Lance Armstrong’s public castigation prior to having his Tour de France titles stripped, and graver punishment of confessing to a disapproving Oprah Winfrey of his doping days and winning ways, revealed one of his self-justifications. He researched the ethics of violating doping regulations, and decided after consulting a dictionary that he was not cheating, as he was not gaining any advantage over his competitors.
Resorting to testosterone, EPO, other drugs as well as blood doping was a perceived need for Armstrong, who said, “I viewed it as a level playing field”1… the everyone else is doing it defense that stopped working for most of us in kindergarten.
Bodybuilding (other than drug-tested organizations) suffers from the same “level playing field” mentality as cycling, without the apparently ineffective barrier of rules regarding performance-enhancing drug use. At the level of the Mr. Olympia, the perfect combination of genetics, training, diet and drugs is required to excel. The number of contestants has escalated (some of the early Mr. Olympia contests had a single competitor, while today over 30 qualify and approximately 20 compete onstage), and the margin between winning and fading in the ranks narrows every year. It is a given that the vast majority of competitors use anabolic steroids dosed far into the supraphysiologic range (generally between 2,000 to 5,000 mg total androgen intake weekly). I would contend that the use of anabolic steroids is universal in this population, but acknowledge the slim (naive) possibility that a truly gifted individual might reach these heights unaided.
By the time a bodybuilder acquires his pro card, he has already committed years of training, financial cost and strained relationships. Entering the pro arena, he arrives at a new tier of competition— much like NFL rookies who excelled in college, only to falter at the pro level. The rewards (e.g., fame, prize money, guest posing, endorsements and business opportunities) are tremendous; the level of risk these men accept encourages them to experiment with potentially life-threatening concentrations of potent drugs and hormones, extreme physical stress and adverse conditions. In the quest to find an advantage, many are turning to unproven experimental drugs and biologics, even surgeries. Every time a new standard for definition or size is set, the bar is raised for all competitors. There are rumors of gene therapy or stem cell implants in elite athletes, making it possible that bodybuilders are also submitting to extremely risky and unethical procedures. This is the irresistible “cookie jar” that has arisen from advances in cellular, genomic and metabolomic science.
There are certain anabolic steroids/hormones that are well established in bodybuilding: insulin, growth hormone and IGF-1 are familiar to many. At the professional level, these drugs have become nearly as ubiquitous as anabolic steroids. Some might suggest the beta-2 adrenergic drug Clenbuterol as another example, but at the doses used in humans, it fails to promote anabolism reliably over the long term. Clenbuterol, and same-class drugs, are used to promote fat loss
Insulin is best known as a glucose (sugar) partitioning hormone secreted from the pancreas in response to a meal, prescribed to treat type 1 diabetes. However, in addition to driving glucose into most tissue (e.g., skeletal muscle), it also activates the uptake of amino acids and stops the breakdown of cellular protein. Insulin also promotes the storage of fatty acids as triglycerides in fat cells. In terms of whole-body growth, insulin is a more potent anabolic than testosterone. Bodybuilders have learned to time insulin injections in conjunction with training and some meals to drive nutrients into recently worked muscle, resulting in greater lean mass gains. The downside is that a miscalculation when preparing an injection or reconstituting a vial could lead to a lethal (life-threatening or life-ending) event. If insulin is overdosed, it can drive circulating glucose (blood sugar) so low that the brain is starved. Unless corrected very rapidly, it can lead to death. Insulin can also increase appetite and resistance to fat loss. It is unclear as to whether insulin or growth hormone first gained widespread use among mass-seeking bodybuilders; combined, they have increased the size and mass of the contestants noticeably. Human growth hormone (HGH) induces a state of insulin resistance which insulin treatments overcome; insulin increases fat storage, which HGH combats.
Human growth hormone was rarely used prior to the late 1980s due to cost and scarcity. Prior to the advent of recombinant technology, HGH was sourced from pituitary extracts of cadavers (the brains of dead people). There are rumors of bodybuilders in the late 1970s or early 1980s using GH derived from the pituitary of rhesus monkeys, but these are not verified by any credible source. HGH has both anabolic and lipolytic (fat releasing) effects, making it very appealing to bodybuilders; the mass gains do not involve the contractile proteins in muscle.3 Thus, increases in size are not associated with increases in strength. HGH use may increase the IGF-1 response to exercise in muscle, but that will be discussed later.4
The hormone also aids in tissue repair, possibly accelerating recovery from tendon or ligament strains. Dosing is an issue with this hormone, just as it is with insulin. Unlike insulin, there does not appear to be an acute toxicity (e.g., hypoglycemia). However, chronic (long term) use of excessive doses of HGH can result in life-shortening conditions (e.g., cardiomegaly, type 2 diabetes, tumor growth) and permanent disfigurement (e.g., overgrowth of facial, hand and foot bones). Over time, bodybuilders have learned to lessen HGH dosing and add the related hormone, IGF-1. The lipolytic (fat reducing) effect of HGH is accomplished at a low dose, whereas the anabolic (net) effect requires concentrations approximately three times greater than physiologic in young men; bringing with the mass gains several adverse effects.
