Professional and Competitive Bodybuilding has to be one of the most dangerous sports in existence, and a large part of that is due to estrogen-blocking.
What other sport has a 34% HIGHER death rate than the average American male?
“Daniel Gwartney, MD, and colleagues at Baylor College of Medicine in Houston identified 1,578 professional male bodybuilders who compete from 1948 to 2014. They were able to obtain complete mortality data for 597.”
“…Of the 597 men, 58 (9.7%) were reported dead. Only 40 deaths were expected in this population based on age-matched data, for a standardized mortality rate of 1.34. The mean age of death was 47.7 years (range 26.6 – 75.4 years).”
The saddest part about all this is how bodybuilders consciously KNOW and ACCEPT a fate that involves early death:
“In the 1980s, Dr. Robert Goldman began asking top-level athletes if they’d accept a proverbial deal with the devil that guaranteed victory in every competition they entered… but also guaranteed their death within five years.
Goldman consistently found that the majority of athletes would eagerly accept the deal. It became known as ‘Goldman’s Dilemma.’”
Let me be as clear as possible in saying this…I DO NOT endorse the lifestyle of most competitive body builders.
As a former physique competitor myself (winner of various NPC contests and having consulted with numerous aspiring and pro bodybuilders over the last 2 decades)
I have massive respect for the amount of work, both in and out of the gym these men(and women)put in to build their phenomenal stage worthy physiques.
I consider it an honorable mission to help minimize the number of unnecessary bodybuilding injuries and deaths.
This will allow these competitors to live longer and hopefully maintain some level of fully optimized health.
The best way I can help is via presentation of the scientific evidence in combination with the empirical evidence of prescribing doctors who have thriving and healthy patients.
Both of which unequivocally prove aromatase inhibition is toxic to male health.
Therapeutic Testosterone Works So Damn Well BECAUSE Of Estrogen
If you read my previous article on the dangers of suppressing men’s estrogen levels, you already know the answer.
For those of you who don’t, allow me to summarize it in a single sentence:
Testosterone MUST be converted into the pleiotropic hormone estradiol “E2” (via the aromatase enzyme) to manifest its numerous therapeutic benefits to biological systems.
You know all the 600+ studies I cited in The TOT Bible regarding all the positive health effects of therapeutic testosterone?
News flash: Not a SINGLE STUDY involved blocking or suppressing estrogen levels in any of the studied test subjects.
As I’ll discuss later on in this blog post, estrogen is essential for bone strength, heart health, and a wide variety of important biological functions.
Furthermore, estrogen has been falsely labeled as a “female sex hormone” when it is just as crucial for optimal male sexual health:
“…estradiol, the predominant form of estrogen, also plays a critical role in male sexual function.
Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis.
Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function.”
For this reason alone, there is no such thing as ‘estrogen dominance’ or ‘high estrogen symptoms’.
What you’re really looking at is a potential deadly combination of high body fat, chronic inflammation and insulin resistance working together to KILL YOU!
Your Body IS NOT Designed To Function At Clinically Low Estrogen Levels
What 99% of physicians fail to realize is that the body has a natural fail-safe mechanism to ensure an optimal balance of testosterone and estrogen.
This mechanism comes in the form of the aromatase enzyme I talked about earlier:
“Aromatase is a specific component of the cytochrome P450 enzyme system responsible for the transformation of androgen precursors into estrogens.
This enzyme is encoded by the CYP19A1 gene located at chromosome 15q21.2, that is, expressed in ovary and testis, but also in many extraglandular sites such as the placenta, brain, adipose tissue, and bone”
In other words, the correct testosterone-to-estrogen ratio for YOUR body is already genetically encoded and in constant regulation.
Everyone’s “sweet spot” is entirely dictated by biochemical individuality (due to your genetics) and your epigenetics (a.k.a. your lifestyle).
Therefore, attempting to get your estradiol (E2) levels to conform within ranges set forth by laboratory standards is a big fat waste of time.
