Excessive androgen exposure and risk of malignancies: A cohort study.

BACKGROUND: A link between androgen use and the risk of cancers, especially prostate and breast cancer, has been suggested. The knowledge about a possible association is limited. OBJECTIVE: The study aimed to investigate cancer incidence rates, particularly those related to prostate and breast cancer, in male androgen users and compare them to a control group. METHODS: We included male androgen users identified through a nationwide anti-doping testing program in Danish fitness centers from 2006 to 2018. We paired each case with 50 male controls of the same age, selected randomly. The cohort was followed from baseline and until 2023. The outcome was the incidence of prostate cancer, breast cancer, or any cancer excluding non-melanoma skin cancer. RESULTS: The study included 1,189 androgen users and 59,450 controls, with a mean age of 27 years at enrolment. During the follow-up period with a mean length of 11 years, 13 androgen users, and 612 controls were diagnosed with cancer. This resulted in an incidence rate ratio of 1.05 (95% CI: 0.55-1.81). None of the androgen users were diagnosed with prostate or breast cancer. DISCUSSION AND CONCLUSION: Male androgen users did not face an increased short-term risk of cancer, neither overall nor related to prostate or breast cancer. Our study indicates that the absolute risk of malignancies in androgen users is comparable to that in the background population. However, we cannot exclude androgens as a cancer risk factor due to the limited sample size, relatively short follow-up period, and subject age.

The dichotomy between health and drug abuse in bodybuilding.

Aim: The aim of the present study was to investigate the expansion and prevalence of anabolic steroid use by examining the divergent effects between health and drug abuse and to create more awareness around the harmful consequences of these drugs when administered at abusive levels. Methods: A focused and concise literature search was conducted, and 101 high-quality articles were included in the review. Results: The findings underscore the adverse health risks of steroid abuse, emphasizing the stark contrast between health and drug abuse. Conclusions: While steroids and other performance-enhancing drugs can yield muscle growth, strength and even fat loss, abusing these substances can lead to adverse health outcomes. Furthermore, within the fitness subculture, particularly in the realm of bodybuilding, steroid abuse fosters an atmosphere of cheating and deception, frequently downplaying or ignoring the negative and sometimes deadly consequences it brings.

Deloading Practices in Strength and Physique Sports: A Cross-sectional Survey.

BACKGROUND: This study explored the deloading practices of competitive strength and physique athletes. A 55-item anonymised web-based survey was distributed to a convenience-based, cross-sectional sample of competitive strength and physique athletes (n = 246; males = 181 [73.6%], females = 65 [26.4%]; age = 29.5 ± 8.6 years) who had 8.2 ± 6.2 years of resistance training and 3.8 ± 3.1 years of competition experience. RESULTS: All athletes deloaded within training with energy and fatigue management being the main reasons to do so. The typical duration of a deload was 6.4 ± 1.7 days, integrated into the training programme every 5.6 ± 2.3 weeks. Deloading was undertaken using a proactive, pre-planned strategy (or in combination with an autoregulated approach) and undertaken when performance stalled or during periods of increased muscle soreness or joint aches. Athletes reported that training volume would decrease (through a reduction in both repetitions per set and sets per week), but training frequency would remain unchanged during deloads. Additionally, athletes reported that training intensity (load lifted) would decrease, and effort would be reduced (facilitated through an increase in repetitions in reserve). Athletes would generally maintain the same exercise selection during deloading. For athletes that supplemented deloading with additional recovery modalities (n = 118; 48%), the most reported strategies were massage, static stretching and foam rolling. CONCLUSION: Results from this research might assist strength and physique athletes and coaches to plan their deloading. Future research should empirically investigate the findings from this study to further evaluate the potential utility of deloading in strength and physique sports.

Bodybuilders and high-level meat consumers' behavior towards rabbit, beef, chicken, turkey, and lamb meat: A comparative review.

