Bodybuilders use a range of anabolic-androgenic steroids, with testosterone as the universal foundation. From there, the specific compounds vary depending on whether someone is trying to gain size or lean out before a competition. Most cycles combine two to four drugs at doses far beyond what a doctor would prescribe, and nearly all users add ancillary medications to manage side effects and recover afterward.
Testosterone: The Base of Every Cycle
Testosterone is the starting point for virtually every steroid cycle. It’s the hormone the body produces naturally, and synthetic versions come in several injectable forms that differ mainly in how long they stay active. Testosterone enanthate and testosterone cypionate are the most common, typically injected once or twice per week. Testosterone propionate clears the body faster, requiring more frequent injections, and is often favored closer to competitions because of its shorter detection window. In clinical studies, propionate showed the most rapid elimination of any testosterone ester, detectable for about four to five days, while longer esters like testosterone undecanoate remained detectable for 60 days or more.
For medical testosterone replacement, doctors typically prescribe 100 to 200 mg every one to two weeks. Bodybuilders commonly use 500 mg per week or more, sometimes stacking it with other compounds at similarly elevated doses. That gap between therapeutic and bodybuilding dosing is what drives both the exaggerated muscle growth and the health consequences.
How Anabolic Steroids Build Muscle
All anabolic steroids work by binding to androgen receptors inside muscle cells. Once bound, they enter the cell nucleus and switch on genes that ramp up protein production, activate satellite cells (the repair cells responsible for muscle growth), and improve the uptake and storage of nutrients like glucose. At the same time, they suppress genes involved in muscle breakdown. The net result is that the body builds new muscle tissue faster and loses less of it during hard training or calorie restriction.
Some steroids also act through a faster, non-genomic pathway by binding to receptors on the cell surface, which triggers additional growth signaling. This dual mechanism helps explain why anabolic steroids produce such dramatic results compared to natural training alone.
Compounds Used for Bulking
During the off-season, when the goal is maximum muscle mass, bodybuilders gravitate toward steroids known for promoting size and strength. A case study of competitive bodybuilders published in the European Journal of Translational Myology documented the specific regimens: two male bodybuilders used 500 mg per week of testosterone enanthate, 200 mg per week of boldenone, and 150 mg per week of trenbolone acetate during their bulking phases.
The most common bulking compounds include:
- Testosterone enanthate or cypionate: The backbone of bulking cycles, providing a steady release of testosterone over days.
- Nandrolone decanoate (Deca-Durabolin): Valued for promoting joint comfort alongside muscle growth, making it popular during heavy training blocks.
- Trenbolone: Considered one of the most potent anabolic steroids, used for both strength and muscle density. It does not convert to estrogen, which reduces water retention but introduces its own set of harsh side effects.
- Boldenone (Equipoise): Often stacked with testosterone for steady, moderate gains with less water retention than nandrolone.
- Oxymetholone (Anadrol) and methandrostenolone (Dianabol): Oral steroids used to kickstart cycles with rapid weight gain in the first few weeks while injectable compounds build up in the bloodstream.
Compounds Used for Cutting
As bodybuilders diet down for a competition, the drug selection shifts toward compounds that preserve muscle on restricted calories while promoting a harder, drier appearance. In the same case study, cutting phases featured testosterone propionate at 400 mg per week, stanozolol (Winstrol) at 200 mg per week, oxandrolone (Anavar) at 160 mg per week, and drostanolone propionate (Masteron) at 400 mg per week.
The pattern is consistent: shorter-acting testosterone esters replace longer ones, and the added compounds tend to be those that don’t cause water retention. Stanozolol and oxandrolone are both available in oral form and are popular for their reputation of adding hardness without bloating. Drostanolone is an injectable that bodybuilders prize for its cosmetic effects on muscle definition. Interestingly, the Men’s Physique competitors in the study did the opposite with their testosterone esters, using propionate for bulking and enanthate for cutting, which suggests individual variation in how athletes structure their protocols.
Female competitors in the study used lower total doses but similar compound choices: stanozolol, nandrolone decanoate, testosterone propionate, oxandrolone, and drostanolone at various phases of preparation.
Ancillary Drugs and Estrogen Management
Anabolic steroids don’t exist in a vacuum. The body converts excess testosterone into estrogen through an enzyme called aromatase, and elevated estrogen levels can cause breast tissue growth (gynecomastia), water retention, and fat accumulation. To prevent this, bodybuilders commonly use aromatase inhibitors alongside their steroid cycles.
The two most widely used are anastrozole (Arimidex) and exemestane (Aromasin). Anastrozole is a nonsteroidal inhibitor that blocks the aromatase enzyme, while exemestane is a steroidal inhibitor that permanently deactivates it. Both reduce circulating estrogen levels. Not all steroids aromatize equally. Testosterone and Dianabol convert readily, making aromatase inhibitors essential during cycles heavy in those compounds. Trenbolone and stanozolol don’t convert to estrogen, which is part of why they’re favored during cutting phases.
Post-Cycle Therapy
After stopping a steroid cycle, the body’s natural testosterone production is suppressed, sometimes severely. The hypothalamic-pituitary-gonadal axis, the hormonal chain responsible for signaling the testes to produce testosterone, can take weeks or months to recover. Post-cycle therapy (PCT) aims to speed that process.
Typical PCT protocols combine human chorionic gonadotropin (hCG) with selective estrogen receptor modulators like clomiphene (Clomid) or tamoxifen (Nolvadex). hCG directly stimulates testosterone production in the testes, while the estrogen modulators work indirectly by blocking estrogen’s suppressive signal to the brain, which prompts the pituitary gland to release more of the hormones that drive testosterone production. A survey of 470 male steroid users found that those who used PCT reported fewer withdrawal symptoms than those who stopped without it.
Cardiovascular and Organ Risks
The muscle-building benefits of anabolic steroids come with well-documented damage to the cardiovascular system. Steroid use disrupts cholesterol balance by lowering HDL (protective cholesterol) and raising LDL (harmful cholesterol), which accelerates plaque buildup in arteries. Long-term users show increased vascular calcification, where arteries stiffen and lose elasticity. The risk of blood clots, including deep vein thrombosis and pulmonary embolism, also rises.
The heart itself takes direct damage. Imaging studies of steroid users reveal pathological thickening of the heart muscle, increased fibrosis (scarring), and abnormal electrical activity that can cause arrhythmias during exertion. Blood pressure elevation from steroid use can persist for five to twelve months after stopping. These aren’t theoretical risks: they represent the leading cause of premature death among long-term steroid users.
Oral steroids carry an additional burden on the liver. Because they pass through the liver before entering circulation, compounds like oxymetholone and stanozolol can cause liver fibrosis and impaired clotting function with prolonged use. The kidneys face strain as well, with documented cases of renal enlargement and reduced function in chronic users.
How Common Steroid Use Has Become
Steroid use extends well beyond competitive bodybuilding. A large survey of over 3,600 resistance training practitioners found that 53% of men and 42% of women reported using anabolic steroids. While these figures come from a population already engaged in weight training (not the general public), they reflect how normalized steroid use has become in gym culture, particularly following the COVID-19 pandemic when interest in physique enhancement surged. The line between competitive bodybuilder and recreational gym-goer, at least in terms of drug use, has blurred considerably.