(And by the way…the mean ranges provided by LabCorp and Quest Diagnostics are NOT designed for men using therapeutic testosterone!)
Blocking the aromatase enzyme is a terrible idea because you’re preventing your body from reaching a state of hormonal equilibrium between testosterone and estrogen levels:
“Men with estrogen deficiency caused by a mutation in the CYP19 gene suffer from low bone mineral density (BMD) and unfused epiphyses, and have high gonadotropin and testosterone levels.
As you can see, there are multiple disease pathologies possible when a genetic mutation causes estrogen deficiency.
Which leads me to the main takeaway of this section…
Anytime estrogen is attenuated, lowered, or blocked, pathology develops because estradiol is very protective in men.
Most of the beneficial effects of therapeutic testosterone are MODULATED by estradiol!
As one of the world’s leading Androgen Researchers and epidemiologists, Dr. Scott Howell has spent the last 2 decades pouring over tens of thousands of studies and has made the same discovery.
Specifically, he came up with five main conclusions:
1. Optimal cellular physiology of sex steroid target tissues vitally depends on the androgen-to-estradiol ratio rather than single hormone action in isolation.
2. This ratio is controlled in vertebrates by aromatase enzyme levels set through the aromatase gene.
3. Alteration of this ratio in either direction leads to pathology of most organ systems.
4. Aromatase is a fail-safe mechanism in men to protect organ systems through the needed levels of estradiol for organ protection relative to circulating endogenous or exogenous androgens.
5. Only 20 cases of true aromatase deficiency or true aromatase excess syndrome has been described in the medical literature since 2014 so there is no justifiable reason to block aromatase in men on testosterone replacement or bodybuilders taking massive amounts of synthetic androgens.
Aromatase Inhibitors: Dangerous Medications You Should Stay Away From
Aromatase inhibitors (AIs) are the #1 go-to drug for any physician who wants to suppress estrogen levels in men.
How they work is very straightforward:
“Aromatase inhibitors and inactivators interfere with the body’s ability to produce estrogen from androgens by suppressing aromatase enzyme activity.”
If you refer to the diagram I posted earlier in the article, this will make sense right away.
By blocking the ability of aromatase to convert testosterone to estrogen, you have more testosterone and less estrogen.
Strangely enough, AI’s were specifically formulated for the treatment and prevention of invasive breast cancer in women.
It wasn’t until the 80s when legendary steroid guru Dan Duchaine popularized the use of AIs for bodybuilders injecting copious amounts of anabolic steroids:
“Male bodybuilders started using Nolvadex and Proviron to combat the aromatization (estrogen conversion) of high dosages of anabolic steroids.”
“It must be working; bodybuilders will quickly abandon a drug if there is no bang for the buck. I’ve dieted with and without Nolvadex, and I lost fat faster with Nolvadex.”
Even though he dedicated an ENTIRE chapter to using anti-estrogenic drugs for removing stubborn lower body fat, his conclusion was nothing short of interesting:
“In the grand hierarchy of diet drugs, anti-estrogens are now considered below average.
Certainly, you will get better effects with clenbuterol, yohimbe, ephedrine and phenformin. After all of these, choose Nolvadex or Teslac.
Although anti-estrogens can be helpful for a variety of other maladies, they are an unnecessary luxury for dieters.”
It was thanks to Dan that the emerging issue of “high estrogen symptoms” became so dominant in bodybuilding circles.
Ironically, even breast cancer patients are increasingly avoiding the use of AIs to treat breast cancer:
“This meta-analysis confirms that an aromatase inhibitor (AI) is not the best therapy for all postmenopausal women with hormone-receptor positive, early-stage, breast cancer.
This potentially practice-changing article provides new evidence for AI toxicities, which practitioners should consider when choosing between adjuvant endocrine therapies for postmenopausal breast cancer patients.
The authors conducted the study to clarify why AIs, when compared with tamoxifen, increased disease-free survival but not overall survival.