In bodybuilders' diets, protein plays a crucial role in supporting muscle growth and repairing damaged muscle tissue. These individuals meet their protein needs by combining dietary sources with supplements. Animal-based proteins are often preferred over plant-based proteins because they are believed to better support muscle protein synthesis. This review explores the meat consumption patterns of bodybuilders and high-level meat consumers, focusing on rabbit, beef, chicken, turkey, and lamb. We describe and compare the types of meat bodybuilders commonly consume and provide an overview of protein supplements, including meat-based options, plant-based alternatives, and whey-based products. Our aim is to gain insight into the dietary preferences of bodybuilders and high-level meat consumers, considering their nutritional requirements and the potential effect on the meat industry. We conducted an extensive search across various databases, including Scopus, Web of Science, PubMed, and Google Scholar. We found that individual choices vary based on factors such as attitudes, trust, taste, texture, nutritional content, ethical considerations, and cultural influences. Nutritional factors, including protein content, amino acid profiles, and fat levels, significantly influence the preferences of bodybuilders and high-level meat consumers. However, it is crucial to maintain a balance by incorporating other essential nutrients such as carbohydrates, healthy fats, vitamins, and minerals to ensure a complete and balanced diet. The findings from this review can inform strategies and product development initiatives tailored to the needs of bodybuilders and discerning meat enthusiasts.

Peak Week Carbohydrate Manipulation Practices in Physique Athletes: A Narrative Review.

BACKGROUND: Physique athletes are ranked by a panel of judges against the judging criteria of the corresponding division. To enhance on-stage presentation and performance, competitors in certain categories (i.e. bodybuilding and classic physique) achieve extreme muscle size and definition aided by implementing acute "peaking protocols" in the days before competition. Such practices can involve manipulating nutrition and training variables to increase intramuscular glycogen and water while minimising the thickness of the subcutaneous layer. Carbohydrate manipulation is a prevalent strategy utilised to plausibly induce muscle glycogen supercompensation and subsequently increase muscle size. The relationship between carbohydrate intake and muscle glycogen saturation was first examined in endurance event performance and similar strategies have been adopted by physique athletes despite the distinct physiological dissimilarities and aims between the sports. OBJECTIVES: The aim of this narrative review is to (1) critically examine and appraise the existing scientific literature relating to carbohydrate manipulation practices in physique athletes prior to competition; (2) identify research gaps and provide direction for future studies; and (3) provide broad practical applications based on the findings and physiological reasoning for coaches and competitors. FINDINGS: The findings of this review indicate that carbohydrate manipulation practices are prevalent amongst physique athletes despite a paucity of experimental evidence demonstrating the efficacy of such strategies on physique performance. Competitors have also been observed to manipulate water and electrolytes in conjunction with carbohydrate predicated on speculative physiological mechanisms which may be detrimental for performance. CONCLUSIONS: Further experimental evidence which closely replicates the nutritional and training practices of physique athletes during peak week is required to make conclusions on the efficacy of carbohydrate manipulation strategies. Quasi-experimental designs may be a feasible alternative to randomised controlled trials to examine such strategies due to the difficulty in recruiting the population of interest. Finally, we recommend that coaches and competitors manipulate as few variables as possible, and experiment with different magnitudes of carbohydrate loads in advance of competition if implementing a peaking strategy.

Alimentation and nutrition applied to the new fitness disciplines in Italian gym.

Background: The energy balance between inputs and outputs is essential to avoid a reduction in performance, recovery difficulties, hormonal problems, an increased risk of fatigue, injuries and illnesses. Aim: The purpose of the study is to evaluate whether the energy intake assumed by non-professional sportsmen of the new fitness disciplines on the basis of the guidelines present in the literature, meets the needs required by their sporting activity. Methods: The sample consist of 20 non-competitive adult sportsmen (n.10 females; n.10 males) that were voluntarily enrolled in a gym, belonging to the various fitness disciplines: bodybuilders (n = 2); calisthenics (n = 3); crossfitters (n = 15). The subjects underwent an anamnestic-nutritional interview and used a photographic atlas to estimate the energy intake in the training day (in terms of macronutrients, micronutrients and H2O). Results: The results of the study reported: a lower energy intake, the breakdown of macronutrients was suitable for the nutritional indications reported by bibliographic sources, with the exception for protein intake that was higher than the other macronutrients; a lower intake of fibers, mono/polyunsaturated fatty acids; an higher intake of simple sugars, proteins and H2O, and by a normal parameters of carbohydrates, fats and saturated fatty acids. Conclusions: Generally the study has shown that the sample energy intake is extremely low in the training day. Therefore, it is useful to educate sportsmen, coaches and families in order to avoid deficiencies/excess of calories and nutrients which may not be functional for the sporting activity performed.

