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.[43][44][45] Other performance-enhancing substances used by competitive bodybuilders include human growth hormone (HGH), which can cause acromegaly.
Intensive weight training causes micro-tears to the muscles being trained; this is generally known as microtrauma. These micro-tears in the muscle contribute to the soreness felt after exercise, called delayed onset muscle soreness (DOMS). It is the repair of these micro-traumas that results in muscle growth. Normally, this soreness becomes most apparent a day or two after a workout. However, as muscles become adapted to the exercises, soreness tends to decrease.[22]

The first U.S. Women's National Physique Championship, promoted by Henry McGhee and held in Canton, Ohio in 1978, is generally regarded as the first true female bodybuilding contest—that is, the first contest where the entrants were judged solely on muscularity.[13] In 1980, the first Ms. Olympia (initially known as the "Miss" Olympia), the most prestigious contest for professionals, was held. The first winner was Rachel McLish, who had also won the NPC's USA Championship earlier in the year. The contest was a major turning point for female bodybuilding. McLish inspired many future competitors to start training and competing. In 1985, a movie called Pumping Iron II: The Women was released. It documented the preparation of several women for the 1983 Caesars Palace World Cup Championship. Competitors prominently featured in the film were Kris Alexander, Lori Bowen, Lydia Cheng, Carla Dunlap, Bev Francis, and McLish. At the time, Francis was actually a powerlifter, though she soon made a successful transition to bodybuilding, becoming one of the leading competitors of the late 1980s and early 1990s.
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.[55] This is known as "fluffing".[56][57] Synthol is 85% oil, 7.5% lidocaine, and 7.5% alcohol.[56] It is not restricted, and many brands are available on the Internet.[58] The use of injected oil to enhance muscle appearance is common among bodybuilders,[59][60] despite the fact that synthol can cause pulmonary embolisms, nerve damage, infections, sclerosing lipogranuloma,[61] stroke,[56] and the formation of oil-filled granulomas, cysts or ulcers in the muscle.[60][62][63] Rare cases might require surgical intervention to avoid further damage to the muscle and/or to prevent loss of life.[64]

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.[citation needed] 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.[51]

Carbohydrates play an important role for bodybuilders. They give the body energy to deal with the rigors of training and recovery. Carbohydrates also promote secretion of insulin, a hormone enabling cells to get the glucose they need. Insulin also carries amino acids into cells and promotes protein synthesis.[26] Insulin has steroid-like effects in terms of muscle gains.[27] It is impossible to promote protein synthesis without the existence of insulin, which means that without ingesting carbohydrates or protein—which also induces the release of insulin—it is impossible to add muscle mass.[28] Bodybuilders seek out low-glycemic polysaccharides and other slowly digesting carbohydrates, which release energy in a more stable fashion than high-glycemic sugars and starches. This is important as high-glycemic carbohydrates cause a sharp insulin response, which places the body in a state where it is likely to store additional food energy as fat. However, bodybuilders frequently do ingest some quickly digesting sugars (often in form of pure dextrose or maltodextrin) just before, during, and/or just after a workout. This may help to replenish glycogen stored within the muscle, and to stimulate muscle protein synthesis.[29]
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.[citation needed] 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.[51]

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.
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