Bodybuilders Are Dying: An Investigation Into Modern Bodybuilding, Health, & PED Use

This post may contain affiliate links (disclosure policy).

Bodybuilding, steroids, and untimely deaths: is there a link? And what can be done?

The bodybuilding world has been shaken yet again in 2025, with several high-profile athletes passing away unexpectedly. Most recently, Spanish pro bodybuilder Erik Markov, just 37 years old, died suddenly only months after earning his IFBB pro card at the Mr. Olympia Amateur competition. His death has not been publicly linked to any specific cause, but the sudden nature has reignited conversation about the risks competitive athletes take in pursuit of extreme physiques.

This tragedy follows the recent loss of Hayley McNeff, a respected bodybuilding champion, who also died at 37 in what her family described as an “unexpected” tragedy. Not long after, the bodybuilding world mourned Craig Licker, an IFBB Pro, who passed away at the age of 57. His cause of death remains undisclosed, but his passing adds to the unsettling pattern.

These names are now part of a growing list of bodybuilders who have died far too young over the past few years. While not every case is directly linked to performance-enhancing drug (PED) use, the recurring theme of sudden cardiovascular events, organ failure, or unexplained deaths among otherwise fit individuals raises serious questions.

We at Generation Iron started conducting our own research in direct response to these deaths to figure out what exactly is happening. But it hasn’t been easy. The challenge in researching and writing this piece was evident from the start with many individuals declining to talk about the topic. The lack of transparency was enough to make us dig deeper. With steroid use being a taboo subject in bodybuilding, as well as sports in general, many individuals embedded in the industry were not willing to come forward.

This is not the first time bodybuilding has faced such heartbreaking losses. In 2021, at least 21 bodybuilders died within the span of a year, sparking conversations across the fitness community. While genetics, lifestyle, and underlying conditions certainly play roles, many experts point to the misuse of black market steroids, growth hormones, insulin, diuretics, and stimulants as a driving force behind these tragedies.

One of the most infamous examples was Bostin Loyd, a 29-year-old bodybuilder who openly shared his steroid cycles online and became known for his extreme experimentation. In 2022, he died from a retrograde aortic dissection (a tear in the major artery of the heart), compounded by Stage 5 kidney failure. His autopsy revealed thickened heart walls, severe kidney and liver damage, and traces of stimulants and opioids in his system. While some pointed to genetics, most experts agreed that years of high-dose PED use contributed heavily to his early death.

While in some respects this is an extreme example, Loyd’s tragic passing isn’t an isolated incident in a vacuum. Here is a list of bodybuilders we’ve lost in the recent years. While not all of their deaths are related to drug use, they were still members of this great sport and should be remembered as such:

The risks of using performance enhancing drugs are incredibly high, yet we still find ourselves continuing these conversations. In fairness to bodybuilding, this epidemic of steroid use has plagued other institutions of sport for a long time. Most notably we can look at Lance Armstrong and the cycling community, baseball and their unprecedented team of sluggers sending the ball into oblivion, and the Russian doping scandal as showcased in the documentary, Icarus.

Bodybuilding is a part of health and fitness, but to be competitive, it can be seen as an extreme sport. With this often comes the use of steroids and other compounds such as Deca, Tren, insulin and diuretics, among others. Most competitors rarely openly talk about using such compounds, for not only is this subject taboo, but it is also illegal in the United States and other parts of the world. This makes it extremely challenging to create a real study and proper research. Without this deeper research, it also becomes harder to have transparent conversations that could lead to necessary changes.

Steroids: What They Are, How They’re Made & More

Anabolic-androgenic steroids are essentially man-made forms of testosterone. A vital sex hormone predominantly in men, testosterone is involved with everything from muscle growth and increased strength, enhanced libido and sperm production, and tone of voice, body hair, and other bodily functions. Taking a testosterone enhancer would clearly elevate all of these so you see greater gains to strength and overall muscle development (1,2).

Steroid use didn’t just quickly become popular. It was a slow burn until athletes began to fully understand how these drugs could take them to the next level. Once discovered, the use of steroids became common place and it wasn’t a question of if you were using, but how much.

Ergogenic effects of steroid use include an increase in muscle mass, decreased body fat percentage, better recovery between workouts and from injury, more muscle endurance, higher bone mineral density, increased glycogen stores, and better pain tolerance, among many others (1,3).

It’s clear why athletes would use steroids. To look at the above benefits and still question why a dedicated and determined athlete would put themselves in harm’s way would make one naïve. All of those are what an athlete wants. That’s what we all want. And if your competitor is doing the same thing and beating you, then you probably don’t stand a chance unless you join them.

