Bodybuilders use a wide spectrum of substances, from over-the-counter protein powder to prescription hormones and banned performance-enhancing drugs. What they take depends heavily on whether they compete in natural (drug-tested) or untested divisions, and whether they’re in a muscle-building phase or leaning out for a show. Here’s a practical breakdown of the major categories.
Legal Supplements With Strong Evidence
Three supplements form the foundation of most bodybuilders’ regimens, whether natural or enhanced.
Protein supplements. Whey, casein, and plant-based protein powders help bodybuilders hit their daily protein targets, which range from 1.2 to 2.0 grams per kilogram of body weight. For a 180-pound person, that’s roughly 100 to 165 grams per day. Timing matters too: about 20 grams of high-quality protein consumed within two hours after training, then every three to five hours throughout the day, is the protocol most sports nutrition bodies recommend for maximizing muscle repair and growth.
Creatine monohydrate. This is the single most researched sports supplement, and it reliably increases strength, power, and work output during high-effort muscle contractions. A standard protocol starts with a loading phase of 20 grams per day (split into four 5-gram doses) for five to seven days, followed by 3 to 5 grams daily for maintenance. An alternative approach skips loading entirely and uses 3 to 6 grams daily for three to four weeks to reach the same effect. Over time, creatine helps the body adapt to progressively harder training.
Beta-alanine. This amino acid buffers the acid buildup in muscles during intense sets lasting roughly one to four minutes. Its benefits are most noticeable during high-rep training or supersets rather than maximal-strength work. A typical loading dose is 4 to 6 grams per day, split into portions of 2 grams or less to avoid the harmless but intense tingling sensation it causes in the skin.
Pre-Workout Formulas
Most pre-workout products are built around caffeine, typically delivering 100 to 400 mg per serving (roughly one to four cups of coffee). Caffeine blocks the brain’s drowsiness signals and triggers a release of adrenaline-like hormones that sharpen focus and increase heart rate, letting you train harder.
Beyond caffeine, many formulas include nitric oxide boosters like L-citrulline and L-arginine. These amino acids help relax blood vessels and improve blood flow to working muscles, which is what produces the “pump” bodybuilders chase. Creatine, beta-alanine, and taurine are also common additions. Some products contain synephrine, a stimulant derived from bitter orange that became popular after ephedrine was pulled from the supplement market. Stacking multiple stimulants together raises cardiovascular strain, so the ingredient list matters more than the brand name.
Anabolic Steroids
In untested bodybuilding, anabolic steroids are the cornerstone of performance enhancement. These are synthetic versions of testosterone that dramatically accelerate muscle protein synthesis, allowing users to build muscle far beyond natural limits and recover faster between sessions.
What bodybuilders use shifts depending on the phase of training. During bulking, when the goal is maximum muscle gain, common choices include testosterone enanthate, boldenone, nandrolone, and trenbolone. A case study of six competitive bodybuilders published in the European Journal of Translational Myology found that male competitors used 500 to 750 mg of total steroids per week during bulking.
During cutting, when the goal shifts to losing fat while keeping muscle, bodybuilders typically switch to shorter-acting compounds like testosterone propionate, stanozolol, oxandrolone, and drostanolone. Surprisingly, total weekly dosages often increase during this phase, not decrease. The same study found cutting-phase dosages reaching 720 to 1,160 mg per week in men. These drugs tend to produce a harder, drier look by promoting muscle retention without as much water bloat.
Growth Hormone and Insulin
At the upper levels of competitive bodybuilding, human growth hormone (HGH) and insulin enter the picture. HGH promotes both muscle growth and fat loss. Bodybuilders typically inject 3 to 8 mg per day, three to four times per week, in cycles lasting four to six weeks.
Insulin is one of the most powerful anabolic hormones in the body, and some bodybuilders inject synthetic versions to push nutrients into muscle cells faster after training. Short-acting insulin is the most common form used, typically at doses around 10 units per injection, administered right before a post-workout meal. This is also one of the most dangerous substances bodybuilders use, because miscalculating the dose or not eating enough carbohydrates afterward can cause blood sugar to crash to life-threatening levels. Most users learn dosing protocols through word of mouth rather than medical supervision.
