Giant Killers: Dead Bodybuilders, Drugs, and the IFBB

What’s Really Killing Bodybuilders?

Bodybuilders continue to die young. Is it the steroids? Their sheer heart-stopping size? Their intense workouts? T Nation examines the evidence.

I’ve been dragging my dick along this earth for a relatively long time but oddly enough, I don’t have much experience with death, at least in my personal life. Sure, I lost my parents, but I’ve only lost one close friend when he succumbed to pancreatic cancer.

I’ve never even attended a traditional funeral. It makes me think I’m like John Coffey from “The Green Mile” in that I lure friends close to my cell by saying, “Boss, please, I got to whisper in your ear,” and then bazinga! I grab their crotch (but strictly as someone with an unblemished record of staunch heterosexuality) and cure them of their urinary tract infection, and as a bonus, confer upon them a long life.

Okay, maybe not.

But unlike my personal life, this dearth of death doesn’t exist in my professional life as a health, medicine, and nutrition journalist/essayist, where I know a shitload of people who died young or relatively young. The common thread, of course, is that they were all competitive bodybuilders, or at least civilians who occasionally competed.

Here, just off the top of my head, are some of them:

  • John Meadows
  • Mike Matarazzo
  • Sonny Schmidt
  • Dan Duchaine
  • Charles Durr
  • Mike Mentzer
  • Andreas Muenzer
  • Mono Benaziza
  • Paula Piwarunas
  • Don Ross
  • Ron Teufel
  • Ray McNeil
  • Vince Comerford
  • Shelly Beattie
  • Tonya Knight
  • David Dearth
  • Victor Richards
  • Nasser El Sonbatty
  • Dr. Bruce Nadler

And what I want to know is, how do you like your blue-eyed – and brown-eyed – boys and girls, Mister Death?

And these are just the bodybuilders I knew personally. There are plenty who I didn’t know who’ve died prematurely. Consider that in 2021, over two dozen competitive bodybuilders kicked, along with several retired bodybuilders under the age of 60. Add to that the people on my list and the other bodybuilders who died before or after 2021 and you’ve got a whole cemetery of moribund muscle.

Most people assume they all died from steroid-related health conditions, but that’s not entirely accurate, at least concerning the people I listed above. Some of the ones I knew, it’s true, did probably die from classic bodybuilding issues like heart failure, stroke, or kidney failure that were likely related to steroid or diuretic use/abuse. But one died from anorexia, two from *shotgun blasts (one of them self-inflicted), and another hung herself. At least two died from an undisclosed type of cancer and another from “dystrophic multiple organ failure.”

(*One of these shotgun deaths is now the subject of a Netflix documentary, “Killer Sally,” in which Ray’s wife, Sally, recounts the story of Ray’s abuse and her act of alleged self-defense in which she blasted him twice, once in the chest and once in the face. While no one knows whether Ray was indeed physically abusive towards Sally, jealousy might have also played a role. A few months before she killed him, I walked into a bodybuilding show in San Diego only to see Sally, also a competitive bodybuilder, seated atop some slip of a girl dressed in a mini skirt and high heels – someone Ray had allegedly been seeing on the side – and slamming her head into the tile of the lobby floor while a crowd cheered her on.)

I recently wrote about this spate of deaths in an article titled “Dead Bodybuilders: An Autopsy Report,” which described the findings of a group of researchers who’d dug through the autopsy reports of various bodybuilders that had died of cardiovascular events before the age of 50. Many of the reports described a litany of cardiac-related catastrophes:

  • Steroid-induced cardiomyopathy.
  • Severe cardiomegaly with concentric left ventricular hypertrophy.
  • Sudden cardiac dysrhythmia due to hypertensive cardiovascular disease.

Well, I’ve had some more time to research and think about things. It’s possible the post-mortem analysis I described above might have been too simplistic and too narrow in scope. After all, a whole lot of bodybuilders died early from other causes that may or may not have been related to steroids. Additionally, it seems the deaths of the bodybuilders in the report, along with the others who died before or since, might have been multi-factorial.

