Due to the growing concerns of the high cost, health consequences, and illegal nature of some steroids, many organizations have formed in response and have deemed themselves "natural" bodybuilding competitions. In addition to the concerns noted, many promoters of bodybuilding have sought to shed the "freakish" perception that the general public has of bodybuilding and have successfully introduced a more mainstream audience to the sport of bodybuilding by including competitors whose physiques appear much more attainable and realistic.
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.
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.
Although muscle stimulation occurs in the gym (or home gym) when lifting weights, muscle growth occurs afterward during rest periods. Without adequate rest and sleep (6 to 8 hours), muscles do not have an opportunity to recover and grow. Additionally, many athletes find that a daytime nap further increases their body's ability to recover from training and build muscles. Some bodybuilders add a massage at the end of each workout to their routine as a method of recovering.
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.
Many other important bodybuilders in the early history of bodybuilding prior to 1930 include: Earle Liederman (writer of some of bodybuilding's earliest books), Zishe Breitbart, Georg Hackenschmidt, Emy Nkemena, George F. Jowett, Finn Hateral (a pioneer in the art of posing), Frank Saldo, Monte Saldo, William Bankier, Launceston Elliot, Sig Klein, Sgt. Alfred Moss, Joe Nordquist, Lionel Strongfort ("Strongfortism"), Gustav Frištenský, Ralph Parcaut (a champion wrestler who also authored an early book on "physical culture"), and Alan P. Mead (who became an impressive muscle champion despite the fact that he lost a leg in World War I). Actor Francis X. Bushman, who was a disciple of Sandow, started his career as a bodybuilder and sculptor's model before beginning his famous silent movie career.
The general strategy adopted by most present-day competitive bodybuilders is to make muscle gains for most of the year (known as the "off-season") and, approximately 12–14 weeks from competition, lose a maximum of body fat (referred to as "cutting") while preserving as much muscular mass as possible. The bulking phase entails remaining in a net positive energy balance (calorie surplus). The amount of a surplus in which a person remains is based on the person's goals, as a bigger surplus and longer bulking phase will create more fat tissue. The surplus of calories relative to one's energy balance will ensure that muscles remain in a state of anabolism.
Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature for aesthetic purposes. An individual who engages in this activity is referred to as a bodybuilder. In competitive bodybuilding, bodybuilders appear in lineups and perform specified poses (and later individual posing routines) for a panel of judges who rank the competitors based on criteria such as symmetry, muscularity, and conditioning. Bodybuilders prepare for competitions through the elimination of nonessential body fat, enhanced at the last stage by a combination of extracellular dehydration and carbohydrate loading, to achieve maximum muscular definition and vascularity, as well as tanning to accentuate the contrast of the skin under the spotlights. Bodybuilders may use anabolic steroids and other performance-enhancing drugs to build muscles.