Dianabol

When discussing anabolic steroids, one common name you will see is Dianabol. Like most steroids, Dianabol increases testosterone to promote muscle growth while burning fat. This is done by improving nitrogen retention and promoting the production of testosterone. This steroid was first available in pill form, which made it more desirable over injectable options. Dianabol hits a user hard in the first six weeks as they see greater muscle mass and decreased recovery times.

Dianabol was one of the early steroids to be sold commercially. It was created by an American doctor and hit the market in 1958. Once the results were seen, the steroid became popular among bodybuilders and other athletes. Even non-athletes were dabbling to see some changes in physique (4).

Trenbolone

Trenbolone acetate is another well-known steroid that is used to increase size, strength, and decrease fat. This is a steroid that has been known to be about four times as powerful as testosterone. The benefit is that it works synergistically with testosterone and other steroids that might be taken.

In many countries, this is a legal product but requires a prescription to acquire. Tren is commonly used for veterinary purposes, and when combined with other aspects, Tren helps grow healthy livestock. It became popular with bodybuilders because of the way it works with other supplements. At the same time, this steroid comes with some other major risks because of the strain it puts on the athlete.

One study notes that a 23-year-old bodybuilder was hospitalized with a myocardial infarction due to Trenbolone use. This athlete had a heart attack, and he was using Trenbolone for over a year (5).

Deca Durabolin

Deca is an injectable steroid used with other stacking compounds and is highly effective for off-season gains. Since it is slow-acting, it is commonly stacked with things like Dianabol in efforts to increase muscle fullness and add thickness. However, using Deca can cause a host of side effects including changes in libido, water retention and swelling, and mood disorders. Most notably, Deca can affect the liver, heart, and kidneys leading to damage and increased oxidative stress (6).

Health Risks Associated With Steroid Use

While bodybuilding celebrates discipline and transformation, the widespread use of PEDs has created a hidden health crisis. These drugs can transform physiques, but they come with consequences that accumulate silently over years of use.

1. Cardiovascular Strain

Anabolic steroids increase red blood cell count and thicken heart muscle walls, raising the risk of high blood pressure, blood clots, heart attacks, and aortic dissections. These cardiovascular risks are believed to be the leading cause of many sudden deaths among bodybuilders in their 30s and 40s.

2. Kidney and Liver Damage

Many steroids, especially oral compounds, are highly toxic to the liver. Combined with diuretics and dehydration strategies used before competition, kidney damage becomes almost inevitable. Bostin Loyd’s progression to kidney failure is a case study in how prolonged abuse takes its toll.

3. Endocrine System Chaos

Supraphysiological doses of testosterone and other hormones shut down the body’s natural testosterone production. Many users find themselves permanently dependent on external hormones, with infertility, gynecomastia, and long-term imbalances.

4. Blood and Circulatory Issues

Steroid use can thicken the blood, increase bad cholesterol, and decrease good cholesterol. This combination accelerates plaque buildup in arteries, raising the risk of sudden strokes and heart attacks.

5. Mental Health Risks

Beyond physical health, PEDs can fuel mood swings, anxiety, aggression (“roid rage”), and even depression when users come off cycles. This rollercoaster can have devastating psychological consequences.

6. Black Market Dangers

Perhaps the most under-discussed risk is the source of the drugs themselves. Many PEDs are purchased through underground labs or online sources, where products are often:

Contaminated with bacteria or heavy metals
Under-dosed or overdosed compared to the label
Spiked with unlisted chemicals that further endanger health

When athletes gamble on unregulated drugs, they are essentially rolling the dice with their lives. Steroids provide results with the potential to take lives. So, does the reward outweigh the risk?

Steroids Side Effects Summed Up

Now that we’ve covered extensively the harm in using anabolic steroids and other PEDs, the overall side effects and harm caused by steroid use includes:

Elevated blood pressure
Decreased myocardial function
Testicular Atrophy
Thrombosis (blood clots)
Reduced sperm count
Changes in libido
Acne
Baldness
Increased liver damage
Psychological issues (mania, depression, mood swings, aggression, irritability, etc.)

So how does all of this information fit into the world of competitive bodybuilding? And what real world examples can we use to compare to the data? As we have mentioned before, the legal status of many of these drugs makes most information anecdotal. In addition to this, many of the athletes who have passed in bodybuilding have not undergone an autopsy.

However, a small minority of those who have passed did produce autopsy reports. In this next section, we take a closer look at the information that has been made public regarding bodybuilder deaths in the sport.

A Closer Look At Dallas McCarver

Dallas McCarver was an incredibly hardworking and dedicated bodybuilder who many thought could one day win Mr. Olympia. His winning attitude and unparalleled work ethic allowed him the opportunity to work with REDCON1 and build an amazing relationship with its founder, Aaron Singerman.

In a Generation Iron Exclusive interview, Singerman told us that Dallas was, “…one hell of a good guy and an extremely important person for this business [REDCON1]”. He also talked about how Dallas became part of not only the RECON1 family, but also his own family and that losing Dallas is extremely difficult.