Beyond that, there’s someone who’s directly to blame for the whole mess. More on that later in the article.

Was It the Steroids?

A new research paper came out last December that did a workman-like job in teasing apart many of the nuances of this plague of deaths. This research paper – “Premature Death in Bodybuilders: What Do We Know?” – begins by pointing out the great contradiction in all these deaths: that resistance training is generally associated with reduced all-cause mortality rates and even superior cardiovascular health.

So, what do the authors of the paper – Smoliga, Wilber, and Robinson – think’s been happening? It’s a known fact that steroid use adversely affects various cardiovascular risk factors: cholesterol, homocysteine, hematocrit, blood pressure – the whole “you’re gonna’ die” kit and kaboodle. Further analysis, like the “autopsy report” I referred to above, found thickening of ventricular walls and evidence of subclinical systolic and diastolic dysfunction from long-term steroid use/abuse, along with the occasional fatal electrical disturbance.

However, it’s naïve to think that steroids are the only drugs that bodybuilders abuse. Most of them also have vials of HGH stashed in their underwear drawers, along with thyroxine and maybe Nubain and ephedrine and who knows what else. And their relaxed attitude towards these drugs sometimes spurs them to use recreational drugs like cocaine, amphetamines, and nicotine with impunity. None of these drugs are commonly taken into consideration when final analyses are done, which makes it difficult to isolate the effects of steroids.

The Adverse Effects of Steroids are Often Reversible

Smoliga, et al. think it’s important to realize that at least some of the adverse cardiovascular effects associated with AAS are reversible, which calls into question their significance in evaluating the long-term health of these bodybuilders.

The many cardiovascular changes (ventricular hypertrophy, etc.) to a group of 100 steroid-using bodybuilders in the HAARLEM study completely reversed to baseline in 3 to 12 months after the athletes stopped using steroids. Other, smaller studies haven’t found such dramatic and hopeful results, but left-ventricular mass often reverts to the size of weight trainers who didn’t use anabolics.

Now, it’s quite possible (and likely) that long-term AAS exposure could lead to irreversible changes in the health of athletes, e.g., atherosclerotic lesions and kidney damage that might lead to non-vascular pathologies like liver tumors (which often seems to be the case in other autopsy reports of competitive, steroid-using bodybuilders).

But again, some research shows that any liver dysfunction that results from AAS reverts to normal within a year of cessation.

All of this might be moot because it’s quite likely that many of the dead were on a perpetual cycle, choosing to give up other things for Lent instead.

How do the Death Rates of Steroid Users Compare to Other Athletes?

I remember hearing a grim story about basketball great Pete Maravich. After he retired, he continued to play in pick-up games and was presumably in great shape. It was during one of these games that one of the other players shouted out, “Hey Pete, how you feelin’?” Pete’s response was, “Great!” after which he immediately collapsed onto the basketball court, dead of a heart attack.

Clearly, people in other sports who have a low risk of cardiovascular disease (normal blood fats, no history of smoking, regular exercise, etc.) drop dead of heart disease all the time. It’s often attributed to family history, frequent air travel, trauma, or other factors like dehydration, heat exposure, or being bonked in the chest by an opposing football player’s helmet.

But steroid use isn’t limited to bodybuilding. American football players, baseball players, and perhaps most egregiously, Tour de France cyclists in the 1970s are widely known to have used steroids. Although we don’t have any reliable studies of the mortality rates of football players (at least that don’t focus on chronic traumatic encephalopathy, or CTE) or baseball players, bicyclists from that time period seem to have a much lower mortality rate than the general population.

Given all that, Smoliga and his fellow researchers think it might be wrong to blindly attribute all this coronary shit to AAS. Of course, the scientists might not be aware of the ridiculous doses used by many bodybuilders, doses that make those used by Tour de France cyclists seem downright dainty.

