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.
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.
In competitive bodybuilding, bodybuilders aspire to present an aesthetically pleasing body on stage.[16][17] 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 modern bodybuilding industry, the term "professional" generally means a bodybuilder who has won qualifying competitions as an amateur and has earned a "pro card" from their respective organization. Professionals earn the right to compete in competitions that include monetary prizes. A pro card also prohibits the athlete from competing in federations other than the one from which they have received the pro card.[12] Depending on the level of success, these bodybuilders may receive monetary compensation from sponsors, much like athletes in other sports.
The bulking and cutting strategy is effective because there is a well-established link between muscle hypertrophy and being in a state of positive energy balance.[19] A sustained period of caloric surplus will allow the athlete to gain more fat-free mass than they could otherwise gain under eucaloric conditions. Some gain in fat mass is expected, which athletes seek to oxidize in a cutting period while maintaining as much lean mass as possible.

The bulking and cutting strategy is effective because there is a well-established link between muscle hypertrophy and being in a state of positive energy balance.[19] A sustained period of caloric surplus will allow the athlete to gain more fat-free mass than they could otherwise gain under eucaloric conditions. Some gain in fat mass is expected, which athletes seek to oxidize in a cutting period while maintaining as much lean mass as possible.
In recent years, the related areas of fitness and figure competition have increased in popularity, surpassing that of female bodybuilding, and have provided an alternative for women who choose not to develop the level of muscularity necessary for bodybuilding. McLish would closely resemble what is thought of today as a fitness and figure competitor, instead of what is now considered a female bodybuilder. Fitness competitions also have a gymnastic element to them. A study by the Clinical Journal of Sport Medicine found that female bodybuilders who are taking anabolic steroids are more likely to have qualified for substance dependence disorder, to have been diagnosed with a psychiatric illness, or to have a history of sexual abuse.[14]
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]
^ Mangano, Kelsey M.; Sahni, Shivani; Kiel, Douglas P.; Tucker, Katherine L.; Dufour, Alyssa B.; Hannan, Marian T. (February 8, 2017). "Dietary protein is associated with musculoskeletal health independently of dietary pattern: the Framingham Third Generation Study". The American Journal of Clinical Nutrition. 105 (3): 714–722. doi:10.3945/ajcn.116.136762. PMC 5320406. PMID 28179224 – via ajcn.nutrition.org.
Comer has an athletic build that comes from years of martial arts and marathon training, not to mention amateur competitive bodybuilding, activities that have taken a toll on her now bandaged 40-something-year-old knees. — Quanta Magazine, "The Art of Teaching Math and Science," 16 June 2019 Teresa Giudice, who's best known as a personality on Bravo's Real Housewives of New Jersey, competed in her first bodybuilding contest Saturday. — Carly Mallenbaum, USA TODAY, "'Real Housewives' star Teresa Giudice shows off new muscles at bodybuilding competition," 10 June 2018 His first wife, Sitora Yusufiy, suggested in an interview with Time magazine, with little evidence other than his penchant for bodybuilding and mirror-gazing, that Omar Mateen could have been gay. — Tim Fitzsimons /, NBC News, "What really happened that night at Pulse," 12 June 2018 The physique competition will be held at McGlohon Theater and includes the following categories: bodybuilding, fitness, men’s physique, figure, bikini, classic physique and women’s physique. — Courtney Devores, charlotteobserver, "Your 5-minute guide to the best things to do in Charlotte | June 22-28," 21 June 2018 Fans who have been following Giudice closely on social media have watched the reality star workout in videos, but Giudice hasn't posted publicly about her first bodybuilding competition. — Carly Mallenbaum, USA TODAY, "'Real Housewives' star Teresa Giudice shows off new muscles at bodybuilding competition," 10 June 2018 Carolyn Marvin, who served as the graduate adviser for both Prosper and Nirenberg, pointed to his thesis, an autoethnography about the subculture of bodybuilding. — Josh Baugh, San Antonio Express-News, "Nirenberg knew immediately that he’d eventually marry Erika Prosper," 17 Mar. 2018 The bodybuilding competition is one of two hosted produced each year in Louisville by Kentucky Muscle promoter Brent L. Jones. — Matt Stone, The Courier-Journal, "Bodybuilders, fitness athletes go flex at 2018 KDF Derby Championships," 29 Apr. 2018 Father John Brown is basically a bodybuilding legend, having won two Mr. Universe titles and three Mr. World crowns. — Jr Radcliffe, Milwaukee Journal Sentinel, "Facts you may have missed about each Packers draft choice in 2018," 4 May 2018

In 1990, professional wrestling promoter Vince McMahon announced that he was forming a new bodybuilding organization named the World Bodybuilding Federation (WBF). McMahon wanted to bring WWF-style showmanship and bigger prize money to the sport of bodybuilding. A number of IFBB stars were recruited but the roster was never very large and featured the same athletes competing; the most notable winner and first WBF champion was Gary Strydom. McMahon formally dissolved the WBF in July 1992. Reasons for this reportedly included lack of income from the pay-per-view broadcasts of the contests, slow sales of the WBF's magazine Bodybuilding Lifestyles (later WBF Magazine), and the expense of paying multiple six-figure contracts while producing two TV shows and a monthly magazine.
In recent years, the related areas of fitness and figure competition have increased in popularity, surpassing that of female bodybuilding, and have provided an alternative for women who choose not to develop the level of muscularity necessary for bodybuilding. McLish would closely resemble what is thought of today as a fitness and figure competitor, instead of what is now considered a female bodybuilder. Fitness competitions also have a gymnastic element to them. A study by the Clinical Journal of Sport Medicine found that female bodybuilders who are taking anabolic steroids are more likely to have qualified for substance dependence disorder, to have been diagnosed with a psychiatric illness, or to have a history of sexual abuse.[14]
Bodybuilding became more popular in the 1950s and 1960s with the emergence of strength and gymnastics champions, and the simultaneous popularization of bodybuilding magazines, training principles, nutrition for bulking up and cutting down, the use of protein and other food supplements, and the opportunity to enter physique contests. The number of bodybuilding organizations grew, and most notably the International Federation of Bodybuilders (IFBB) was founded in 1946 by Canadian brothers Joe and Ben Weider. Other bodybuilding organizations included the Amateur Athletic Union (AAU), National Amateur Bodybuilding Association (NABBA), and the World Bodybuilding Guild (WBBG). Consequently, the male-dominated contests grew both in number and in size. Besides the many "Mr. XXX" (insert town, city, state, or region) championships, the most prestigious titles[according to whom?] were Mr. America, Mr. World, Mr. Universe, Mr. Galaxy, and ultimately Mr. Olympia, which was started in 1965 by the IFBB and is now considered the most important bodybuilding competition in the world.
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