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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.
ReferenceReference
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.
Great article!
TC_Luoma:
The other is attorney Rick Collins, widely known as the legal authority on performance-enhancing drugs.
I’ve hung out with Rick a few times. He’s a great guy.
I don’t see how this is that ‘telling’. The male population in the US alone exceeds 160 million. I would bet hundreds of thousands of men are partaking in anabolics. We get 48 guys, who likely used extreme doses, dead under 50? So what? How many dead under 50 guys have died from couch potato disease? I bet a lot more.
If one thing kills you, other things that kill you are not relevant to the one thing that kills you. Both steroid abuse and couch potato disease kill you so it is best to have nothing to do with either. You have to complete the evaluation of something that kills, then move to the next killer.
Okay, fair enough. However, we generally know what kills couch potatoes. You gotta’ admit that there’s a rash of young or young-ish semi-famous bodybuilders dying lately. These autopsy reports seem to shed a little light on what many of us already suspected.
WOW…So much denial in this group…SMH
Would be helpful to have more info on the long-term effects of TRT, especially as it relates to heart health.
blshaw:
How many dead under 50 guys have died from couch potato disease? I bet a lot more.
That’s almost like saying “I’m 50lbs overweight, but at least I don’t smoke”. I’ve always thought it’s better to try to remove bullets from our own long game of Russian roulette, than to use the contents of other people’s chambers to excuse ourselves.
Here’s a recent article of TC’s related to that:
https://forums.t-nation.com/t/is-trt-safe-heres-what-a-big-new-study-says/
And there’s this:
T NATION – 14 Feb 20
Use Testosterone for Heart Health
Research shows that testosterone replacement therapy (TRT) can do great things for the heart. Too bad it’s been largely ignored… until now.
Est. reading time: 9 minutes
Just keep this in mind:
T NATION – 12 Apr 22
TRT Side Effects: The Big One to Avoid
TRT side effects are fairly rare, but it CAN cause elevated hematocrit. Don’t let thick blood kill you. Here are nine ways to fix it.
Est. reading time: 9 minutes
I was a competitive BB from the early 1980s to my last show, Eastern Seaboard in Atlanta 1990. I did cycle steroids and was as careful as possible. I won my state title and therefore qualified for the Nationals and competed in them one year and did well in the heavy weight division. I was pick by Muscle Mag to win the Eastern Seaboard but there was some “funny stuff” that went on so I didn’t. That is one reason it was my last show. I find this article very interesting because even though I did light cycles I now understand that I was probably affected in some way but now over 30 years since any use those effects are probably gone. Many from that era died young from the same cause. Two that come to mind are the Mentzer brothers, Ray and Mike. They may have had an inherited defect because they both died at about the same age and cause but it is likely that there were other “contributing factors”.
As serious and solemn as this article is, I loved you reference to The Jim Carroll Band and their song Friends That Died. Very appropriate, “….loved you more than all the others, this song is for you my brother.”.
I disagree with that assessment as athletes all over the world have died or suffered cardiac arrest in 2022. The data 400 percent increase confirms the time line with the release of the Covid vaccine which really is gene therapy that compromised your immune system with spike proteins that cannot be turned off and therefore cause autoimmune disorder.
TC_Luoma:
But can we blame it on steroid use
Yes
We have quite a few studies showcasing even “moderate” (quantify moderate, by bodybuilding standards moderate) steroid use leads to subclinical deterioration of cardiac function and in itself AAS use likely in part through up-regulation of beta adrenergic receptor expression within cardiac myocytes (granted this may be a systemic upregulation, not only cardiac myocytes) induces cardiac/overarching autonomic dysfunction.
Cardiac automomic dysfunction + subclinical deterioration in cardiac function + intensive exercise could = fatal arrhythmia in those predisposed or unlucky.
Whether cardiac dysfunction induced is reversible depends… how long have you been using, how much have you been using… how genetically predisposed towards eventuating a negative outcome from a cardiovascular standpoint are you?
For some… low doses are enough to cause serious issues even if duration of use is short. A small minority appear to get away with megadoses for decades… genetics…
TC_Luoma:
This meant that the volume of blood entering the chambers was reduced.
Primary difference between steroid induced cardiomyopathy and athletes heart. The left ventricle of an athlete might hypertrophy (in eccentric, concentric or mixed fashion), however these adaptations in the context of an athlete typically make the heart stronger… hence you don’t see the super low LVEF’s with athletes heart as you do with AAS induced cardiomyopathy.
TC_Luoma:
While medical science doesn’t know for sure if steroids cause atherosclerosis
There’s a linear correlation between years or cumulative AAS use and plaque scores. It’s compound dependent, but drugs like stanozolol have some putting up bloodwork along the lines of
HDL 5LDL 300
Say what you will about the science behind cholesterol. There is a relationship with low HDL and cardiovascular risk.
Whether increased LDL from AAS is dangerous… depends on so many factors. Though an LDL of 300 is terrible under any and all corcumstances
How high? What do sub-fractions/particulate counts look like
Ironically enough, AAS tend to decrease lp (A). Elevated lpa is associated with higher CVD risk. However this is likely offset by crushed HDL…
There is no WAY chronic use of drugs like oxandrolone, stanozolol don’t hasten the process of developing atherosclerosis. All c17aa AAS are particularly bad for lipids, but DHT derived orals that can’t aromatise are the worst. Estrogen plays an important role re glucose and lipid metabolism.