Additional Factors

Steroids might have played a role in the epidemic of premature deaths in another, less insidious ways. Most prominently, perhaps, is that they allow you to train harder, and extreme training is associated with adverse cardiovascular events.

Heavy lifting has been associated with extremely high systolic and diastolic blood pressure. The known “record” for a weightlifter, as reported in the literature, is 480/350 milligrams of mercury. Not even my “Flexzilla” garden hose could withstand that kind of pressure.

It’s possible these severe rises in blood pressure, reached again and again during extreme training, could cause the type of heart remodeling that ultimately leads to fatal cardiovascular events.

There appears to be some corroborating evidence of this among football players. The left-ventricular hypertrophy implicated in the deaths of many competitive bodybuilders was also commonly seen in gridiron warriors but almost exclusively in linemen (20 to 64, compared to 1 out of 49 non-linemen). And linemen, of course, are especially invested in strength training.

Weight Cutting and Extreme Dietary Practices in General

We’re all familiar with most of what it takes to get into contest-ready shape. Smoliga and his colleagues document that male and female bodybuilders typically lose 5-7 kilograms and 3-6 kilograms of body mass, respectively, before a competition, but they admit that these numbers vary widely. Some studies have found a mean loss of 8.4 to 93 kilograms of body mass among supposedly natural female bodybuilders.

These circumstances often invite extreme dehydration and possible disturbances in the balance of micronutrients.

Possibly equally alarming are post-competition eating habits. One 28-year-old bodybuilder gained 10 kilograms in a 4-day post-comp eating binge and was hospitalized with life-threatening hypokalemia (low potassium) and rhabdo. Another 28-year-old bodybuilder developed similar symptoms after first losing 19 kilograms of bodyweight before a contest and then ingesting 800 grams of carbs every day for 5 days.

It must be said, though, the epidemiological studies of obese patients and their legendary weight loss/weight gain yo-yos haven’t shown any adverse effects on long-term health, but their weight loss/weight gain swings probably aren’t as extreme as those of bodybuilders, and typically don’t take place in as short a window of time.

There are also instances of competitive bodybuilders dying from abuse of diuretics, but those typically took place right before or right after a competition, so they don’t account for the types of deaths we’re talking about in this article.

Are Supplements Involved in Premature Deaths?

Ordinarily, no one would suspect over-the-counter supplements in the deaths of competitive bodybuilders, but there’s one factor you need to consider: corruption, i.e., supplement company sleaziness.

Selective androgen receptor modulators (SARMs) are banned by WADA but have been sold online as “green tea extract” and even face moisturizers. Now there’s no evidence that SARMS can damage health (in truth, they haven’t been studied much), but it’s something that needs to be considered.

Similarly, Smoliga reports tamoxifen being hidden in commercially available supplements, while others contained stimulants like DMBA and DMAA. And most egregiously, a study of supplements in the United Kingdom found that 23 out of 24 different supplements contained AAS.

Jesus wept.

So, it’s possible that some supplements can and did adversely affect the long-term health of bodybuilders. (Here’s where I need to say that Biotest doesn’t do that shit. Almost all of us who work for the company use our products, so rest assured we don’t contaminate any of our products. It’d be like the little old ladies in “Arsenic and Old Lace” drinking the very same tea they used to poison their tenants.)

More Mystery

It’s usually difficult to blame steroids alone for the deaths or near-deaths of the majority of bodybuilders. Consider the case of one 26-year-old male who took up the sport. He immediately started training 4 hours a day and consuming 750 grams of protein a day while using an appetite suppressant and a mixture of steroids. Oh, and he also had hepatitis A.

Would his heart attack have been avoided if steroids had been taken out of the equation? Who knows? More broadly, there are dozens of reports that blame AAS for the deaths or hospitalizations of bodybuilders, but rarely do they take into consideration the confounders mentioned in this article (and others that I left out).

