Why Are So Many Bodybuilders Dying Young? The Science Behind the Deaths

If you’ve been following bodybuilding social media, you have probably seen reports of bodybuilders dying way too young.

Turns out it’s not just social media visibility.

In this article, I’m going to talk about the dark cloud hanging over the sport, especially at the elite levels, and three new studies that look at why so many bodybuilders are dying.

Study 1: Mortality in Male Bodybuilding Athletes

In a study published in the May 2025 edition of the European Heart Journal, researchers analyzed 20,286 male athletes who competed in IFBB events between 2005 and 2020, from amateurs up to the very highest (Mr. Olympia) level.¹

They tracked these bodybuilders for an average of 8.1 years, giving them a pretty big data pool to work with. The follow-up period continued all the way through July 2023.

The main goal was to figure out the mortality risk of competitive bodybuilders, if and why they are dying before their time. Most people who are into the sport have heard and read about athletes dying, but a lot of the evidence has been anecdotal.

The Findings

During the study period, 121 of the athletes died.

• The most common cause of death was sudden cardiac death (SCD). It accounted for 38% (46 people) of all identified deaths.
• Professional bodybuilders had a five times higher risk of SCD compared to amateur bodybuilders.
• Among currently competing athletes (those who had competed within the last year), there were 11 sudden cardiac deaths, with their average age only 34.7 years.
• Looking at just the Mr. Olympia competitors, 7 out of 100 bodybuilders died during the study period. Five of those deaths were from SCD, at an average age of 36.

Why Is This Happening?

The study points to a number of factors that are harming the health of these athletes, both on their own and, likely, in combination.

• The autopsies that were available showed cardiomegaly (enlarged hearts) and ventricular hypertrophy (thick heart walls) in the SCD deaths. And not the big-but-healthy “athlete’s heart” you see in runners. These were morbid changes and signs of a heart under pathological stress.
• In the toxicology reports they could get, anabolic-androgenic steroid (AAS) use was confirmed. The authors directly link the abuse of performance-enhancing drugs (PEDs) to an increased risk of SCD. It’s no secret that PEDs are common in the sport, with some studies showing over 75% of male competitive bodybuilders use them, and they are associated with hypertension, the dangerous heart thickening, and systolic dysfunction.
• The authors also note that several athletes died during or shortly after a competition. Drastic weight loss, severe calorie restriction, and hydrosaline depletion (dehydration) put strain on the heart and might trigger a fatal event in an already-compromised system.
• Beyond the heart deaths, several bodybuilders also died from kidney-related causes after having a history of damage to the kidneys and kidney transplants. The researchers suggest the combo of high protein diets, AAS use, and diuretic abuse is a less-than-ideal combination for the kidneys.

• The study also notes that suicides and overdoses were a factor and that the pressure to build an extreme physique can contribute to body dysmorphic disorders and psychological issues. When you combine that with the potential mental side effects of AAS (like depression and aggression), you’ve got a potential powder keg ready to explode.

Study 2: Mortality in Female Bodybuilding Athletes

Four months later, the same team of researchers gathered the available research on mortality rates, this time in female physique athletes and bodybuilders, and again published them in the European Heart Journal.³

They looked at a cohort of 9,447 female athletes who competed in 700 IFBB events between 2005 and 2020, including participants from the Women’s Bodybuilding, Women’s Physique, and Figure divisions.

Their goal was to see what the mortality rates were and to compare them to the data they already had on male bodybuilders, which I talked about above.

The Findings

• Over those 16 years, the study recorded 32 deaths among the athletes. The average age of death was 42.7 years.
• When they were able to determine a specific cause of death (which they could in 75% of cases), the most common one was sudden cardiac death. It accounted for 31% of all deaths.
• The overall SCD rate was 10.47 per 100,000 athlete-years, but there was a big difference between amateurs and pros:
  • Amateur SCD Rate: 2.48 per 100,000 athlete-years.
  • Professional SCD Rate: 53.98 per 100,000 athlete-years.

That is a very big difference, and it suggests that the risks ramp up significantly at the elite level.

How Do Women Compare to Men?

So, is competitive bodybuilding safer for women than for men? Yes and no.

• The better news is that all-cause mortality and SCD were lower in females than males. The risk for SCD in professional female bodybuilders was also a lot lower than in professional male bodybuilders.
• In the few female autopsies that were available (only two), the researchers did not find the cardiomegaly or left ventricular hypertrophy they found in the deceased male bodybuilders. Neither they nor I have a clear explanation for why, but everything that comes with pro bodybuilding might affect male and female hearts differently. Or maybe it was just too small a sample to see anything but chance.
• Deaths due to suicide and homicide accounted for nearly 13% of all deaths in the female cohort. That is roughly four times higher than in male bodybuilders. The researchers suggest this could point to “greater psychosocial vulnerability among female athletes, potentially influenced by gender-specific stressors”, but I am not qualified to speculate deeper into the mental health aspects of these differences.

Why Is This Happening?

The study concluded that the same likely culprits are at play, so this section is basically a repeat of the one above:

• Extreme diets and training regimens
• Drastic weight manipulation
• Dehydration strategies for competitions
• Uncontrolled use of steroids and other PEDs

Of the autopsies they had access to, the bodybuilders again showed evidence of PEDs.

