Whether you can use steroids in a bodybuilding competition depends entirely on which federation you compete in. Most major professional and amateur organizations officially ban anabolic steroids and other performance-enhancing drugs, but enforcement varies dramatically. Some federations test rigorously, others test selectively, and a few are widely understood to have minimal testing despite rules on the books.
How Testing Differs Across Federations
The bodybuilding world is split into two broad camps: “tested” and “untested” (sometimes called “open”) divisions. In tested competitions, athletes submit to drug screening and face disqualification for positive results. In untested divisions, steroid use is technically still against anti-doping rules, but testing is either absent or so limited that enforcement is effectively nonexistent.
The IFBB (International Federation of Bodybuilding and Fitness) maintains formal anti-doping rules and states that any athlete under its jurisdiction may be tested at any time, in or out of competition, with no advance notice, via urine or blood samples. At international events, the IFBB Anti-Doping Commission determines how many tests to perform. However, the IFBB Pro League (the professional arm based in the U.S.) and the NPC (National Physique Committee), its amateur feeder system, operate differently from the international IFBB. Standard NPC and IFBB Pro League shows are widely regarded in the bodybuilding community as untested in practice, with drug screening reserved only for specifically designated “natural” events.
Natural federations take a completely different approach. Organizations like the INBA/PNBA require all athletes to undergo testosterone blood testing, with those who exceed normal levels required to pay for and pass a WADA-certified urine test before competing. Random WADA urine tests are also conducted on competition day, and urine samples are sent to a WADA-accredited lab in the U.S., with results taking 14 to 21 working days. The INBA/PNBA also conducts random out-of-competition testing on members of its national teams throughout the year.
What Gets Tested For
Federations that do test generally follow the World Anti-Doping Agency’s Prohibited List. The broadest category, labeled “Anabolic Agents,” includes all anabolic androgenic steroids when administered from an outside source. The list names dozens of specific compounds and explicitly states it is not exhaustive, meaning new designer steroids are also covered. Beyond steroids, the prohibited list includes hormone modulators, beta-2 agonists, and a catch-all category covering any pharmacological substance not approved by a government health authority for human use, including peptides and research chemicals popular in bodybuilding circles.
Diuretics are also banned both in and out of competition across all sports that follow WADA guidelines. They appear on the list for two reasons: they cause rapid water loss (useful for looking leaner on stage) and they can act as masking agents, diluting urine to hide traces of other banned substances.
Polygraph Testing in Natural Shows
Because urine testing has significant limitations, many natural federations add polygraph (lie detector) screening. The logic is straightforward: most oral steroids become undetectable in urine after just a few weeks, and some clear the body in days. Urine testing also cannot currently detect growth hormone use. Polygraph testing, by contrast, can cover time periods of seven years or more and can address any substance regardless of whether it shows up in a lab test.
The OCB (Organization of Competition Bodies) uses polygraph screenings at all its events, with rules requiring athletes to have been free of anabolic steroids for seven years before competing. Natural NPC regional contests require either urinalysis for all open class winners or polygraph testing for at least 50% of competitors. Natural NPC pro qualifier events require both: urinalysis for class winners and polygraph testing during check-in. Polygraph results are considered final, and any competitor who refuses testing or leaves before it is completed is disqualified with no refund.
The polygraph itself involves four components: chest tubes monitoring breathing rate, an arm cuff tracking pulse and blood pressure changes, metal tabs on the fingers measuring skin conductance through sweat, and a seat cushion detecting movement. A pre-interview process helps the examiner establish baseline reactions and formulate test questions. Critics question polygraph reliability, but federations view it as a practical deterrent that extends well beyond the narrow detection window of lab testing.
The Unspoken Reality of Open Divisions
In open (untested) bodybuilding divisions, steroid use is pervasive. The physiques on stage at major professional shows reflect levels of muscle mass and conditioning that are not achievable without pharmacological assistance. While these organizations maintain official anti-doping policies, the absence of routine testing creates an environment where competitors use anabolic steroids, growth hormone, insulin, and other substances as standard practice during contest preparation.
This creates a practical reality: if you plan to compete in an open division at any level, you will be competing against athletes who are using these substances. If you plan to compete naturally, choosing a tested federation with robust screening protocols gives you the best chance of a level playing field.
Cardiovascular Risks of Steroid Use
Steroid use carries serious health consequences that competitive bodybuilders face whether or not their federation tests for it. The cardiovascular system takes the hardest hit. Steroids disrupt cholesterol balance by lowering protective HDL cholesterol and raising harmful LDL cholesterol, accelerating plaque buildup in the arteries. These lipid changes are generally reversible weeks to months after stopping, but long-term or repeated use compounds the damage.
More concerning is the effect on the heart muscle itself. Imaging studies comparing steroid users to non-users have found pathological thickening of the heart wall in users. This is not the healthy enlargement that comes from exercise. Steroids stimulate protein production and collagen growth in heart cells, making the heart stiffer and less able to pump efficiently. Combined with the demands of heavy training, this cumulative effect can progress to reduced heart function and, in some cases, heart failure. Clinical reports have documented steroid users with scarring of the heart muscle despite having normal coronary arteries, meaning the damage came from the drugs themselves rather than blocked blood vessels.
Risks Specific to Women
Female competitors face additional irreversible changes. Steroid use triggers masculinizing effects including voice deepening, which results from thickening of the vocal folds. Unlike side effects such as weight gain, acne, and increased libido, which typically reverse after stopping, voice changes have been documented as permanent even years after discontinuation. One case study tracked a woman who used a relatively low dose for just six weeks as part of a bodybuilding program and developed a husky, low-pitched voice that persisted. Examination revealed thickened, blunted vocal folds with structural changes that did not resolve.
There is also a longer-term hormonal consequence. Steroid-induced suppression of the body’s own hormone production can lead to abnormally low testosterone levels in women after stopping, causing fatigue and other symptoms, a condition sometimes called steroid-induced hypogonadism.
What Happens When You Stop
Competitors who use steroids and then stop face a difficult recovery period. Steroids suppress the body’s natural testosterone production by shutting down the hormonal signaling chain from the brain to the testes. This suppression can persist for months to years after the last dose. In a survey of 470 men, 73% reported low mood after stopping, 59% experienced persistent tiredness, and 57% reported reduced sex drive. Only about 5% said they had no withdrawal symptoms at all. Other commonly reported effects include erectile dysfunction, depression, anxiety, and in some cases suicidal thoughts.
To manage this crash, many users self-administer what the bodybuilding community calls post-cycle therapy, a combination of drugs that stimulate the testes to restart testosterone production and restore the hormonal feedback loop. This typically involves medications that mimic signals from the brain telling the testes to produce testosterone, combined with drugs that block estrogen’s suppressive effects on that same signaling pathway. While this approach is associated with reduced withdrawal symptoms, it is entirely self-directed, with no standardized medical protocols, and the recovery timeline remains unpredictable.
Choosing the Right Federation
If you want to compete without using steroids and want assurance that your competitors are also clean, look for federations with multi-layered testing: blood panels, WADA-certified urinalysis, random in-and-out-of-competition screening, and polygraph testing. The INBA/PNBA, OCB, and designated natural NPC events all use some combination of these methods. Pay attention to the specific drug-free period required. Some organizations demand seven or more years clean, which screens out athletes who recently cycled off.
If you are considering an open division, understand that you will be competing in an environment where steroid use is the norm regardless of what official rulebooks say. The decision to use or not carries real consequences for your health, your competitive standing, and what happens to your body long after you leave the stage.