TC Luoma
The Coroners Know Why They're Dying
A group of researchers got ahold of the coroner's reports on bodybuilders who died young. Here are their grim findings.
Big. Ripped. Dead.
Steroid-induced cardiomyopathy. Severe cardiomegaly with concentric left ventricular hypertrophy. Sudden cardiac dysrhythmia due to hypertensive cardiovascular disease.
These findings were taken directly from the autopsy reports of bodybuilders under the age of 50 who died from cardiovascular events.
With apologies to the Jim Carroll Band, these are people who died, died, not from jumping in front of a subway train or a slit in the jugular vein, but from causes almost certainly related to long-term steroid use/abuse.
The grim discoveries were compiled in a recent paper titled "Dead Bodybuilders Speaking from the Heart: An Analysis of Autopsy Reports of Bodybuilders That Died Prematurely."
Below are some of its revelations. Let's hope, given the spate of premature bodybuilder deaths in the last few years, that this paper and its findings do some good, perhaps serving as a warning against the relentless, kamikaze pursuit of drug-aided "bigness" and against making a mockery of the notion that bodybuilding is a healthy sport.
What They Did
I was surprised to realize I know two of the paper's five authors. One is Daniel Gwartney, a competitive bodybuilder during the 1990s who's now a doctor. The other is attorney Rick Collins, widely known as the legal authority on performance-enhancing drugs.
Their background is important because their observations carry much more weight than they might otherwise. They understand the lifestyle. They were able to see mitigating factors and consider things those less studied in the sport might have missed.
That being said, on February 10th, 2022, the authors conducted a general Google search with the term "dead bodybuilders." The search yielded 18 websites in the first two pages of the search. After ditching duplicate information and YouTube videos, they narrowed the search down to seven sites, one of which was T Nation.
Those sites served as their starting point. Using them, they found 45 American bodybuilders who had died before the age of 50 from any cause in the previous 12 years. They then narrowed their search further, filtering it down to those who were reported to have died from a heart attack, heart failure, stroke, embolism, fatal arrhythmias, natural causes or unknown causes, and whose location (state) and date of death were available.
They identified a total of 14 bodybuilders, and the authors contacted each individual county coroner's office to request autopsy reports. They got back seven reports but ended up excluding one because the official cause of death wasn't a cardiac-related event (drowning).
For ethical and probably legal reasons, their names – some of which we'd probably recognize – were omitted from the study.
What Their Grim Task Revealed
While the researchers' search parameters included dead bodybuilders under the age of 50, only one of their six "finalists" was even close to that (46 years old). The second oldest was 40, while the youngest was only 26 years old. You don't have to be a pathologist or cardiologist to realize that cardiovascular-related deaths in men that young is an anomaly.
But can we blame it on steroid use? Do we even know for sure that all these bodybuilders were using supraphysiological amounts of steroids? Well, most of the toxicology reports indicated steroid use (67%), but even without that smoking gun, the authors calculated a couple of the dead bodybuilders' fat-free mass index (FFMI).
The average person rarely exceeds an FFMI of over 25 kilograms/meter squared. Two of the guys were getting ready to compete, and assuming that their body fat percentage was 5% (a conservative estimate), their FFMI was estimated to be 31 kg/m².
However, as the authors repeatedly state, association does not mean causation, i.e., just because they used steroids doesn't necessarily mean it led to their cardiovascular failures.
Still, it's pretty damning when you look at the morbid measurements. For instance, the researchers found that the mean heart weight of the dead bodybuilders was 73.7% heavier than their reference man's (575 grams vs. 332 grams, respectively). Further, the mean thickness of their left ventricles was 125% thicker than what's typical for an average man.
This is to be expected because cardiac muscle – one of the three types of vertebrate muscle – has androgen receptors peppered throughout it. As such, the heart muscle cells, like skeletal muscle, likely respond to anabolic steroids, too.
Some of you may be thinking that a larger heart should be a good thing in that it pumps more blood. Ordinarily, you might be right. For instance, the legendary superhorse Secretariat had a heart that weighed 22 pounds, almost three times the size of the average thoroughbred's heart. His large heart enabled him to take in more oxygen, which fueled his muscles and allowed for almost supernatural endurance and recovery.
But the hearts of the dead bodybuilders weren't large in the same way that Secretariat's heart was large. No. Sadly, their hearts were large because the walls of the individual chambers, particularly the left ventricle, had grown much thicker, presumably from large doses of steroids. This meant that the volume of blood entering the chambers was reduced.
