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.
The important role of nutrition in building muscle and losing fat means bodybuilders may consume a wide variety of dietary supplements. Various products are used in an attempt to augment muscle size, increase the rate of fat loss, improve joint health, increase natural testosterone production, enhance training performance and prevent potential nutrient deficiencies.
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.
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.
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.