So aside from the fact we know cardiac myocytes have AR’s. We also need to look at AAS induced hypertension alongside synpathetic nervous system upregulation induced via AAS use as concomittant contributors towards cardiomyopathy seen in bodybuilders (and some hobbyists).
We also need to factor in the doses bodybuilders (and now even hobbyists use)
Speak to @RT_Nomad, you’ll note the doses many bodybuilders of his era used were merely a fraction of what many hobbyists use now, let alone professional bodybuilders.
TC_Luoma:
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
I saw this study, for the most part deleterious changes were subclinical in nature… meaning the deleterious variables didn’t cross over into territory that could mediate say… symptoms of heart failure, nor did the cardiac parameters of participants reach that of what you’d associate with cardiomyopathy.
However this was one cycle… imagine decades of use + an aging body + the fact many never come off and/or go down to TRT and it’s fairly likely “cumulative” damage could lead to premature onset CHF.
I’m not condoning steroid use. The biggest issue I forsee with use is the manner by which many never really manage to stop using. I honestly believe the dangers associated with the average HEALTHY ADULT male running a cycle or two are vastly overblown if we refer to the information one can find via the media. But how many adults who use stop after a cycle or two? Or even three or five?
Most who start using seem to continue for the rest of their lives
At the same time I find bodybuilding circles underestimate the dangers of acute use, let alone chronic use.
unreal24278:
I honestly believe the dangers associated with the average HEALTHY ADULT male running a cycle or two are vastly overblown if we refer to the information one can find via the media.
Agreed. Good post!
cdep89:
That’s almost like saying “I’m 50lbs overweight, but at least I don’t smoke”.
Agreed. I’m not trying to diminish the health implications of steroid use but merely call it what it is rather than targeting it like the media does. The average American lifestyle has a plethora of things that are equally bad but its not sensational.
TC_Luoma:
You gotta’ admit that there’s a rash of young or young-ish semi-famous bodybuilders dying lately.
Just my opinion, but like all things lately, it only appears that way because of social media. Its front and center for you. In the 70s and 80s you wouldn’t have even known,
drbarney1:
If one thing kills you, other things that kill you are not relevant to the one thing that kills you.
Thats the thing. Steroids don’t kill you. Abuse of steroids CAN cause many things that @unreal24278 listed. So can drinking too much alcohol or even too much water for that point. Ask Silvester Stallone or even Arnold if steroids killed them. Wait, despite their known abuse they are still alive.
Edit: Also, from what i’ve read, most of the dead steroid abusers were known to abuse other drugs and narcotics at the same time. Double whammy.
phiroc:
Covid vaccine which really is gene therapy that compromised your immune system with spike proteins that cannot be turned off and therefore cause autoimmune disorder.
Huh?
The spike protein in covid vaccines is almost identical to that of the protein found with covid-19.
The presence of that protein in your body post shot goes away after a few weeks, but the presence of that protein stimulates an innate immune response. This doesn’t prevent you from being able to get covid, but it makes it less likely for you to fall seriously ill
There is no quantative evidence to my knowledge aside from conspiracy theories that suggest covid shots (and why is everyone going after covid shots… out of everything you could go after… it’s a vaccine… seriously…) cause autoimmune disease.
Man, I don’t want to get into a whole thing about vaccines, but that’s just plain wrong. I worked briefly as a microbiologist and I can tell you there is no credible evidence that these elegant mRNA vaccines caused any more deaths than any other vaccine that’s been in use for a hundred years. You would also have trouble finding more than a handful of people with any kind of medical science background to agree with you.
Wantnot46:
Two that come to mind are the Mentzer brothers, Ray and Mike. They may have had an inherited defect because they both died at about the same age and cause but it is likely that there were other “contributing factors”.
I am not sure about Ray, but Mike was using speed to be more productive. From what I remember hearing, quite a bit of it. I think of that as a contributing factor. Perhaps with better heart genetics he could have handled it, perhaps without AAS he could have handled it. I think all three of those things contributed to his death, possible other factors as well.
blshaw:
So can drinking too much alcohol or even too much water for that poi
The difference between water and alcohol is… alcohol is a poison, water is essential for survival.
Alcohol actually does kill you. New data suggests there is literally no safe degree of intake.
Past data linking moderate drinking to health benefits is likely equitable to industry funded studies back in the day that suggested tobacco was good for you and/or was associated with little to no harm.
Are you really going to stop drinking because the couple of beers you have every week might take a year off your lifespan? Probably not… it’s about the bigger picture/quantative risk.
I VERY rarely drink nowadays. But I’m an anomaly for my age. I think most alcohol tastes like feet or (insert gross variable). I like beer though, but I don’t drink beer anymore regardless because it’s high in calories and high in carbs + the metabolic effects of ethyl alcohol make the already unhealthy profile of the beverage even worse.
Anabolic steroids shorten lifepsans, there’s no doubt about that… but how much shortening are we talking about?
Five years? Ten? Twenty? Fifty? It varies so much from user to user…
TC_Luoma:
mRNA vaccines caused any more deaths than any other vaccine that’s been in use for a hundred years
There’s also a myth that mRNA technology with regards to vaccines is a “new thing”. mRNA vaccines have been a concept/used in clinical trials for quite some time now.
Covid shots were the first commercially viable preparations to my knowledge, but a relatively long standing track record of safety has been established.
unreal24278:
There’s also a myth that mRNA technology with regards to vaccines is a “new thing”. mRNA vaccines have been a concept/used in clinical trials for quite some time now.
Absolutely!
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