In other words, the hearts had trouble oxygenating the enormous bodies they were housed in, which, in some of their cases, led to heart attack and death.
I also need to point out that a lot of non-steroid-using bodybuilders and weightlifters (or, for that matter, athletes from a wide variety of sports) have enlarged left ventricles, but in most cases, the enlargement is minimal and not dangerous. Clearly, that wasn't the case for the six dead bodybuilders.
The autopsy reports also revealed that 80% had atherosclerosis. While medical science doesn't know for sure if steroids cause atherosclerosis, steroid abuse has long been associated with elevated levels of low-density lipoprotein (LDL) and low levels of high-density lipoprotein (HDL).
There is, of course, a controversy over whether whacked cholesterol levels even contribute to atherosclerosis, but regardless of whether they do or not, their clogged-up blood vessels might be the natural side-effect of hypercaloric intake.
Because they were large, because they wanted to get larger, and because they were using steroids to aid in their quest for largeness, they ate a lot. They likely ate a lot of meat – sties of pigs, herds of cattle, flocks of chickens – all of which contain a lot of saturated fat, which, according to popular belief, possibly led to atherosclerosis years, if not decades, before it might have naturally occurred.
This quest for calories might also have led them to ingest more processed sugars, trans-fats, and high-glycemic carbs, all of which are probably more likely to cause cardiovascular disease than saturated fats.
One cardiovascular disease risk factor that wasn't revealed by the autopsy reports is high blood pressure. Obviously, dead men don't have a blood pressure of any kind, so the reports don't reveal if these men were hypertensive. However, based on studies of live men and steroid use, we can safely assume that the dead bodybuilders did have high(er) blood pressure, which was likely just another contributing factor in their early deaths.
Can't Swing a Dead Cat Without Hitting a Dead Bodybuilder
This study has a couple of drawbacks, the most prominent among them being the small sample size. Furthermore, as the authors point out, they have no idea what other drugs (GH, insulin, recreational drugs, etc.) the bodybuilders might have been taking. They were also unaware of whether the bodybuilders had genetic predispositions to cardiovascular disease. Lastly, there's that "association does not mean causation" mantra they kept repeating throughout their paper.
So yeah, the authors used due diligence in reporting their findings and urged further research to "further clarify the potential risks of cardiovascular complications with continual supraphysiological abuse of AASs (androgenic anabolic steroids) in bodybuilders."
Methinks they're being a little coy, but that's what you have to do when you write a paper for inclusion in a scientific journal.
The fact is you can't swing a dead cat without hitting a dead bodybuilder lately. You don't have to be a doctor, a researcher, or a coroner to see that a disproportionate number of bodybuilders have dropped dead, and their hearts are the most logical, most obvious suspects.
Look at it this way, even if these super large humans using super large amounts of steroids didn't have enlarged hearts or clogged arteries, the fact that their bodies are so large means their hearts had to work that much harder, John Henry, steel-driving-man hard, just to stay alive. And, like John Henry, they eventually broke their poor hearts.
What About the Average Guy Who Did a Couple of Cycles?
A lot of the people reading this site have done a cycle or two and, if they're prone to any degree of paranoia at all, are likely gingerly massaging their chests right now, wondering just how thick and lumbering the steroids made their left ventricles.
Well, there's at least a little research on the subject, the findings of which should give you a little solace. As described in the paper that's the topic of this article, Smit et al. did a study on the effects AAS had on left ventricular hypertrophy. They recruited 31 men who had self-selected to start a cycle.
After 16 weeks, the "3D left ventricular ejection fraction declined, ratio of early to late ventricular filling velocities decreased, 3D left atrial volume increased, and left ventricular mass increased."
None of that's desirable. However, the values returned to baseline after being clean for about 8 months. Now it must be said that the median dose these guys used was 904 mg. a week. That's a lot, but it pales in comparison to what pros typically do (running non-stop or virtually non-stop cycles of as much as three grams a week for years).
My point is this: If you've done a modest cycle or two or three in your life but have been clean for a while, you're probably no more likely to drop dead than the average non-steroid-using guy your age (which may or may not give you peace of mind).
However, if you're thinking about doing additional cycles in your obsessive quest for bigness, let the lessons left by these dead bodybuilders guide you in making your decision.
Reference
- 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.