Fat-Loss Compounds for Cutting
Beyond steroids that favor a lean physique, some bodybuilders use non-steroidal drugs to accelerate fat loss. One of the more common is T3, a thyroid hormone that ramps up the body’s metabolic rate. By flooding the system with extra thyroid hormone, the body burns through calories and fat stores faster. The risks are serious: palpitations, flushing, bone loss, irregular heart rhythms, and in extreme cases, a thyroid crisis that can cause cardiovascular collapse. These effects are often poorly recognized by healthcare providers unfamiliar with bodybuilding drug use, which means emergency situations can be misdiagnosed.
Ahead of competition, bodybuilders also manipulate water levels under their skin to appear more defined on stage. Natural competitors rely on strategies like water loading followed by sharp restriction, high vitamin C intake, herbal teas, and high-protein diets to trigger the body’s own diuretic responses. In untested divisions, pharmaceutical diuretics strip subcutaneous water more aggressively, which carries risks of dangerous electrolyte imbalances.
SARMs: A Newer Category
Selective androgen receptor modulators, or SARMs, are synthetic compounds that activate testosterone receptors in muscle and bone while largely avoiding other tissues like the prostate or skin. This selectivity is their main appeal: in theory, users get muscle-building effects with fewer of the side effects that steroids cause, like acne, hair loss, or organ enlargement.
The most commonly discussed SARMs in bodybuilding circles include RAD-140, S-23, LGD-4033, and enobosarm (also known as ostarine). In clinical trials, enobosarm at a 3 mg daily dose produced an average gain of 1.3 kg of lean mass with a 0.6 kg drop in fat. LGD-4033 increased lean mass in a dose-dependent pattern in early studies. These are far more modest results than what anabolic steroids produce, but some users view them as a lower-risk entry point.
SARMs are not approved for human use by any major regulatory agency. They’re sold in a legal gray area, often marketed as “research chemicals,” and independent testing has shown that many products labeled as SARMs contain different compounds entirely, or none at all.
Estrogen Management and Post-Cycle Therapy
When the body is flooded with synthetic testosterone, some of it gets converted into estrogen. This can cause breast tissue growth in men, water retention, and mood changes. To prevent this, many steroid users take aromatase inhibitors like anastrozole, letrozole, or exemestane, which block the enzyme responsible for that conversion. Others use tamoxifen, which doesn’t lower estrogen levels but blocks its effects in breast tissue specifically.
After finishing a steroid cycle, the body’s natural testosterone production is suppressed, sometimes severely. Post-cycle therapy (PCT) is a self-administered protocol designed to restart that production faster than it would recover on its own. It typically combines human chorionic gonadotropin (hCG), which directly stimulates the testes to produce testosterone, with a SERM like tamoxifen or clomiphene, which signals the brain to release the hormones that drive testosterone production.
A survey of 470 men who used anabolic steroids found that those who followed PCT protocols reported fewer withdrawal symptoms, including less fatigue, depression, and sexual dysfunction during their off-cycle periods. Without PCT, recovery of natural hormone function can take months, and some long-term users never fully recover.
Cardiovascular and Organ Risks
The most consequential risks of performance-enhancing drug use center on the heart. Imaging studies comparing steroid users to non-users have consistently found pathological thickening of the heart muscle, a condition distinct from the healthy heart enlargement that comes from exercise alone. Steroid-induced thickening makes the heart stiffer and less efficient at pumping blood.
At the cellular level, anabolic steroids stimulate collagen production in heart tissue and promote the death of heart muscle cells in a dose-dependent manner. Over time, this can produce scarring in the heart wall. Case reports have documented steroid users with completely normal coronary arteries who still developed significant heart muscle damage and scarring, confirming that the harm comes from the drugs themselves, not from blocked arteries.
The liver and kidneys also bear a significant burden, particularly from oral steroids that must pass through the liver before reaching the bloodstream. Documented effects include liver fibrosis, impaired blood clotting, kidney enlargement, and in severe cases, organ failure. The combination of long-term use, high doses, and stacking multiple compounds, which is standard practice in competitive bodybuilding, compounds these risks substantially.