A much-referenced study from Europe compared all-cause mortality rates in 545 male confirmed steroid users with 5450 healthy, non-steroid users and found that the steroid users had a mortality rate that was three times higher than that of the controls. They also found a threefold increase in nonischemic heart disease and a fivefold increase in thromboembolic conditions.

But again, potential confounders weren’t considered. Neither were all 545 of the steroid users bodybuilders. Many were recreational athletes competing in other sports, guys just trying to look better, prisoners, military personnel, and law enforcement, most of which have their own risk factors.

So, Are the Steroids Killing Them or Not?

My observation is that it’s not directly the steroids killing most of these bodybuilders but bigness, or the pursuit of bigness, and for that we can blame the International Federation of Bodybuilders (IFBB).

Let me explain.

Let’s say you’re the conductor of a steam locomotive. Your engine powers your little choo-choo just fine, but then Beauregard McPherson, who owns the train and half of Montana, tells you to start adding railway cars to the train. First a couple. Then a couple more.

But the bastard gets greedy and hitches dozens of cattle and coal-laden cars to the line. To keep it moving, you’ve got to keep shoveling more and more coal into the engine. The poor thing is working beyond its capacity, so much so that it eventually explodes, raining pieces of coal and cattle parts on Billings.

Now replace engine with “heart” and railway cars with “muscle” in the above analogy and you’ll get what I’m talking about. Steroids, as much as the enormous amount of food itself, makes bodybuilders preternaturally muscular, preternaturally huge, and it takes more blood vessels to vascularize a pound of muscle than a pound of fat. That fact, and their sheer size, makes the heart work that much harder. Failure is a natural conclusion.

Oh, my choo-choo analogy needs one more thing to make it complete: Replace Beauregard McPherson with the IFBB.

So, Who or What is Really to Blame for all these Deaths?

Let’s go back to bodybuilding’s “Golden Age” for a minute. It wasn’t like things were exactly health-minded back then, either. Consider what Steve Michalik, Mr. America in 1972 and Mr. Universe in 1975, had to say about the state of bodybuilding in his hey-day, as quoted in The Village Voice in 1991:

“I knew it was all over for me… Every system in my body was shot; my testicles had shrunk to the size of cocktail peanuts. It was only a question of which organ was going to explode on me first. See, we’d all of us been way over the line for years, and it was like, suddenly, all the bills were coming in. Victor Faizowitz took so much shit his brain exploded. The Aldactazone (a diuretic) sent his body temperature up to 112 degrees, and he literally melted to death. Another guy, an Egyptian bodybuilder training for the Mr. Universe contest, went the same way, a massive hemorrhage from head to toe – died bleeding out of every orifice. And Tommy Sansone, a former Mr. America who’d been my very first mentor in the gym, blew out his immune system on Anadrol and dbol and died of tumors all over his body.”

Although Michalik was vague in that quote about exactly which “bills had come due” for him, it started with him passing blood in his urine, which apparently resulted from multiple liver tumors. He recovered from the cancer, only to later suffer a heart attack, followed by a stroke.

This cosmic kick to his ass convinced him to become an anti-steroid crusader. Unfortunately, his efforts fell largely on deaf ears, and he passed away in 2012 from a self-inflicted gunshot wound.

You’d think the IFBB and other bodybuilding organizations would have been a little freaked out about the tumors, the “melting,” the blood flowing out from all orifices, and horrible untimely deaths in general. But no, they continually rewarded bodybuilders for getting bigger and more shredded.

If dog shows had “evolved” in the same way as bodybuilding contests, the miniature poodles that won best-in-shows back in the 1970s and 80s would now look like Shetland ponies, only with pom-poms on their legs.

Yes, the IFBB wanted bodybuilders to push the envelope, to get bigger and freakier and more insane looking. As such, they were tacitly complicit in competitive bodybuilding becoming more and more dangerous, and the way to get bigger was through insane doses of steroids.

