Premature Death in Bodybuilders: What Do We Know?

Abstract

Premature deaths in bodybuilders regularly make headlines and are cited as evidence that bodybuilding is a dangerous activity. A wealth of research has revealed elite athletes typically enjoy lower mortality rates than non-athletes, but research on bodybuilder lifespan is surprisingly limited. Anabolic androgenic steroid (AAS) use is commonly cited as a key contributor to morbidity and premature mortality in bodybuilders, but this area of research is highly nuanced and influenced by numerous confounders unique to bodybuilding. It is quite possible that bodybuilders are at elevated risk and that AAS use is the primary reason for this, but there remains much unknown in this realm. As global participation in bodybuilding increases, and healthcare providers play a more active role in monitoring bodybuilder health, there is a need to identify how numerous factors associated with bodybuilding ultimately influence short- and long-term health and mortality rate. In this Current Opinion, we discuss what is currently known about the bodybuilder lifespan, identify the nuances of the literature regarding bodybuilder health and AAS use, and provide recommendations for future research on this topic.

Fig. 1

Factors which may contribute to morbidity and premature death in bodybuilders. There is little epidemiologic research investigating significant morbidity and mortality in bodybuilders, but case reports and anecdotal evidence suggest a number of causes. These include myocardial infarction, cardiomyopathy, heart failure, pulmonary embolism, kidney failure, epilepsy, and suicide. Androgenic anabolic steroids (AAS) are commonly cited as the primary cause of morbidity and mortality in bodybuilders, but many other factors can also influence short- and long-term health and clinical outcomes in all bodybuilders. Each individual factor may contribute to pathology, and it is possible that there are additive or synergistic effects. Genetics likely modulate the magnitude of pathology/morbidity for each individual risk factor. Socioeconomic factors (e.g., education level, access to high-quality healthcare) may influence whether pathology results in premature death. It should be noted that this figure focuses on suspected pathology/health risks of bodybuilding behaviors, but it is also possible that some behaviors could be beneficial (e.g., extreme weight training might improve overall health, some supplements or drugs may provide protective effects)