As fate would have it, Singerman was officially sentenced to 4.5 years in prison for selling anabolic steroids and other unlawful controlled substances marketed as dietary supplements. On top of this prison term, he will also be required to pay $2.9 million dollars for his involvement. This case revolves around Blackstone Labs, a former company of Singerman’s unrelated to REDCON1. We would be remiss for not mentioning this here for full transparency.

Dallas was just 26-years old when he passed away and his death sent shockwaves through the bodybuilding community. An autopsy was done and made public and while the manner of death was deemed natural, the coroner made a point to list chronic use of exogenous steroid and non-steroid hormones as contributing conditions.

The cause of death as listed by the coroner was severe concentric left ventricular hypertrophy with coronary artery atherosclerosis. Left ventricular hypertrophy is when the muscle wall of the left pumping chamber becomes thickened. As a result, blood flow and blood pumping are severely reduced. This can lead to heart attack or sudden cardiac death (12). Along with this, coronary artery atherosclerosis was mentioned. This is a disease where there is an accumulation of lipids and fibrous elements in the large arteries and is a primary cause of heart disease and stroke (13).

It was reported in the autopsy that Dallas has a family history of early-onset atherosclerosis and hypertension (high blood pressure). Here is where this debate gets complicated. Family history and potential underlying factors can pop up at any time. With contributing conditions of steroid use prevalent as well, stating that steroid use caused his death is not entirely accurate. But given the evidence of steroid use and its effects on cardiovascular health, it is certainly in the conversation, for Dallas was young and very fit.

Anabolic steroid use can increase concentric left ventricular hypertrophy without affecting cardiac function (14), giving the athlete no sign that such issue is occurring. Another study found that bodybuilding together with anabolic steroids induced concentric hypertrophy and altered the ventricular diastolic function (15). When it comes to coronary atherosclerosis, it was found that performance enhancing drugs could accelerate this and that anabolic steroid use was associated with increased coronary plaque volume (16, 17).

With Dallas’ autopsy made public, it is easy to dive in and speculate as to what exactly happened. The evidence can imply that steroid use was a contributing factor, however, his family history cannot be neglected. At the end of the day, a young and talented bodybuilder is no longer able to compete, his family is no longer able to see him succeed with what he loves, and the bodybuilding community has lost someone bringing positive attention to the sport.

It’s entirely possible that steroids contributed to his hereditary history of cardiovascular issues. It’s this kind of health history that must be considered by all athletes, weightlifters, and dedicated fitness enthusiasts when adding PEDs into the picture as well. A direct conclusion cannot be made here, but this information should be a major focus for all athletes considering drug use in athletic activity.

A Closer Look At George Peterson

George Peterson was a professional bodybuilder in the Classic Physique division. Like Dallas McCarver, he was dedicated and determined in his own right to become a champion and someone admired in the bodybuilding community. However, that chance was cut short when the 37-year old bodybuilder was found dead on October 6, 2021.

His death touched many in the bodybuilding community as competitors and fans alike took to social media to pay their respects. Chris Bumstead, Olympia champion and fellow Classic Physique competitor, posted to Instagram saying. “I appreciate you pushing me on stage and being a man to look up to both on and off the stage. Humble and hardworking at its finest”.

At just 37-years old, the coroner found the cause of death to be sudden cardiac dysrhythmia as a result of hypertensive cardiovascular disease. Anabolic steroid use was a contributory factory, with boldenone and stanozolol named specifically.

Sudden cardiac dysrhythmia is an abnormal rhythm of your heartbeat, either faster or slower than normal rate. If the heart cannot pump enough oxygenated blood to either itself or the rest of the body, this can become deadly (18). The autopsy notes that this irregular rhythm was due to hypertensive cardiovascular disease, which ultimately is high blood pressure and the increased pressure inside blood vessels forcing the heart to work harder. Therefore, by the heart working harder to get blood in and out, on top of increased pressure, this dysrhythmia occurred and became lethal.

On top of the cause of death, cardiomegaly was also noted which is where the heart becomes enlarged and much bigger than normal size along with ventricular hypertrophy, which was discussed with Dallas McCarver. This was when the muscle wall of the left chamber becomes so thick that pumping blood through can be challenging and the volume may be severely reduced.

The two anabolic steroids listed in the autopsy were boldenone and stanozolol. Boldenone is a synthetic derivative of testosterone designed for veterinary use before making the jump to athletics. This is used to increase muscle and strength by stimulating protein synthesis (19). Potential risks associated with boldenone are decreased testosterone production, lower sperm count, and lower sperm mobility.

