Wednesday, May 18, 2011

BODYBUILDING PHARMACOLOGY : Death of a Fitness Competitor by Jerry Brainum

While large doses of anabolic steroid drugs can have many side effects, the scientific literature mostly describes their effects on men. Men are more likely to use them, as all anabolic steroids are modifications of testosterone, the primary male sex hormone. On the other hand, since women produce only a tenth as much testosterone as men, side effects that do occur among female high-dose steroid users are more apparent. That’s led some bodybuilding officials to surmise that steroid use among female competitors is more immediately dangerous than it is for their male counterparts. For a while only female competitors, at both the amateur and professional levels, were tested for illicit anabolic steroid use.

Most side effects produced in female high-dose steroid users fall under the general heading of “androgenization,” a polite way of saying that a woman is slowly converting into a man.

Indeed, testosterone is a primary treatment for women undergoing gender conversion—women who want to become men. Women who use steroids grow increased facial and body hair and lose scalp hair; their voices deepen; they experience clitoral enlargement and concomitant shrinkage of other sexual organs, including the breasts; and they have menstrual disturbances. Some female competitors compound those problems by adding other drugs, such as Nolvadex, which inhibits estrogen activity.

Using Nolavadex amounts to a chemical menopause, and taking steroids with it significantly increases the chances of androgenic side effects. While side effects—if they occur—in men usually recede when they get off the drugs, the structural changes that occur in women on steroids are permanent.

Female bodybuilders are the most often accused of using anabolic steroids. Indeed, since the primary female hormone is estrogen, which tends to bring on water retention and fat deposition under the skin—both of which obscure muscularity—successfully competing drug-free in female bodybuilding events today (especially on the pro level) is a definite challenge. So-called natural competitions may be an exception. It’s hard for female athletes on high-dose steroid regimens to deny using.

The stigma of steroids has proved more detrimental to female than male bodybuilding competition. The popularity of female bodybuilding has declined over the years in direct proportion to the increased muscularity many of the competitors show. Other competitions—fitness and figure events—have evolved for women who either can’t or won’t do what many think is necessary to compete in bodybuilding events. In those events, high muscularity leads to deducted points, and the tacit assumption is that figure and fitness contestants are “drug free.”

Fitness women are usually more athletic than their figure counterparts because fitness events require skilled routines involving a marked degree of dexterity and athleticism. Although they’re careful to limit their size gains in line with judging restraints, casual observation of fitness competitors indicates that they’ve become more muscular over the years. Rumors have long circulated that many of them resort to help from their chemical friends, particularly the ones that help bring down bodyfat: clenbuterol, ephedrine, thyroid drugs and even estrogen blockers, such as Nolvadex, and anti-aromatase drugs, such as Arimedix.

Until recently no serious health problems have been linked to fitness-contest participation. A recently published study, however, documents the case of a 29-year-old Swedish fitness competitor who may have gone too far in her quest to be a champion.1 She was found dead just three days after winning a national fitness contest in Sweden. She had a shady background that included prior arrests for drunk and disorderly conduct and prostitution. A diary found in her apartment indicated that she suffered from depression, but there was no indication of suicide. Also found was a sheet of paper detailing her use of anabolic steroids for the eight months before her death—nine different products in different combinations. Examiners found three unmarked jars in her kitchen containing five kinds of pills, as well as three-tablet packs of clenbuterol. Upon analysis, the pills in the unmarked jars turned out to be ephedrine, tadalafil, metandienon, mestanolon and stanozolol.

Ephedrine is the synthetic active ingredient of the herb ma huang, which was banned in the United States in 2004, reputedly because of an abundance of side effects related mainly to cardiovascular overstimulation. Why the woman had tadalafil—trade name Cialis, a treatment for erectile dysfunction that takes the body 36 hours to excrete—in her possession is somewhat of a mystery. Metandienon is a generic name for the popular anabolic steroid drug once sold as Dianabol. Mestanolon was once sold as an over-the-counter “pro-hormone” called Superdrol but was removed from the market. Mastanolon was an old anabolic steroid developed by a major drug company but never sold commercially because of concerns over toxicity, particularly in the liver. Stanozolol, also known as Winstrol, is a steroid used both orally and in injectable form.

A postmortem showed that she had extremely low bodyfat and that she had silicone breast implants. Because women’s breasts require a certain level of estrogen to maintain their size, they shrink when there isn’t enough of it. Many women opt to disguise that effect with implants, which, sadly, are as obvious to the onlooker as a cheap wig is on a man—especially when implants are selected on the basis of size rather than proportion to natural body structure. One former multi–Ms. Olympia champion had five sets of implants, each pair progressively larger than the last.

The deceased fitness competitor’s face showed acne scars, and she had stretch marks on her thighs. Her clitoris was enlarged, but her vaginal lips were atrophied, which was linked to her low bodyfat. She showed no signs of trauma but did have very atrophied adrenal glands. Though her heart was of normal size, her internal organs were unusually large and heavy. Her coronary arteries were open, but there was the beginning of a thickening in the left anterior descending coronary artery, which supplies blood to the left ventricle, the heart’s pumping chamber. Most fatal heart attacks occur when that artery is blocked because it negatively affects coronary pumping action, resulting in death from ventricular fibrillation unless you’re lucky enough to have cardioversion—that is, shock—to your heart within six minutes or get effective CPR until shock can be provided.