AI toxicities were suspected to counteract decreased recurrence rates.”
Here is just a small sample of some of the side effects which come with the use of AIs:
- Increased intra-abdominal fat
- Sexual dysfunction
- Breast swelling or pain
- Thinning hair
- Extreme fatigue
Looks like Dan Duchaine was half right — there ARE better drugs you can use if you are serious about getting shredded as fast as possible!
The Numerous Health Benefits Of Leaving Aromatase Alone
I mentioned the health benefits of estrogen earlier, but I want to examine another worthwhile yet related topic.
Namely, why is it in our best interest to leave the aromatase enzyme untouched?
There are numerous reasons why we should let Mother Nature handle things, as revealed in a major review examining the connection between aromatase deficiency and various facets of health…
- Cognitive Health: Estradiol is neuroprotective, and is also essential for mood stabilization and normal sexual behavior in males.
- Biologically Protective: In the same study cited above, estradiol was shown to be protective of both the immune and cardiovascular systems.
- Lower Body Fat: Aromatase deficiency is correlated closely with increased visceral body fat
- Better Metabolism: Men with true aromatase deficiency have insulin resistance and impaired carbohydrate metabolism.
- Healthier Lipid Profile: Aromatase deficiency usually leads to lower levels of high-density lipoprotein cholesterol — also known as the “good” cholesterol — and elevated triglycerides
(As a sidebar, oftentimes a precise course of estradiol treatment can fully resolve this)
Bone Density: Aromatase deficiency is associated with lower body mineral density and stunted bone growth.
This study was published 14 years ago in 2006, and even they were fully aware of the adverse health outcomes associated with using AIs!
Two Common Bodybuilder Side Effects Wrongly Blamed On Estrogen
Even with all of the information above, bodybuilders will commonly blame high levels of estrogen for two side effects they commonly experience.
So let’s debunk both of them really quick…
Testosterone and other androgens (i.e. male sex hormones) are able to retain elements such as sodium, nitrogen and calcium.
Testosterone can also increase the production of anti-diuretic hormone (ADH) through an aromatase-dependent mechanism, while estradiol decreases ADH production in a dose-response manner.
(FYI: ADH is responsible for maintaining electrolyte balance and controlling how much water your kidneys should hold)
This means that testosterone is responsible for conserving bodily water and preventing fluid loss.
And therefore it does not make sense to say that estradiol is responsible for water retention.
Here’s the really interesting part about androgen-related water retention:
It is mediated through local renin-angiotensin system activation in the kidneys and ADH.
In plain English, estrogen is not the problem here.
Any supposed issues around water retention will resolve in 4-6 weeks.
However, it will recur if someone consumes a diet high in sodium and/or carbohydrates and also has high systemic inflammation and visceral body fat from living a poor lifestyle.
Despite what you may have heard, the vasomotor symptoms experienced by women are also present in men:
“Vasomotor symptoms are those that occur due to the constriction or dilation of blood vessels.
They include hot flashes, night sweats, heart palpitations, and changes in blood pressure.
The most likely reason why these symptoms can occur during menopause is that hormonal fluctuations affect the mechanisms that control blood pressure and temperature control.”
One side effect which wasn’t mentioned above are emotional and mood disturbances, which are often tied with so-called estrogen dominance.
<Remember there is no such thing as estrogen-dominance, only insulin resistance and systemic inflammation>
This was disproven in a 2016 study examining two separate cohorts of men with low testosterone from two separate yet randomized trials.
The main purpose of the study was to see how testosterone and estradiol deficiency contribute towards the development of vasomotor symptoms.
One cohort received either a placebo or various doses of testosterone gel for 16 weeks.
The other cohort received either a placebo or the same doses of testosterone gel AND anastrozole (a popular AI) for 16 weeks.
What was the key mediator of vasomotor symptoms?
A LACK of estrogen!
Furthermore, the incidence of vasomotor symptoms was most present in the men who were taking the AI.
