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By: Daniel Gwartney, M.D. From: Muscular Development

Bodybuilding Purists wish to trace modern-day bodybuilding to the sport’s roots of the 1960s, but it could easily be argued that modern bodybuilding branched away from classic bodybuilding in the 1990s, deviating to extremes in size and form that bring to mind caricatures or comic book drawings. Historical precedent may be the gladiatorial games of ancient Rome, as the public was distracted from the failings of government with evermore extravagant “bread and circuses.” Warrior versus warrior duels were replaced with mob battles, exotic slaves and prisoners of war from foreign lands, and even predatory animals.

Once the boundaries of reality have been broken, it is impossible to put the genie back in the bottle. The trend that began in the 1990s has escalated, with bodybuilders developing physiques of such extreme that they bear little resemblance to the classic icons. Arnold Schwarzenegger famously decried this path, voicing his displeasure over a year ago.1 The road to this state includes the application of scientifically designed nutrition and training programs, as well as a year-round persistence in the use of a cadre of physique-enhancing drugs. Of course, anabolic-androgenic steroids (AAS) are a foundation component of the drug protocols. However, other drugs used in combination have developed muscle growth and fat loss effects that are like “steroids on steroids.”bmi


Prior to the 1990s, bodybuilders depended upon drugs used clinically, basically those one could buy from a pharmacy if one had a prescription, or the back of a warehouse/locker room if one didn’t. The classic physiques were muscular and well shaped, though lacking in the extremes of definition and size seen later. About 1991-1992, professional bodybuilders experienced a “gap up” in mass. The nearly three decades prior to this point exhibited a gradual increase in BMI (body mass index) from a respectable 26-28 range in the 1960s to 28-30 by 1990.2 This was achieved by a progressive increase in AAS dose and cycle duration, with the advent of early estrogen receptor antagonists (e.g., tamoxifen/Nolvadex) and more reliable post-cycle therapy. Focusing on hypertrophy rather than traditional power training also played a role, as well as a better understanding of nutrition. Within two years (1991-1992), professional bodybuilders catapulted upward in BMI to approximately 32 or greater, and exhibited less subcutaneous fat. That short two-year period compressed as much enhancement (well, augmentation) as 30 years of improvements in diet, training, sponsorship, travel and drug enhancement. This was not due to whey protein, cable workouts, genetic drift or cosmic radiation during an IFBB-hosted spaceflight. This was nearly exclusively the result of new drug regimens that immediately penetrated the bodybuilding, three drugs accounted for the increased BMI—insulin, human growth hormone (hGH) and IGF-1. Though some had access to cadaveric (sourced from the brains of dead people) hGH during the 1970s and 1980s, it was very limited in accessibility and supply. With the advent of recombinant technology, an essentially unlimited supply of hGH was available. Initially, this was dosed inappropriately by the early adopters, resulting in bodybuilders with paper-thin skin and dysmorphic facial features, as well as hands and feet that were suddenly two to four sizes larger.3 Recombinant technology was rapidly applied to insulin to serve the needs of type 1 diabetics who relied upon biologic insulin sourced from cows and pigs. However, many diabetics eventually form antibodies to animal-based insulin, necessitating the need for a source of “human” insulin. Recombinant technology inserts human DNA into bacteria, which produces the desired protein specific to that gene (e.g., hGH, insulin, IGF-1). Human and animal source hormones are molecularly different enough to stimulate the human body to reject animal-based insulin by developing antibodies to the animal molecules. Recombinant IGF-1 was developed as a practical extension of the technology. Another category of drug that made a dramatic impact is aromatase inhibition—primarily Arimidex (anastrozole) and Femora (letrozote).

So, during the 1990s, bodybuilders were relying upon the stalwarts of AAS, but capable of administering ever higher doses of aromatizable AAS as the rate of estrogen conversion could now be reliably controlled.4 Further, the trend for continuous AAS use—with cycles no longer having an “off-cycle” period but rather an occasional “bridge” whereby only a replacement dose of testosterone would be used—maintained the anabolic stimulus of these drugs within the high end of the physiologic range, and greatly minimized the loss of muscle mass and strength that was common when cycling off. hCG went from being a post-cycle therapy (PCT) to a “during cycle” adjunct to minimize testicular atrophy (i.e., ball shrinkage).5 Professional bodybuilders, either knowingly or ignorantly, have been jeopardizing future fertility and natural testosterone production in the pursuit of professional gain.6gains-in-size


The addition of high-dose hGH provided dramatic gains in size, but variable levels of satisfaction and an epidemic of adverse side effects. Most were concerned about the cosmetic effect of the facial bones growing, resulting in pronounced jaws and brows, as well as hands and feet becoming elongated to an almost comical degree if it were not a serious event.3 There was also the recognition of insulin resistance and an awareness that the increase in size was not necessarily quality mass, as there was little increase in strength. Noticeably, body fat dropped to near non-existence as hGH has potent lipolytic effects. Though no longer prevalent, carpal tunnel syndrome was once very common among hGH users in the gym.