[Collapsing Glomerulopathy Secondary to Anabolic Steroids for Bodybuilding: A Case Series].

The abuse of anabolic androgenic steroids (AAS) for competitive (and non-competitive) purposes for bodybuilding practice is increasingly common. The consequences of these substances on the various organs are only partially known. Cases of FSGS following the use of AAS have been reported in the literature, even with evolution to ESKD. We describe three cases of bodybuilding athletes who presented alterations in renal function indices after taking AAS for a long time. Three renal biopsies were performed with histological diagnosis of FSGS collapsing variant. We examine the lesions observed on histological examination. Two athletes had rapid progression of renal disease requiring replacement therapy. The third one continues conservative treatment for chronic renal failure. We discuss the risks related to the intake of doping substances and how bodybuilders are exposed to different causes of kidney damage: anabolic steroids, supplements, and a high-protein diet.

Cutaneous Manifestations of Anabolic-Androgenic Steroid Use in Bodybuilders and the Dermatologist's Role in Patient Care.

Young adults have been increasingly facing pressure to achieve an appealing athletic physique, often influenced by social media influencers on platforms like Instagram. This viewpoint highlights the association between image-centric social media, dissatisfied body image, the use of anabolic-androgenic steroids (AAS) to achieve desired results, and the overlooked dermatological side effects of AAS, including acne and acne fulminans. We underscore the importance of recognizing acne fulminans as an indicator of possible AAS abuse and encourage dermatologists to actively identify and address AAS use to improve their patients' well-being.

Bilateral simultaneous quadriceps ruptures in an elite bodybuilder: A case report of treatment success.

Tendon injuries in weightlifters is known to be associated with steroid use. Bilateral simultaneous quadriceps tendon rupture (BSQTR) is extremely rare with few cases reported in literature in young athletes. Unlike patellar tendon ruptures, they are more common in older age individuals. These injuries can jeopardize an athlete's career. In this paper, we report a very rare case of BSQTR in an elite bodybuilder who sustained a high mechanism trauma while squatting heavyweights. He sustained bilateral anterior cruciate ligament (ACL) injury and a left ankle fracture. All injuries were treated surgically except for the left ACL as it was asymptomatic on follow-up. The challenge in this case was to treat his injuries and to regain his baseline functional status in the shortest period of time. Following treatment, the patient had a satisfactory clinical outcome with focused rehabilitation. Despite the devastating trauma, the patient was able to progress throughout the treatment plan and has regained his baseline functional status in less than 18 months and has resumed his competitive bodybuilding career. From the available literature, this is the first case to be reported with such combined injuries that was treated and showed a satisfactory outcome in a short period of time.

Predictors of Ongoing Androgen Abuse. A Prospective 2-year Follow up of 100 Male Androgen Abusers.

BACKGROUND: The abuse of androgens is common among visitors to fitness centers. Prospective data regarding patterns of androgen abuse and predictors of future use are not well studied. METHODS: This is a 2-year prospective observational cohort study among 100 male androgen abusers. The median age of the subjects was 31 years (range, 19-67 years). Participants were meticulously characterized and observed for 1 year before, during, and after the use of a cycle of androgens. They remained in follow-up for a second year to study subsequent androgen abuse. Using multivariable regression analysis we aimed to identify baseline sociodemographic factors and cycle characteristics that would predict future androgen abuse. RESULTS: Ninety-seven (97%) men completed the second year of follow-up. Sixty-three subjects (65%) abused androgens again and 16 (16%) for the entire duration of the second year. The variables that were positively associated with the cumulative time of androgen abuse during the 2 years of follow-up were historical cumulative androgen exposure and the intention to take part in bodybuilding competitions. Cycle duration in year 1 and training time at baseline were positively associated with repeated use in year 2. Cycle duration in the first year was also positively associated with the cumulative time of androgen abuse in the second year. For all the other investigated baseline variables and cycle characteristics, no associations with future use were found. CONCLUSION: The results of this study support the assumption that body building competitions are a driver for androgen abuse. Most androgen abusers use androgens repeatedly. The factors that predict future androgen abuse may assist in harm reduction strategies that aim to minimize long-term health problems in androgen abusers.