A study conducted on rabbits looked into the effects boldenone had on oxidative stress and the outcomes on muscular tissues in respect to bodybuilding and the use of boldenone in the sport. It was found that those who suffer muscle damage, heart disease, and myocardial hypertrophy could see the link from injecting drugs like boldenone to build muscle (20).

Stanozolol is one of the most frequently abused anabolic androgenic steroids by professionals and amateurs and is a derivative of testosterone with high androgenic properties (21). Anabolic androgenic steroids, like stanozolol, do have a link to hypertension in some studies, however, other studies refute this notion, so a solid conclusion between stanozolol and hypertension remains unclear (22).

As for cardiac hypertrophy, athletes who tend to use anabolic androgenic steroids for long term use, when mixed with high-intensity training, can run the risk of cardiac hypertrophy, dysfunction, and heart failure. Peterson’s autopsy noted the cause of death as sudden cardiac dysrhythmia, which was an irregular heartbeat of either too fast or slow where it becomes difficult for the heart to bring in oxygenated blood. The use of anabolic androgenic steroids has been linked to fatal ventricular arrhythmias as well as ventricular hypertrophy (23), two issues noted in the autopsy report.

As discussed with Dallas McCarver, to say that steroids caused George Peterson’s death without a medical background would be irresponsible. However, knowing what we know about the risks of anabolic androgenic steroids, seeing the report which notes steroids as a contributory factor, and linking the cause of death with noted studies surrounding the effects of steroids on certain cardiac issues like sudden cardiac dysrhythmia and hypertensive cardiovascular disease, we can shed light on the seriousness surrounding the abuse of these drugs and the fatal consequences they have towards users.

A Closer Look At Bostin Loyd

Bostin Loyd was just 29-years old when he passed away on February 25, 2022. While his cause of death is not official, he has a long and open history of steroid and other PED use that has contributed to his controversial position in the sport. Loyd was very honest about how he used his body as a testing ground to see just what results would show and he continued to push his body further than what a usual pro bodybuilder would do. In 2020, he received a diagnosis of kidney failure and did not shy away from talking about this as well.

There are two ways to view Loyd and his openness about his own steroid use. The first is that he is bringing to light an issue in bodybuilding that no one really wants to talk about. However, he did go to more of the extreme than other bodybuilders, so this argument may not hold up as well given that his routine and cycling was not the norm.

The other view is that his opinions and outspoken nature around steroid use were damaging to the sport. Many saw steroid abusers as a liability, giving a negative stigma to the sport and revealing something that has traditionally been kept quiet. More evidence lends credence to this argument given the fact that Loyd was so open about exposing the fact his body was a testing ground of sorts. This experiment with his body, and ultimately his life, was not something normal bodybuilders do, yet if this makes the top headlines, then perception doesn’t often reflect the truth.

As is usually the case, we cannot say definitively that steroid use cause Loyd’s death. Despite his opinions and openness about using, plus his death at such a young age, it would only be speculation. Given his long history of use, along with his medical history, the use of steroids is unfortunately going to be a topic of conversation when Loyd and his manner of death are discussed.

Cedric McMillan’s Death

At the age of 44, Cedric McMillan passed away after suffering a heart attack on the treadmill, although details have not yet been confirmed. Aside from being a beloved bodybuilder, he was also a father and active service member in the U.S. Army. Cedric earned his pro card and won the Arnold Classic in 2017, bringing back the “classic” bodybuilder look and encouraging change to the sport.

Cedric has also been open about his heart issues and a near death experience in 2021 that kept him from competing and focusing on recovery. As the bodybuilding community continues to mourn the loss of bodybuilders passing away at an all too frequent rate, the loss of Cedric McMillan is felt by all as he was a catalyst for change and a true and honest competitor and ambassador for the sport.

Why Someone Would Use Steroids

What do all these athletes have in common? Despite the risks, why do athletes continue to use? The psychology of steroid use is not something to take lightly. Behind every athlete and every bodybuilder there is a concentrated decision, convincing the athlete that steroids are a necessary option.

The obvious answer is to reach the top. “Performance enhancing” is simply the idea of giving oneself the ability to reach new heights and peak performance to take the body into levels not possible naturally. The end goal: to win. Despite all risks, all possible health complications, little regard is given when one’s goal is to be the most competitive and see the best results regardless of their athletic pursuits (24). We as humans are competitive by nature and that competitive drive transcends sport and infiltrates all areas of society. But sport is an easy example, a physical example, where the human body is pushed to the limit in efforts to prove oneself superior to other athletes.

However, aside from the physical results of a top podium spot, when it came to bodybuilding, one study notes that:

“Bodybuilders reported significantly greater body dissatisfaction, with a high drive for bulk, high drive for thinness, and increased bulimic tendencies than either of the other athletic groups [runners and martial artists]”, with, “…the greatest use of anabolic steroids and most liberal attitudes towards using steroids” (25).