The heart of the fitness competitor showed some signs of previous muscle damage, which may have been caused by minor heart attacks. Tissue destruction like that is often observed in habitual cocaine users and sets you up for a major heart attack, as may have happened here. Her liver was in surprisingly good shape, which is mute testimony to the resilience of that organ. Indeed, you can remove 75 percent of the liver, and it will regenerate if given a chance.

Her toxicology tests showed the presence of ephedrine in an amount too small to be toxic but an amount of testosterone 10 times higher than normal. Tests also revealed metabolites of Winstrol and boldonone, an anabolic steroid sold as Equipose. The major test for testosterone looks for a ratio of testosterone to epitestosterone. In males, a ratio exceeding 6-to-1 indicates illicit testosterone use. The cutoff for women is 4-1, and the fitness competitor showed a ratio of 28.3-1. No other illicit drugs were found in her system.

The cause of death was identified as sudden cardiac arrhythmia, or a heart rhythm disturbance, possibly influenced by the combination of an unspecified inflammatory heart condition and the acute influence of anabolic steroids and ephedrine. Both steroids and ephedrine have been implicated in causing a spasm of the coronary arteries, which can induce a deadly heart rhythm disturbance. For example, researchers who gave rats cocaine, which markedly stimulates the heart, found that adding nandrolone led to even higher heart rates. In the Swedish case the woman’s prior heart damage may not have been enough itself to cause a rhythm problem but might have played a role with the use of the drugs. The authors suggest that the primary cause of death was likely ephedrine, but you’d have to take large amounts of ephedrine or have prior heart damage before it could cause serious cardiovascular problems. Before it was removed from the market, millions of doses of ephedrine were used with few, if any, side effects. The woman’s heart damage, however, was consistent with habitual cocaine use, although none was in her system at the time of her death.

Another possibility is that she may have succumbed to heavy diuretic use, although the toxicology panel didn’t test for diuretics. Although officially banned in bodybuilding and fitness competitions, diuretics are nonetheless commonly used prior to a competition. They rid the body of the excess water that obscures muscular definition. When you hear that a competitor dropped 10 pounds during the final hours before a contest, it’s likely because of diuretic use.

Diuretics can cause a rapid electrolyte or mineral imbalance, which can induce a serious heart rhythm disturbance. The medical literature lists several cases of competitive bodybuilders dying from overdosing on diuretics, and I’ve witnessed many lesser but dramatic problems over the years. In the case of the woman discussed here, an examination of the liquid in her eyes (which reveals current electrolyte status) didn’t show any mineral imbalance. That, however, reflects the mineral state only at the time of her death. Her probable use of the drugs three days before her final contest may have played a role in her death, but the authors say that this is purely speculation.

The most distinctive aspect of this tragic case was the finding of markedly atrophied adrenal glands, something not seen before in an otherwise athletic person. The authors suggest that the shrinkage may have occurred because of her extensive anabolic steroid use. Steroids interfere with the activity of cortisol, which is considered desirable because cortisol is catabolic. On the other hand, long-term, heavy use of anabolic steroids could have sent an inhibitory signal to the pituitary gland, which responded by not secreting adrenocorticotropic hormone, which tells the adrenal glands to synthesize and secrete cortisol. No ACTH, no cortisol or even DHEA release. When that happens, the adrenals shrivel up. The same occurs in the testicles when large doses of anabolic steroids are used. In that case the pituitary stops secreting luteinizing hormone, resulting in no testosterone production in the testes—hence shrunken testicles.

Although the Sweden case study looked at a single individual, it suggests what some people will resort to for competitive success. While bodybuilders bear the stigma of steroid use, the evidence is that the use of these drugs extends to all forms of competition, as the recent news headlines clearly attest.

1 Thiblin, I., et al. (2009). Sudden unexpected death in a female fitness athlete, with a possible connection to the use of anabolic- androgenic steroids and ephedrine. Forensic Sci Int. 184, 1:E7-E11.

Editor’s note: Jerry Brainum has been an exercise and nutrition researcher and journalist for more than 25 years. He’s worked with pro bodybuilders as well as many Olympic and professional athletes. To get his new e-book, Natural Anabolics—Nutrients, Compounds and Supplements
That Can Accelerate Muscle Growth Without Drugs, visit

©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.

Have you been ripped off  by supplement makers whose products don’t work as advertised? Want to know the truth about them? Check out Jerry Brainum's book Natural Anabolics, available at


The Applied Ergogenics blog is a collection of articles written and published by Jerry Brainum over the past 20 years. These articles have appeared in Muscle and Fitness, Ironman, and other magazines. Many of the posts on the blog are original articles, having appeared here for the first time. For Jerry’s most recent articles, which are far more in depth than anything that appears on this blog site, please subscribe to his Applied Metabolics Newsletter, at This newsletter, which is more correctly referred to as a monthly e-book, since its average length is 35 to 40 pages, contains the latest findings about nutrition, exercise science, fat-loss, anti-aging, ergogenic aids, food supplements, and other topics. For 33 cents a day you get the benefit of Jerry’s 53 years of writing and intense study of all matters pertaining to fitness,health, bodybuilding, and disease prevention.


See Jerry's book at


Want more evidence-based information on exercise science, nutrition and food supplements, ergogenic aids, and anti-aging research? Check out Applied Metabolics Newsletter at