IGF-1 is produced primarily in the liver and skeletal muscle. It is considered a secondary messenger of GH, as it carries out some of the GH-related effects. However, IGF-1 has unique effects and is more specific to anabolic effects in muscle. IGF-1 is produced locally by exercised muscle, and has a role in increasing contractile protein and tendon strength, increasing the hypertrophic response to weight training. Combined use of HGH and IGF-1 allows bodybuilders to experience the benefits of both hormones to a greater degree than relying upon injected hGH and the systemic (liver) production of IGF-1.
If one looks at the bodybuilders of the 1990s and early 2000s, one frequently sees facial deformities, elongated hands and feet and “GH belly” on the larger contestants. Today’s competitors achieve equal or greater size with a lower incidence of these deformities.
However, over time (years), even replacement therapy can cause both physical and metabolic signs associated with acromegaly (GH excess). The point may be moot if the trend of shorter life spans among professional bodybuilders continues.
Other growth factors exist, though are not in use clinically— insulin, HGH and IGF-1 all have established clinical use in medicine. Tissue growth factors are being studied in research labs for use in treating human conditions, or to better understand cellular and molecular processes. Though access to material that other bodybuilders may not have is very appealing to competitive individuals, the risks associated with self-experimentation are immense. These materials often have not been evaluated relative to toxicity, or effectiveness in humans. Further, there are often negative side effects that are unanticipated that might lead to organ damage, organ failure, or death. Even in carefully controlled clinical trials performed by pharmaceutical companies, there are rare cases of severe harm or death. Certain of these growth factors are fairly well understood, and appear to be capable of being used effectively with a reasonable expectation of short-to intermediate-term safety. Long-term safety is a complete crapshoot with absolutely no available data to formulate a guess, especially at the doses being used by these men in conjunction with numerous other drugs.
IGF growth factors are a family of protein hormones that regulate tissue growth and repair. In skeletal muscle, they are prominently involved with exercise-induced hypertrophy and satellite cell recruitment. Among the muscle-derived IGFs are: IGF-IEa, IGF-IEb or IGF-IEc (also known as mechano growth factor, MGF) and IGF-II. These growth factors act locally; circulating IGF-1 (blood concentrations) is often unchanged during this time. MGF acts locally, and promotes muscle growth in ways unique from IGF-1, including activating satellite cells. It would seem that MGF injections would work best administered the day a muscle group is trained, separated from the workout by a few hours. MGF has been detected in black-market products, and it is being explored for treating aging-related muscle loss, supporting the speculation that it may be effective (and in use) as an anabolic agent in bodybuilding.
Shortly after scientists demonstrated the potential to introduce genes into a living host, the concept of “gene doping” was born. As opposed to traditional doping, where hormones are injected into the body at concentrations much higher than normally present, gene doping is a method where strands of DNA are introduced that generate the same hormones at supraphysiologic concentration within the body. It is unnatural because it is not the “blueprint” the person was born with, though it could be argued as “natural” as the resulting hormone is produced entirely within the body and is not injected or swallowed. The concern of anti-doping agencies is that as the hormone is produced in the body, there would be no means of proving that it was not natural. Do not be surprised if we begin to see entire teams of athletes at the Olympics that have mutations or gene copies that are mathematically improbable.
For the bodybuilder, imagine the possibilities- after being infused with tissue implants of satellite cells, Leydig cells, islet cells, brown fat, etc. Then the new genes are activated, issuing concentrations of growth factors, betaadrenergic neurotransmitters, HGH, IGF-1, etc. The result would be nearly limitless growth. As utopian as that sounds, it is the cheese in the trap. Gene transfer is not perfected, and even in the best-case scenario, these growth factors are involved with many disease processes as well (i.e., cancer, enlarged heart, autoimmune diseases).
An area that is anabolic in that it increases muscle size, and is disappointingly prevalent in bodybuilding, is the use of site-enhancing oils such as synthol. The practice of injecting oils into tissue to increase size or (supposedly) cosmetic appeal is decades old. One of the original oils was paraffin oil, once used to augment breast size. Paraffin oil, and later other blended oils, have been used by bodybuilders to increase the size of lagging body parts or to exaggerate dominant muscle groups. Aficionados of bodybuilding are familiar with unsightly lumps in deltoids, biceps, gastrocnemius and other sites. What is not appreciated by those who depend upon these oils is that the long-term effect is destruction of the very muscle being “inflated.” Several cases are present in the medical literature of men who have experienced chronic, severe pain and loss of strength. The damage, detected by MRI or ultrasound, shows pockets of oil, inflamed and scarred muscle. The reported cases resulted in surgical removal of sections of the involved muscle, and segments removed in the surgeries reported were roughly five by two by two inches.
There are other agents with anabolic effects capable of increasing muscle size, such as myostatin inhibitors and specific prostaglandins. It is clear that an ever-expanding cocktail of growth promoters, cellular implants, gene transfer and other techniques are being explored in the eternal quest for greater size/strength. Greater complexity and more numerous concurrent manipulations nearly guarantees foreboding consequences.
While the cavalier may boast it is survival of the fittest, or what does not kill you makes you stronger, the reality is that bodybuilding will become extinct as a consequence of natural selection. Though it is advanced scientific knowledge that is providing the avenues for growth, it is not wisdom guiding the practice as we now see it.