This idea of aesthetic and dissatisfaction can be attributed to many factors, especially with so many people on social media flaunting these massive physiques. Bigorexia, muscle dysmorphia and body image issues were clear. Results proved that bodybuilders had a higher risk for body image disturbance and other psychological characteristics that would cause one to use steroids (25).

With one’s drive to win and the idea around body image and perception, it is no wonder why athletes turn to steroids and performance enhancing drugs for that extra boost. But if confidence and results are driven by something so high risk, it would seem that the foundation of an athletes’ mindset isn’t strong enough to depart from what works, even if what “works” could cost them their life.

Separating the Issues: PED Abuse vs. Legitimate Testosterone Therapy

Here’s where an important distinction must be made: not all hormone use is dangerous or abusive. The health risks associated with PEDs come primarily from unregulated black market steroids and the extreme doses used in bodybuilding culture—not from medically supervised hormone therapy.

Testosterone Replacement Therapy (TRT) is a legitimate, FDA-approved medical treatment. It is prescribed to men who suffer from clinically low testosterone levels, a condition known as hypogonadism. Symptoms of low testosterone can include:

Chronic fatigue and low energy
Depression and irritability
Loss of muscle mass and strength
Increased body fat
Low libido and sexual dysfunction
Cognitive decline and brain fog

For men in this situation, TRT is not about chasing extreme muscle growth—it’s about restoring normal body function and quality of life.

Why TRT is Safe When Done Correctly

TRT is carefully monitored by physicians and tailored to the patient’s needs. Unlike black market steroids, TRT uses pharmaceutical-grade testosterone at safe, therapeutic doses.

Key differences between TRT and PED abuse:

Dose Levels: TRT restores testosterone to normal physiological ranges, while steroid cycles often use 5–10x natural levels.
Medical Oversight: TRT patients undergo regular blood tests to monitor hormone balance, cardiovascular health, and organ function. PED users rarely get professional medical monitoring.
Product Quality: TRT uses medications from licensed pharmacies. Black market steroids may be contaminated, mislabeled, or dangerous.
Purpose: TRT is designed to improve well-being and long-term health. PEDs are often abused for short-term physique changes, regardless of long-term damage.

When done under medical guidance, TRT has been shown to improve heart health markers, boost mental clarity, restore libido, and help men regain a sense of vitality.

For men struggling with low testosterone, the safest option is to seek care from a trusted medical provider. Titan Medical is one of the most respected clinics specializing in testosterone replacement therapy.

Titan Medical: A Safe Path for TRT

When it comes to finding a good TRT clinic, Titan is one of the best options out there. What makes Titan Medical a standout choice?

Expert Physicians: Specialists who understand hormone health and tailor treatment to the individual.
Personalized Plans: No one-size-fits-all dosing—patients receive care based on bloodwork and symptoms.
Comprehensive Monitoring: Regular check-ins and lab tests to ensure safety and effectiveness.
Quality Medications: Only pharmaceutical-grade testosterone from licensed pharmacies is used.
Holistic Approach: Beyond just hormones, Titan Medical helps patients improve energy, weight management, and overall health.

For those suffering from the effects of low testosterone, Titan Medical provides a safe, medically sound alternative to dangerous black market shortcuts.

Moving Forward: What Bodybuilding Needs to Learn

The bodybuilding world is in a critical moment. The repeated losses of athletes like Erik Markov, Hayley McNeff, Craig Licker, and Bostin Loyd demand a deeper conversation. The relentless pressure to push size, conditioning, and PED use is proving deadly.

But the solution is not to demonize all hormone use—it’s to educate, regulate, and distinguish between reckless PED abuse and responsible medical therapy.

If bodybuilding federations, athletes, and fans truly care about the longevity of competitors, the culture of silence needs to end. Transparency about risks, regular medical monitoring, and honest conversations about safe alternatives like TRT can save lives.

Beyond Steroids: The Use Of Diuretics & Insulin In Bodybuilding

While steroid use runs rampant in the bodybuilding community, the use of diuretics and insulin is something to take note of as well. Many bodybuilders have gone on record about being hospitalized, or very close to being hospitalized, from taking diuretics right before competing. This shows that drug use is not simply tied to steroids as a sole entity, but rather other substances used to enhance performance and an overall aesthetic.

Insulin

Insulin is produced in the pancreas and the main purpose is for cells to take in and store sugar from the blood. But bodybuilders tend to take insulin in efforts to produce more muscle. One effect of insulin, aside from its role as it pertains to blood sugar, is that it helps with muscle protein synthesis, and when combined with other drugs, like steroids, this can greatly enhance the effect (26).