Bodybuilding: A Comprehensive Review of Performance-Enhancing Substance Use and Public Health Implications.

The use of performance-enhancing substances in bodybuilding is a well-known and long-standing issue. This comprehensive review article provides a detailed overview of the history of performance-enhancing substance use in bodybuilding, the types of substances commonly used, and the short-term and long-term health effects associated with their use. Additionally, the article discusses the regulation of performance-enhancing substances in various countries and the role of healthcare professionals in preventing substance use. The article also highlights the impact of substance use on society and the importance of prevention and intervention strategies. Finally, the article emphasizes the role of policymakers in addressing performance-enhancing substance use, including the development of regulations, penalties for violating rules, and the provision of resources for prevention and intervention programs. Overall, this review article sheds light on the dark side of bodybuilding and provides insight into the public health implications of performance-enhancing substance use.

Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Alterations in Measures of Body Composition, Neuromuscular Performance, Hormonal Levels, Physiological Adaptations, and Psychometric Outcomes during Preparation for Physique Competition: A Systematic Review of Case Studies.

The present paper aimed to systematically review case studies on physique athletes to evaluate longitudinal changes in measures of body composition, neuromuscular performance, chronic hormonal levels, physiological adaptations, and psychometric outcomes during pre-contest preparation. We included studies that (1) were classified as case studies involving physique athletes during the pre-contest phase of their competitive cycle; (2) involved adults (18+ years of age) as participants; (3) were published in an English-language peer-reviewed journal; (4) had a pre-contest duration of at least 3 months; (5) reported changes across contest preparation relating to measures of body composition (fat mass, lean mass, and bone mineral density), neuromuscular performance (strength and power), chronic hormonal levels (testosterone, estrogen, cortisol, leptin, and ghrelin), physiological adaptations (maximal aerobic capacity, resting energy expenditure, heart rate, blood pressure, menstrual function, and sleep quality), and/or psychometric outcomes (mood states and food desire). Our review ultimately included 11 case studies comprising 15 ostensibly drug-free athletes (male = 8, female = 7) who competed in various physique-oriented divisions including bodybuilding, figure, and bikini. The results indicated marked alterations across the array of analyzed outcomes, sometimes with high inter-individual variability and divergent sex-specific responses. The complexities and implications of these findings are discussed herein.

Underlying Subclavian Artery Occlusion Initially Misdiagnosed in Weightlifter Using Anabolic Steroids: A Case Report and Review of Literature.

Subclavian artery occlusion (SAO) is a rare form of peripheral artery disease, sometimes associated with arterial thoracic outlet syndrome (ATOS). Subclavian arterial and venous occlusions are often misdiagnosed initially, and their clinical presentation can be confusing in bodybuilding athletes with increased vascularity in combination with anabolic steroid use. We present a 63-year-old male weightlifter with a history of hypertensive cardiomyopathy, renal transplant with left upper extremity arteriovenous fistula and subsequent takedown, cervical spinal stenosis, left rotator cuff surgery, and decades of testosterone injections who presented with years of left shoulder and neck pain. After having seen multiple providers and being diagnosed with various common disorders, CT angiography and conventional angiography were eventually performed and confirmed the presence of chronic SAO. The chronic occlusion was not deemed amenable to surgery or endovascular intervention and was treated medically with anticoagulation. Although anabolic steroid use is associated with arterial thrombosis, to our knowledge, this is the first reported case of SAO in a weightlifter. Initial misdiagnosis resulted in a long and costly workup. Although the patient's symptoms were consistent with occlusion (and his increased vascularity could potentially suggest chronic thrombosis of any kind), these key signs were masked given his weightlifting history, anabolic steroid use, and concurrent degenerative musculoskeletal conditions common to the weightlifting population. A thorough history, comprehensive physical examination, appropriate imaging studies, and a high index of suspicion for vascular occlusion in athletes who use steroids are critical for the timely diagnosis and treatment of SAO.