There are few type 1 diabetics (insulin dependent) among the ranks of professional and elite bodybuilders. It is likely that the earliest discovery of manipulating not only the timing but also the amount of insulin injected had an effect on recovery and growth following workouts was realized among these men. As type 1 diabetics are taught to closely monitor blood sugar, it would be logical that they would notice changes in insulin requirement—indicating an increase in insulin resistance. The risk-tolerant, diabetic bodybuilder would conceivably experiment with dosing his insulin to allow for greater post-workout carbohydrate intake to increase muscle recovery, growth and to protect against muscle loss. With the focus on mass and body composition, the amplified effect of hGH and insulin on muscle mass increase would have been quickly evident, not just to the diabetic bodybuilder but also to his gym mates and fellow competitors. Insulin is readily obtained, so there was little barrier to experimentation among non-diabetic bodybuilders.7

IGF-1 is a secondary messenger hormone created by the liver in response to hGH, and skeletal muscle in response to resistance training as well as hGH. IGF-1 likely accounts for most of the anabolic effects of hGH in the relevant tissues, and for muscle mass, it has become the go-to drug over hGH for mass gains.3 However, during the early 1990s, it was primarily hGH and insulin, as experience and access to IGF-1 was more limited. The entry of Chinese manufactured biologics (i.e., hGH, IGF-1) to the market made those drugs much more affordable and accessible.cellucor-c4-article-ad

Flash ahead 20-plus years, and we see that the professional bodybuilder is continuing to increase in size. Thankfully, the earlier dosing errors that lead to the adverse cosmetic and metabolic effects caused by overdosing hGH have diminished greatly due to a deeper experience base. Further, hGH and IGF-1 have become more expensive and less accessible due to customs enforcement and tracing of Chinese material through ports whereby the country of origin was changed. This will be even more restrictive with the pending passage of several trade acts, such as the Trans-Pacific Partnership (TPP) and Transatlantic Trade and Investment Partnership (TTIP). Yet, the bodybuilders continue to grow. As one might imagine, some of this change is due to practical experience revealing the optimal ways, conditions and dosing schedules for the use of the relatively novel drugs added during the 1990s. There has also been an explosion in the use of drugs that are not yet available through retail pharmaceutical dispensaries. These drugs include veterinary compounds (admittedly used throughout the 1980s and beyond), pre-approval pharmaceutical drugs in development and designer compounds available only through research labs or chemical suppliers.8,9 Licensed and unlicensed compounding pharmacies are also making traditional AAS available in more potent forms, such as the 50-milligram tablets of stanozolot (Winstrol).

Along with the complexity of options comes the inevitable lack of uniformity. Once, bodybuilders followed very similar protocols, often determined by the results of those they trained alongside. Over time, as “stables” of bodybuilders were groomed by certain sponsors, experimentation occurred among the lower-tier competitors. As chemists and pharmacists entered the direct supply chain, novel drugs entered the scene. Now, the resources available to elite-tier bodybuilders is limited only by imagination. Hormones, cytokines, SARMs, receptor antagonists and adjuncts to control adverse effects are myriad and legion. Myostatin is a molecule that limits muscle growth. Inhibiting myostatin leads to an increase in skeletal muscle mass by 25 percent or greater, if animal models are relevant.10 However, there are many tissues that are affected by myostatin, so non-specific forms have been reported to impair cardiac (heart) function. Long-acting activators of certain receptors—including mechano growth factor (mGF), a variant of IGF-1—may lead to augmented growth as well. Even cell energetics are playing a role, with mitochondrial activity and capacity being manipulated. Stem cell harvesting, with ex vivo proliferation and differentiation, is used in sports recovery and very likely applied to enhancement. Though only rumored at this point, gene therapy is entirely plausible.11

For the modern bodybuilder, anabolics no longer mean AAS cycles with PCT. It has advanced beyond persistent supraphysiologic AAS use with supportive hCG, adjuncts to control estrogen conversion and the classic global anabolics of insulin, hGH and IGF-1. It has become a constellation of distantly related factors that converge upon the final outcome of increased muscle mass. As with all emerging technology, it is likely that the more potent and complex this becomes, the more likely we are to see unintended consequences. Bodybuilders continue to grow, and will do so until they reach the biologic limits of mass.
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