Study 3: Risk of Death in Bodybuilding (1900–1990)

The third study is called “The Golden Paradox“. At the time I’m writing this, it’s still in preprint form.⁴ A preprint is a manuscript that has not yet been formally reviewed or published, so take it for what it is: these results haven’t been checked, vetted, or approved by any other experts yet. It very much ties into the two studies above, so I’m going to talk about it, but keep that in mind.

In this study, the researchers look at how the mortality risks of bodybuilding have evolved over the years. They analyzed the lifespans of 120 male bodybuilders during three eras (40 per era):

• Bronze Era (1900–1930): The original strongmen and early bodybuilders (like Eugen Sandow).
• Silver Era (1930–1960): The pre-steroid (mostly) guys, like Steve Reeves and John Grimek.
• Golden Era (1960–1990): Arnold and Sergio up to and including the Haney era, right before Yates and the mass monsters.

The Findings

They found that the early bodybuilders lived longer than their average contemporaries.

• Bronze Era average lifespan: 74.8 years
• Silver Era average lifespan: 80.2 years

These guys were outliving the general population, sometimes by a sizable margin; natural bodybuilding was associated with increased longevity.

And then came the Golden Era.

Golden Era average lifespan: 68.6 years

That’s an 11.6-year drop from the Silver Era. Their lifespan was right back down to roughly the general population average.

Why Did This Happen?

The researchers point to two shifts that happened during the Golden Era:

1. The Drugs

This era saw the widespread introduction of steroids. Bronze-era bodybuilders were on protein supplements and liver tablets, and while the Silver-era guys likely weren’t all natural, they didn’t take the massive dosages of today’s pros.

The Golden Era brought in multi-compound steroid protocols, and you suddenly needed to take a lot of drugs to be competitive.

2. The Standard

At the same time, the goal of the sport changed. Bronze and Silver era competitions were judged on things like “vitality” and symmetry, and the Mr. America even judged personality.

But in 1965, when the Mr. Olympia contest started, things became 100% about the physique, with the judges rewarding extreme muscle mass and definition over everything else.

That meant more and more extreme diets, with massive weight-cycling as bodybuilders bulked massively off-season (some blew up like toads) and dieted down super-strict for contests, even using diuretics.

Note that this was only up to and including 1990. As far as I know, there are no such comprehensive data for the modern age of bodybuilding. Has the average lifespan declined even more over the past 35 years? I would hazard a guess that this is the case.

Is Bodybuilding Unhealthy?

I think most people would agree that competitive bodybuilding, where the use of steroids and other anabolic compounds and diuretics are involved, is far from healthy. Including the bodybuilders themselves, although some claim otherwise on social media.

Sure, there may be healthy parts to it, like the focus on clean eating and sleep, but the overall picture of high-level bodybuilding is not one of health. Then again, many sports are not healthy at the top echelons, even if not as unhealthy as pro bodybuilding. And pro bodybuilders are very much aware of the fact that what they are doing to their bodies isn’t conducive to long life and health.

By the way, in the first two studies above, there was no causal link (PED → death) definitively proven. The studies describe associations and suggest mechanisms but do not establish causality. But that was not the job of these researchers.

Even natural competitive bodybuilding can’t be called healthy during competition prep. Your hormones crash, your metabolism down-regulates, you feel cold and tired, you lose cognitive focus, and your mood isn’t tip-top most of the time.

The “Lifestyle” Natural Bodybuilder

But what about the natural bodybuilding lifestyle? This is an entirely different animal. This is the person who loves to lift, eats healthily, and wants to be strong and look good, but isn’t planning to oil up and wear tiny shorts in front of judges.

• More muscle mass fights off type 2 diabetes, increases resting metabolism, and is the #1 defense against age-related decline (sarcopenia).
• When you get into bodybuilding, you learn more about healthy nutrition than 99% of the population. You prioritize protein, focus on unrefined carbs, get healthy fats for hormone production, and make sure you stay hydrated. You eat a lot, but it’s mostly high-quality, whole foods (I’m sure there are junk food exceptions, but the bodybuilding lifestyle ideal promotes healthy living through a healthy diet).
• Sleep is super important to your health, and the bodybuilding lifestyle forces you to prioritize sleep because it’s also essential for building muscle and efficient fat loss.
• The structure of train, eat, sleep, repeat brings a level of discipline and routine that benefits every other area of your life.

Admittedly, it can go too far and have an opposite fixation effect in some. Because health is also about the mental aspect. If your “healthy” lifestyle means you can’t go out for dinner with friends, or you skip family events to get a workout in, you’ve moved from health into obsession.

But despite that, I’d argue that the natural bodybuilding lifestyle is the peak of a healthy, active life, as long as you keep your head on straight and remember that health includes your mind and your relationships, not just your muscles and your meals.

And if you do want to compete as a natural, it might be “unhealthy” during prep, but your body is going to rebound from the hormonal slumps, and you’re not going to fall down dead from it.

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Last reviewed: 2025-11-26

References

1. European Heart Journal, Volume 46, Issue 30, 7 August 2025, Pages 3006–3016. Mortality in male bodybuilding athletes.
2. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. Eighth ed. Boston MA: Cengage Learning; 2022.
3. European Heart Journal, ehaf789, 20 October 2025. Mortality in female bodybuilding athletes.
4. The Golden Paradox: Mortality Trends Across Three Eras of Bodybuilding (1900-1990). SportRxiv, 2025-02-06.