Pectoralis major rupture in body builders: a case series including anabolic steroid use.

BACKGROUND: Rupture of the pectoralis major (PM) muscle is a rare injury, with increasing incidence over the last decades, mainly due to participation in weightlifting and contact sports. Surgical management of PM injuries has been related with superior functional outcome, faster return to activities, better cosmesis and higher level of patients' satisfaction. The aim of the study is to present our experience in the management of this rare clinical entity and to correlate the use of anabolic steroids in the occurrence of the injury and the impact of type of injury, method of reconstruction and anabolic steroids on the post-operative outcome. CASES: We present a series of six male bodybuilding athletes who sustained PM rupture during weightlifting. We recorded the location & type of injury, the history and type of anabolic steroids use, the method of repair and the post-operative outcome. TREATMENT AND OUTCOMES: The mean follow-up period was 16 (12-24) months. All patients treated surgically had excellent results according to Bak criteria and returned to full activity within 5.4 (5-7) months following surgical reconstruction. No post-operative complications were recorded, despite the continued use of anabolic steroids, however one patient died from myocardial infarction within a year of surgical treatment. CONCLUSIONS: PM rupture is an injury with increasing incidence within bodybuilding athletes probably not related to the dominance of the limb. Fixation of the tendon with suture anchors results in excellent clinical outcome and patient's satisfaction postoperatively regardless the chronicity of the repair. Our observations in these cases suggest that anabolic steroids use may contribute to the injury due to an excessive upward adjustment of the athlete's goals in lifting weights and moreover the continuation of administration even in the recovery period does not seem to have a negative effect either on the time or on the level of adequate functional recovery postoperatively.

Bioimpedance Patterns and Bioelectrical Impedance Vector Analysis (BIVA) of Body Builders.

Bodybuilders are athletes characterized by high muscle mass. During competitions, the evaluation is performed based on aesthetic parameters. The study aims to provide normative references of body composition with the vector bioimpedance methodology (BIVA). A second aim is to compare BIVA assessments performed on both sides and the upper and lower body. A group of 68 elite bodybuilders (41 males aged 30.1 ± 9.2 years and 27 females aged 32.1 ± 8.0 years) was enrolled. A BIVA assessment was performed the day before the 2021 World Natural Bodybuilding Federation Italian Championships. As a result, male and female bodybuilders ranked to the left in the BIVA ellipse relative to the general population. Furthermore, unlike females, males also ranked lower than the general athletic population. In addition, in the symmetry assessment, males show a significantly greater upper body than the lower, right, and left parts, while in women, this is observed for the lower part of the body. The differences in the results obtained between males and females can be attributed to the different patterns of endocrine production between the sexes and the different criteria used by the juries to attribute the final score during the competitions. Therefore, BIVA references in bodybuilders could help adjust the training and nutritional program during the peak week before a competition.

Adverse events of clenbuterol among athletes: a systematic review of case reports and case series.

Clenbuterol is a potent beta-2 agonist widely misused by professional athletes and bodybuilders. Information on clenbuterol associated adverse events is present in case reports and case series, though it may not be readily available. This systematic review aimed to critically evaluate the evidence of adverse events associated with clenbuterol among athletes. The search strategy was in accordance with PRISMA guidelines. Databases such as PubMed, Science Direct, Scopus, and Google Scholar were searched from 1990 to October 2021 to find out the relevant case reports and case series. There were 23 included studies. Using a suitable scale, the included studies' methodological quality analysis was evaluated. In total, 24 athletes experienced adverse events. Oral ingestion of clenbuterol was the most preferred route among them. The daily administered dose of clenbuterol was ranging from 20 µg to 30 mg. Major adverse events experienced by athletes were supraventricular tachycardia, atrial fibrillation, hypotension, chest pain, myocardial injury, myocarditis, myocardial ischemia, myocardial infarction, cardiomyopathy, hepatomegaly, hyperglycemia, and death. The cardiac-related complications were the most commonly occurring adverse events. Clenbuterol is notorious to produce life-threatening adverse events including death. Lack of evidence regarding the performance-enhancing effects of clenbuterol combined with its serious toxicities questions the usefulness of this drug in athletes.