Too much insulin, however, can have adverse effects on the body like lowering blood sugar, overall weakness and confusion, and increased sweating. More severe effects include hypoglycemia, which is when your blood glucose levels drop below normal limits, and if left untreated for too long, can lead to coma and death (27). During the bulking phase of a bodybuilders cycle, insulin may be taken as a tactic to put on as much weight as possible, and here one may find the so-called “bubble gut” occur.

Samir Bannout, the Lebanese bodybuilder known as “The Lion of Lebanon”, won the Mr. Olympia contest in 1983. In a Generation Iron Exclusive interview, he mentioned how insulin works in the short term, however, can have long-lasting health problems in the long term and can ruin physiques. While Samir is no medical expert, he has experience as an accomplished bodybuilder on some of the biggest stages and in his opinion, insulin is, “…a ruin for modern bodybuilding. It’s a ruin for bodybuilding”.

Diuretics

There are several different diuretics, but they serve a purpose to promote diuresis, which is the increased production of urine. What this does is increases the excretion of water from your body and relies heavily on your kidneys to do so (28). For bodybuilders, diuretics work to tighten the skin and really get those muscles to pop, giving off an even more lean and shredded look.

The risk in taking diuretics relates to a number of factors including cardiovascular issues, muscle cramps, limited cognitive functioning, and kidney problems, since your kidneys take on much of the load. The unfortunate effect on your kidneys results in damage and potential failure. Misuse of diuretics can lead to a bodybuilder quickly passing out and if not treated immediately, it can lead to death. Dr. George Touliatos, also known as Dr. Testosterone, sat down with Generation Iron to discuss diuretics and made a scary, but honest point: “Diuretics are an instant danger and can kill you right away”.

The risks of using insulin and diuretics are far more immediate than steroids if used incorrectly, for steroids tend to have health complications farther down the line. And even still, if a user believes they are using insulin and diuretics correctly, there are too many factors that come into play that are hard to predict. With drugs as powerful as these, one mistake can lead to hospitalization, or worse.

In respect to bodybuilding and the use of any performance enhancing drug, insulin and diuretics are unfortunately all too common and even with Olympia legends like Ronnie Coleman expressing the dangers, the warnings have fallen on deaf ears, and the price paid is ultimately someone’s life.

What The Experts Say

Experts, both with advanced degrees and not, have studied, researched, and tirelessly worked to get information and factual evidence to back the claim that steroid use is a serious issue and one worth paying attention to.

Jerry Brainum is a former bodybuilder and longtime industry expert having written for, or been editor for, several health and fitness publications in his 35-year career. The author of Natural Anabolics, Brainum has worked diligently to push information about the dangers of steroid use while promoting natural and drug-free bodybuilding. He is also a regular for Generation Iron with his series Straight Facts, where Brainum shares his expert knowledge and opinions on all things bodybuilding.

In a most recent episode, Brainum addressed the issue of if bodybuilders are dying more than the average person. What he notes is that bodybuilders, on average, are dying at a rate of 12.6%, where the average male is around 13.5%, because of steroid use. This is centered around the thought that bodybuilders live a healthier lifestyle overall in terms of diet, training, and legit supplementation, thus giving their bodies the ability to handle a larger steroid load.

However, despite these findings, bodybuilders of the past have proved to live longer than those of today. Those bodybuilders of the 1940’s and 1950’s lived well into their 70’s and 80’s, with some living even longer, despite using steroids. Many factors could contribute to this including potency and black market drugs.

Before we continue, let’s narrow in on black market steroids. The problem with these drugs is that a black market network is clearly unregulated, with quality control being one of the biggest problems. With many of these raw materials coming from China, users have no idea what is included in the actual substance (Jerry notes one bodybuilder took steroids containing arsenic).

As a result, incorrect dosing, mismatched labels, and what the actual ingredients of that substance are remain either unknown or are flat out wrong (29, 30). A great example of an obvious black market drug is Insulin-like Growth Factor 1 (IGF-1). A very expensive drug legally, any time IGF-1 appears for a cheap price, it should be a tell-tale sign of suspicious activity. Despite the apparent obvious risks of black market drugs, athletes fail to heed these warnings and continue to purchase poor quality, and often times lethal, drugs.

In our exclusive with Brainum, he notes a study where 60 deceased bodybuilders were examined. Some of these deaths were attributed to causes unrelated to steroids (suicide, certain cancers, and unspecified natural deaths). However, 25 of these 60 died of cardiovascular related events including heart attack, aneurisms, and heart failure. A number of them had calcium build-up in their arteries that when combined with drug use, can lead to premature heart attack and other heart complications.

Another notable finding was kidney problems leading to multiple organ failure as a result of a chain reaction that takes place. When one organ fails, others are likely to follow. With kidney-related deaths at a relatively high 10%, Brainum attributes this to the use of diuretics (28), which can have dire effects towards the kidneys. Liver damage was another finding that could be attributed to oral anabolic steroid use. These drugs accumulate in the liver leading to cholestasis, which causes bile to build up in the liver and destroy liver cells (31).