Now, it is true that the IFBB does have drug-testing policies that conform to the World Anti-Doping Association (WADA) code. Surprised to hear that, aren’t you? And they have indeed submitted 171 samples for testing, according to a 2018 WADA report (the latest available). The trouble is, the IFBB and its members host over 6,000 competitions a year. Compare that with the 787 samples sent in by the International Powerlifting Federation and the 3,238 samples submitted by the International Weight-Lifting Federation during the same time period.

Clearly, the IFBB wanted bigger and freakier, health be damned. It seems to me, however, that bodybuilding would have been a lot more successful in the long run – instead of the freak show it is – if they’d “stayed put.” If bodybuilders had continued to compete with bodies like Frank Zane’s and even Arnold’s, the sport would have been literally and figuratively a lot healthier. The IFBB “trained” fans of the sport to like these asymmetrical, ungainly, unathletic, and unattractive bodies and, in doing so, set up many of these premature deaths.

It’s almost as if the Coca-Cola company discovered back then that Coke was killing some people, only instead of fixing the problem, they came out with New Coke that not only tasted worse but also killed more people.

I should point out, however, that several steroidal bodybuilders from that era, including Arnold and Lou Ferrigno, are still very much with us, and old-time greats Dave Draper and Chris Dickerson died “normal” deaths at respectable ages, but these are guys are more of the exception than the rule.

Now I’m not suggesting that they take steroids out of competitive bodybuilding. That’d be like taking fish away from chips, pigs from blankets, or hugs from kisses. However, professional bodybuilders should, at minimum, be able to pass the modest, low-bar requirements that some insurance companies require you to pass before they grant you life insurance.

That means blood pressure, hematocrit, and cholesterol should be within reasonable limits. Ditto for liver and kidney enzymes. Obviously, amateur contests couldn’t afford the costs of this type of scrutiny (lab tests cost money), but if the pros stop being rewarded for being the antithesis of health, it’ll trickle down the various levels of bodybuilding competition.

Only then will these stupid, unnecessary deaths become more uncommon.

There’s this old Robert Redford movie, “The Electric Horseman,” that, in my mind, has parallels to this whole debacle. Redford plays an old competitive rodeo rider who’s hired to use his riding skills to show off a 12-million-dollar retired racehorse that’s the symbol of a cereal company that’s also part of a big corporate conglomerate.

Redford doesn’t like how the horse is being used, so he steals him so he can set him free in some remote part of the western U.S. Here was his explanation to a reporter, played by Jane Fonda:

“Lady, that horse is a champion. He’s got more heart and more drive and more soul than most people you’ll ever know. And they’re hangin’ lights all over him. They’re trottin’ him around on stages with dancin’ girls. Ta-ta-da-ta-ta-ta! They’d have him wearin’ short pants and smokin’ a cigar if they thought it’d sell more of their damn junk!
Look it! They got him all tanked up on tranquilizers and Bute. They’re stickin’ him full of needles! Look at this tendon! It’s all filled up. He’s shot all full of steroids. And it’s not just for looks. Makes the horse sterile. So even if they… God, this is so damn funny. Even if they wanted to breed him, even if they wanted to pass on some of them fine qualities, they couldn’t. To say nothin’ what the horse hisself is missin’.”

Well, if pro bodybuilding were a horse, I’d steal it too, if only to save some lives.




  1. Escalante G et al. Dead Bodybuilders Speaking from the Heart: An Analysis of Autopsy Reports of Bodybuilders That Died Prematurely. J Funct Morphol Kinesiol. 2022 Nov;7(4):105.

  2. Smoliga, James M. et al. Premature Death in Bodybuilders: What Do We Know? Sports Medicine, 30 January, 2023.

  3. Solataroff, Paul, The Power and the Gory, Village Voice, 29 October 1991, 30.