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Sources of Funding: AWP is a National Institutes of Health (NIH) K12 Scholar supported by a Male Reproductive Health Research Career (MRHR) Development Physician-Scientist Award (HD073917-01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program (to Dolores J. Lamb).


Professional male bodybuilders use high-dose testosterone and other performance enhancing drugs to improve athletic performance. These anabolic agents are potentially associated with negative sequelae including hyperlipidemia, cardiovascular effects, and possible liver damage. We sought to determine if the use of high-dose testosterone and other performance enhancing drugs could be linked to a higher mortality rate when compared to the general population.


An initial cohort of all 1,578 professional male bodybuilders who competed between 1948-2014 was identified, and complete mortality data were obtained for 597. This cohort was identified via competition listings and bodybuilding websites. Proof of life or death was compiled using data from public records, competition listings, bodybuilding websites, and social media venues. Mortality rates among bodybuilders were compared with CDC mortality rates for an age-matched male population.


The mean age within the study cohort was 47.5 years (range 25.0-81.7) and mean age during competitive years was 24.6 years (range 18-47). Of the 597 bodybuilders with mortality data, 58 (9.7%) were reported dead and 539 living. Only 40 deaths were expected in this population based on age-matched data, yielding a standardized mortality rate (95% confidence interval) of 1.34 (1.10-1.88) for these competitors, which is higher than in the general population. The mean age of death was 47.7 years (range 26.6-75.4), and no significant difference in mortality rates was observed above the age of 50 (Figure 1).


Mortality rates of bodybuilders within the cohort were 34% higher than those in an age-matched general U.S. male population. The cause of this increased mortality is currently unclear, but supports the possibility that the use of performance enhancing drugs and the unique competitive training (e.g. extreme weight changes) may contribute to deaths among younger professional bodybuilders. Current work is focused on determining cause of death by linkage to the National Death Index.

Daniel Gwartney
Andrew Allison
Alexander W. Pastuszak
Steven Canales
William T. Stoll
Mark C. Lindgren
Michael L. Eisenberg
Larry I. Lipshultz

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