Brainum was very candid with his thoughts on bodybuilding and was open to the fact that many of these bodybuilders entrust their steroid cycling routine to those coaches and “experts” who train and prep them for competitions. With little medical background, athletes are coached on anecdotal evidence with nothing based in science given that doctors don’t know enough about PED’s. A drug routine worked for one bodybuilder so it must work for another. Wrong. Everyone is different and reacts differently to such drugs, especially with underlying conditions that may be unknown.

With no medical monitoring, these gurus and self-appointed experts must hold some responsibility, and with actual medical doctors not keen on the exact risks of using such drugs, a vicious cycle begins: A steroid is given to a bodybuilder by a guru, something bad happens to the bodybuilder as a result, a real doctor doesn’t know enough about it to help, and our trusty guru doesn’t have the medical background to do anything further.

Dr. Thomas O’Connor, also known as the Anabolic Doc, is the creator of Testosteronology, a sub-specialty of Internal Medicine. His mission is to help those get off anabolic steroids safely while using his medical practice to improve the quality of life for those seeking to protect their health. His medical services include Testosterone Replacement Therapy, Anabolic Recovery Medicine, and Cardio-Metabolic Men’s Health.

Dr. O’Connor notes that athletes need two things to compete in bodybuilding; great genetics and steroids. For those looking to compete at a high level, steroids are just common place. However, all professional bodybuilders suffer at some point in their life from steroid use. While problems don’t necessarily arise immediately, down the line you will start to see various issues arise. Various factors that contribute to the effects of steroids include underlying conditions, how many steroids you are taking, what else you might be taking on top of anabolic steroids that could interact poorly, and mental state, most notably things like anxiety and depression (32). The most common diseases seen are those of the heart and major organs, like the kidneys and liver.

To make matters worse, bodybuilders suffer from steroids quietly, those issues covered extensively in this piece weighing on their minds as they seek to be the absolute best. Top bodybuilders have the best genetics and lifestyle habits, in terms of diet and training, but the toll steroid abuse takes transcends all else. Dr. O’Connor makes this clear and is confident in saying:

“We don’t know. Now, these men suffer quietly. I know, because who comes to see me? They come to see me and they tell me the truth with their wife, their children, their mothers. And there’s a lot of tears. Because they have heart disease and kidney disease. And they have psychiatric disease”.

Dr. O’Connor sees the effects of this first hand and while his methods of treatment are effective and his medical knowledge is put to use as best it can to help those suffering, the physical and mental toll has already laid claim to the lives of these competitors. And for that, what can be done becomes more and more unclear as each day goes by.

Seeing the effects of steroids as Dr. O’Connor cycles athletes off, there are key side effects to note. Decreased sexual performance is a big problem and can be tied to depression, weak and lethargic feelings, among others. Since steroids significantly increase sex drive and overall sexual function, this is easily flipped when cycling off (33). And while it is incredibly difficult to undergo a steroid detox, this is something of great importance to Dr. O’Connor who time and time meets with those suffering the unfortunate effects of anabolic steroid use.

A possible solution, brought forth by Jerry Brainum, is to legalize steroids and implement better monitoring of these athletes. Extensive tests like heart scans and calcium checks should be regularly performed and if a lab test comes back indicating that an athlete is at risk, then they must back off and address their physical health. Not only does this keep the athlete safe, but it brings awareness to a troubled sport while taking down a poor-quality black market.

Conclusion

We as humans are competitive by nature. We love to be the best. The thrill of competition, the values learned through sport, and the family bond that unites athletes together can be construed as unbreakable. But steroid use and the idea around performance enhancing drugs can easily break that bond. To use an external substance to find success will never lead to true success. And more, the risks of using such drugs can have devastating consequences on your life and the lives of those around you.

There are three key factors that can contribute to dangers in using PEDs for bodybuilding and other athletic endeavors:

There are many studies that emphasize the long term health effects and risks associated with steroids use.
Due to being illegal in many major countries, resorting to black market sales of substances brings in an added risk as the user never really knows what they are purchasing.
Many athletes receive advice or “protocols” on steroid and PED use from coaches who are not certified doctors, using only anecdotal evidence based on past individual experiences. But each body can react differently due to a wide variety of factors such as family health history, genetic predispositions, and more.

None of these three factors can verifiably prove that steroid or other PED use will lead to the untimely death of an individual. But they do provide evidence in a growing case against the very real risks in drug use for bodybuilders.

Bodybuilders work so hard to create the perfect routine, the perfect physique in efforts to be a near perfect physical being. But as giants that walk among us, too many are dying with no one held accountable. To change the attitude around this sport will require diligence from everyone and as fans, coaches, promoters, and competitors alike, it is our job to create that change. If we don’t, more people will lose their lives. And more of those bodybuilding giants we love will most certainly fall.

