Site enhancement oil, often called "santol" or "synthol" (no relation to the Synthol mouthwash brand), refers to oils injected into muscles to increase the size or change the shape. Some bodybuilders, particularly at the professional level, inject their muscles with such mixtures to mimic the appearance of developed muscle where it may otherwise be disproportionate or lacking. This is known as "fluffing". Synthol is 85% oil, 7.5% lidocaine, and 7.5% alcohol. It is not restricted, and many brands are available on the Internet. The use of injected oil to enhance muscle appearance is common among bodybuilders, despite the fact that synthol can cause pulmonary embolisms, nerve damage, infections, sclerosing lipogranuloma, stroke, and the formation of oil-filled granulomas, cysts or ulcers in the muscle. Rare cases might require surgical intervention to avoid further damage to the muscle and/or to prevent loss of life.
This period also saw the rise of anabolic steroids in bodybuilding and many other sports. In bodybuilding lore, this is partly attributed to the rise of "mass monsters", beginning with Arnold Schwarzenegger, Sergio Oliva, and Lou Ferrigno in the late 1960s and early 1970s, and continuing through the 1980s with Lee Haney, the 1990s with Dorian Yates, Ronnie Coleman, and Markus Rühl, and up to the present day. Bodybuilders such as Greg Kovacs attained mass and size never seen previously but were not successful at the pro level. Others were renowned for their spectacular development of a particular body part, like Tom Platz or Paul Demayo for their leg muscles. At the time of shooting Pumping Iron, Schwarzenegger (while never admitting to steroid use until long after his retirement) said that "you have to do anything you can to get the advantage in competition". He would later say that he does not regret using anything.
Some bodybuilders use drugs such as anabolic steroids and precursor substances such as prohormones to increase muscle hypertrophy. Anabolic steroids cause hypertrophy of both types (I and II) of muscle fibers, likely caused by an increased synthesis of muscle proteins. They also provoke undesired side effects including hepatotoxicity, gynecomastia, acne, the early onset of male pattern baldness and a decline in the body's own testosterone production, which can cause testicular atrophy. Other performance-enhancing substances used by competitive bodybuilders include human growth hormone (HGH), which can cause acromegaly.
In competitive bodybuilding, bodybuilders aspire to present an aesthetically pleasing body on stage. In prejudging, competitors do a series of mandatory poses: the front lat spread, rear lat spread, front double biceps, back double biceps, side chest, side triceps, Most Muscular (men only), abdominals and thighs. Each competitor also performs a personal choreographed routine to display their physique. A posedown is usually held at the end of a posing round, while judges are finishing their scoring. Bodybuilders usually spend a lot of time practising their posing in front of mirrors or under the guidance of their coach.
In the last week leading up to a contest, bodybuilders usually decrease their consumption of water, sodium, and carbohydrates, the former two to alter how water is retained by the body and the latter to reduce glycogen in the muscle. The day before the show, water is removed from the diet, and diuretics may be introduced, while carbohydrate loading is undertaken to increase the size of the muscles through replenishment of their glycogen. The goal is to maximize leanness and increase the visibility of veins, or "vascularity". The muscular definition and vascularity are further enhanced immediately before appearing on stage by darkening the skin through tanning products and applying oils to the skin to increase shine. Some competitors will eat sugar-rich foods to increase the visibility of their veins. A final step, called "pumping", consists in performing exercises with light weights or other kinds of low resistance (for instance two athletes can "pump" each other by holding a towel and pulling in turn), just before the contest, to fill the muscles with blood and further increase their size and density.
Sandow was so successful at flexing and posing his physique that he later created several businesses around his fame, and was among the first to market products branded with his name. He was credited with inventing and selling the first exercise equipment for the masses: machined dumbbells, spring pulleys, and tension bands. Even his image was sold by the thousands in "cabinet cards" and other prints. Sandow was a perfect "Gracilian", a standard of ideal body proportions close to those of ancient Greek and Roman statues. Men's physiques were then judged by how closely they matched these proportions.