell with fluid during a hard workout and get visibly bigger for a few minutes. The pump is why bodybuilders try to work in a few lifts or biceps curls right before stepping onstage.

The diet: ‘A mind game’

Bodybuilders train in two main phases: bulking and cutting.

Bulking is when they pile on muscle, and they may spend months eating mountains of high-protein food and guzzling protein shakes — up to 12,000 calories a day for some men. (That’s about four times the amount a typical active man would need per day.) Some take appetite-boosting peptide hormones so they can force it all down.

Around mealtime, they may inject insulin, a hormone made in the pancreas, to help build muscle and temper the blood-sugar-raising effects of growth hormone. Anawalt said insulin’s muscle-building capabilities are “unproven and minimally plausible” at best, and that insulin comes with risks. Too large a drop in blood sugar can cause confusion, seizures and, in rare cases, death.

All that packing on of pounds inevitably means some fat as well, so next comes the brutal cutting phase.

Bodybuilders will continue training but will cut calories — often drastically — to try to reduce body fat to artificially low levels. Huge men may subsist on food portions that would barely sustain small women.

Cutting is especially miserable for drug-free competitors who don’t have chemical help, said Schoenfeld, who competed in natural contests in the 1990s. “You become very ornery and obsessed with food.”

Brianny Terry, a powerlifter and bodybuilder who placed fourth in her physique class at the NPC nationals this summer, called cutting-phase dieting “terrible” and “a mind game,” but she said she also appreciates the self-discipline it requires. “You learn a lot about your willpower and how deep you can dig to get through to the end goal,” she said. “It’s just a really bad way of promoting self-growth.”

Some bodybuilders try to burn fat, fight fatigue and curb their raging appetites with legal stimulants such as caffeine, prescription drugs such as thyroid hormone or online purchases such as the potent asthma drug clenbuterol.

“Clen” is approved only for use in horses in the United States, but athletes in various sports consider it to be a “non-steroid steroid” because it is thought to preserve muscle and cut fat with fewer side effects, according to the Drug Enforcement Administration. The risks range from tremors and anxiety to high heart rate, low potassium, seizures and cardiac arrest.

A more lethal cutting drug is DNP (dinitrophenol), a toxic and literally explosive chemical once used in munitions. DNP is banned for human consumption because it revs up the metabolism so ferociously that people dangerously overheat, but it can be purchased on the internet as a weight-loss supplement. Four bodybuilders, including a 17-year-old girl, were among the deaths documented in a 2011 survey of DNP exposure in the journal Medical Toxicology.

For competitive bodybuilders, the last few weeks of cutting are show prep. That is when they try to hone their physiques, eat more carbs to plump up their muscles, shed excess water and get rid of as much remaining body fat as possible.

Some may step onstage with so little body fat that the deprivation sends their bodies into survival mode. Sleeping becomes difficult. Metabolism slows to conserve energy. Brain and immune function suffer. The reproductive system grinds to a halt.

“The look of leanness that they reach is inhuman,” Pla said, “and completely unsustainable.”

The reasons: Why put themselves through this?

It’s rarely the money, as very few are able to support themselves with bodybuilding alone, Davies said.

For some, it’s the competition.

“I love training, and I love powerlifting and bodybuilding,” said Terry, 26. “But I will never sacrifice my femininity or my health for it, because I still have a life to live after this. I want kids. I want to have a family. It is risky behavior, but I’m doing the risky behavior in the most responsible way.”

Others are looking for a shortcut.

Three-time Olympia competitor Jamie Pinder, who is now a coach, said young bodybuilders, egged on by social media, reach for drugs as a pathway to instant gratification. “They are skipping over the foundations of training, the foundations of good nutrition, the foundations of rest and recovery,” she said. “Instead of having the mind-set of ‘I’m using these drugs so I can work harder,’ they’re thinking, ‘What drugs, how many drugs and what can I use so I can do the least amount of work?’”

Some chase success to places they hadn’t planned to go.

“Often people start out not thinking about steroids, and then once they start getting caught up in winning competitions, they realize that that is necessary to win at the pro level,” Schoenfeld said. Pro bodybuilder Brandon Curry, Mr. Olympia in 2019, said on a podcast that year that he didn’t need to use drugs “until it became my job.”

Some just like being big.

Schoenfeld said one bodybuilder told him he wanted to look like the Incredible Hulk. “I remember vividly his specific words,” he said. “‘I want to look like a comic book superhero.’”

Israetel, 38, began bodybuilding in high school and found he could put on muscle fairly easily. He said he did not use drugs until he was 27.

“I kept getting bigger,” he said, “and I thought, ‘Oh, I could look even bigger.’ And then I started reading muscle magazines, and I fell in love with the idea of just becoming a freak.”

Last year he placed second in the super-heavyweight division at the NPC Masters USA Championships, his best-ever finish, and just missed winning a pro card. He said he plans to compete for a few more years and hopes to achieve a certain look, then will be happy to stop.

“I’m almost to that size,” he said. “These are pictures that I’ll have forever, that I can look back on and say: ‘Wow, I really did the thing. I really looked the part, like the part that I was truly capable of looking — within reason.’”

He estimates that bodybuilding and the drugs he has taken for it will probably take five years off his life — less, he hopes, than those who take far more drugs than he does. And he said it will be worth it — “Barely, but yes.”

“If I wanted to live until I was 90 or 100,” he said, “I would absolutely have never taken steroids, or I sure as hell would’ve quit by now.”

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