Let us know what you think in the comments below. Also, be sure to follow Generation Iron on Facebook, Twitter, and Instagram.

*Images courtesy of Dallas McCarver Instagram, George Peterson Instagram, and Envato

References

Hoffman, J.; et al. (2006). “Medical Issues Associated with Anabolic Steroid Use: Are They Exaggerated”. (source)
Kicman, A. (2008). “Pharmacology of anabolic steroids”. (source)
Hartgens, F.; et al. (2004). “Effects of androgenic-anabolic steroids in athletes”. (source)
Joshua, J.; Farr Institute (2020). “Dianabol in Review: How Dbol Works, Effects, and Safe Methandienone Alternatives”. (source)
Shahsavarinia, K.; et al. (2014). “A Young Man with Myocardial Infarction due to Trenbolone Acetate; a Case Report”. (source)
Frankenfeld, S.; et al. (2014). “The Anabolic Androgenic Steroid Nandrolone Decanoate Disrupts Redox Homeostasis in Liver, Heart and Kidney of Male Wistar Rats”. (source)
Cohen, J.; et al. (1986). “Altered Serum Lipoprotein Profiles in Male and Female Power Lifters Ingesting Anabolic Steroids”. (source)
Powers, M. (2002). “The Safety and Efficacy of Anabolic Steroid Precursors: What is the Scientific Evidence?”. (source)
Cabasso, A. (1994). “Peliosis hepatis in a young adult bodybuilder”. (source)
Soe, K.; et al. (1992). “Liver pathology associated with the use of anabolic-androgenic steroids”. (source)
Council on Scientific Affairs (1990). “Medical and nonmedical uses of anabolic-androgenic steroids”. (source)
Giamouzis, G.; et al. (2021). “Left ventricular hypertrophy and sudden cardiac death”. (source)
Lusis, A. (2000). “Atherosclerosis”. (source)
Dickerman, R.; et al. (1997). “Left ventricular size and function in elite bodybuilders using anabolic steroids”. (source)
Grandperrin, A.; et al. (2018). “Extreme cardiac hypertrophy in bodybuilders: Mechanical assessment of diastolic alteration”. (source)
Baggish, A.; et al. (2017). “Cardiovascular toxicity of Illicit Anabolic- Androgenic Steroid Use”. (source)
Aengevaeren, V.; et al. (Exercise and Coronary Atherosclerosis”. (source)
National Heart, Lung, and Blood Institute. “Arrhythmia”. (source)
USADA (2020). “5 Things Athletes Should Know About Boldenone”. (source)
Ali, E.; et al. (2013). “Effects of short and Long Term Growth Promoter Boldenone Undecylenate Treatments on Antioxidant Enzyme Activities and Oxidative Stress Markers in Rabbit Muscles”. (source)
Ozcagli, E.; et al. (2018). “Stanozolol administration combined with exercise leads to decreased telomerase activity possibly associated with liver aging”. (source)
Liu, J.; et al. (2019). “Anabolic-androgenic steroids and cardiovascular risk”. (source)
Achar, S.; et al. (2010). “Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions, and rhythm”. (source)
Dartmouth College (2012). “The scientific side of steroid use and abuse”. (source)
Blouin, A.; et al. (1995). “Body image and steroid use in male bodybuilders”. (source)
Anderson, L.; et al. (2019). “Use of Growth Hormone, IGF-I, and Insulin for Anabolic Purpose: Pharmacological Basis, Methods of Detection, and Adverse Effects”. (source)
Evans, P.; et al. (2003). “Insulin as a drug of abuse in bodybuilding”. (source)
Cadwallader, A.; et al. (The abuse of diuretics as performance-enhancing drugs and masking agents in sport doping: pharmacology, toxicology and analysis”. (source)
Ritsch, M.; et al. (2000). “Dangers and risks of black market anabolic steroid abuse in sports –gas chromatography-mass spectrometry analyses”. (source)
Friedman, O.; et al. (2016). “Body Builder’s Nightmare: Black Market Steroid Injection Gone Wrong: a Case Report”. (source)
Flores, A.; et al. (2016). “Severe Cholestasis and Bile Acid Nephropathy From Anabolic Steroids Successfully Treated With Plasmapheresis”. (source)
University of Gothenburg (2013). “Anabolic steroids may affect future mental health”. (source)
Armstrong, J.; et al. (2018). “Impact of anabolic androgenic steroids on sexual function”. (source)

Bodybuilders Are Dying: An Investigation Into Modern Bodybuilding, Health, & PED Use

Bodybuilding, steroids, and untimely deaths: is there a link? And what can be done?