"Bodybuilding has a long history of performance-enhancing substance [PES] use. The early forms of PES in bodybuilding were simple remedies such as caffeine, alcohol, and opiates. However, the emergence of anabolic-androgenic steroids in the mid-20th century revolutionized the sport and transformed it into what we see today [5]. In the early days of bodybuilding, natural training methods and diet were the only ways to achieve a well-sculpted body. However, with the rise of the anabolic steroid industry in the 1950s, athletes started experimenting with testosterone and other substances to enhance their performance. By the 1960s, anabolic steroids were widely used in bodybuilding circles, rapidly increasing muscle mass and strength gains [6].

"Since then, the use of performance-enhancing substances in bodybuilding has evolved dramatically. Athletes now use various substances, including human growth hormone, insulin, diuretics, stimulants, and others, to gain a competitive edge. Additionally, the methods for administering these substances have become more sophisticated, including intravenous injections, transdermal patches, and oral dosages [7]. The use of performance-enhancing substances in bodybuilding is driven by several factors, including the desire to achieve a competitive edge, the pursuit of the perfect physique, and the pressure to meet societal beauty standards. In addition, some athletes may feel that they need to use PES to keep up with others using them [8]. Moreover, using PES can also provide psychological benefits, such as increased confidence and self-esteem. For many athletes, bodybuilding is a way of life, and they are willing to go to great lengths to achieve their goals [9]."


Mantri S, Agarwal S, Jaiswal A, Yelne S, Prasad R, Wanjari MB. Bodybuilding: A Comprehensive Review of Performance-Enhancing Substance Use and Public Health Implications. Cureus. 2023 Jul 9;15(7):e41600. doi: 10.7759/cureus.41600. PMID: 37559855; PMCID: PMC10409494.