This is the best evidence we have to date, and as anybody knows, anecdotes in the bodybuilding industry never really pan out.
The Medical Community Does NOT Understand The Harm Of Blocking Estrogen
To this day, I am still astounded by the number of clinicians who do not READ modern scientific literature and have no clue how to interpret it properly.
Yet many of them will still assert that blocking estrogen is the way to go.
You can’t simply come to this conclusion after reading 1-2 studies and talking to a few “bros” in the gym.
Dr. Scott Howell, one of the foremost world leaders on managing estrogen levels in men, knows FOR A FACT that aromatase should not be inhibited in otherwise healthy men.
In fact, blocking aromatase is extremely harmful in the long run if you are using androgens.
How did he come to this conclusion?
He looked at the totality of the evidence: Animal or mammal studies, case reports, forensic reports, observational studies, dose-escalation studies, toxicology studies, and designs that are closely related.
Dr. Howell also spent 10 years reviewing and compiling case and forensic reports from all over the world, looking at observational studies, trials, and experiments that were conducted on anabolic steroids.
In about a 15-year period, he compiled nearly 30,000 androgen studies from the early 1900s to the present day.
He found that there was NO SUCH THING as a universal “sweet spot” for estradiol levels in men.
This misguided notion came from a single study published in 2001 that examined 63 men with severe male factor infertility.
What you would discover upon reading the paper more closely is how many of them had other comorbidities:
- 16 men had Klinefelter’s syndrome (born with an extra “X” chromosome, leading to infertility)
- 14 had varicocele (enlarged veins inside your scrotum, lowering sperm production)
- 12 were idiopathic (having diseases or genetic conditions that arise spontaneously for unknown reasons)
Their FSH (follicle-stimulating hormone) levels ranged from 10.0 to 39.1, averaging out at 21.2.
This population was obviously very sick, and yet these researchers thought their testosterone-to-estradiol ratios could be used as reference points:
“We identified an endocrinopathy in men with severe male factor infertility that is characterized by a decreased serum testosterone-to-estradiol ratio.
This ratio can be corrected by aromatase inhibition, resulting in a significant improvement in semen parameters in oligospermic patients.”
The ratios found for these sick men are only applicable to them specifically and nobody else.
You CANNOT take the results from this very niche population and apply them to otherwise healthy men, especially those who are using therapeutic testosterone.
It only shows the ignorance of research methods among clinicians who make this rookie mistake, thereby causing harm to their patients.
So WHY Are Professional Bodybuilders Dropping Dead?
We now arrive at the million-dollar question: How is estrogen-blocking connected to the premature deaths of untold numbers of bodybuilders?
They died from a combination of supraphysiologic dosages of anabolic-androgenic steroids (AAS) and high dosages of AIs.
How do we know this for certain?
We can see it through the number of forensic case reports involving bodybuilders who drop dead from myocardial infarction and heart failure:
“Taking steroids can cause the left ventricle, the main pumping chamber of the heart, to enlarge disproportionately compared to the rest of the heart. This increases chances for irregular heartbeats and sudden death”
And as Dr. Howell put it, “The pathology is characteristically a diffuse collagen infiltration that occurs simultaneously with left ventricular hypertrophy and it happens across the board when estrogen is blocked.”
But I want to dive deeper into this and talk about the five main reasons why bodybuilders are constantly dying of heart problems.
Overloading The Heart Muscle Through Uncontrolled Hypertension
Our heart changes in size, shape and function through a process called “cardiac remodeling.”
Physiologic remodeling takes place when an athlete exerts vigorous effort and it is not considered to be damaging.
Pathologic remodeling, however, takes place when the heart muscle sustains some form of injury.
When you take extremely high doses of AAS and combine them with several hours of exercise per day, you get hypertrophy of the heart’s left ventricle (and the heart overall).
Here’s what I mean…
The physiologic androgens normally found in your body are known to have anabolic effects on your heart cells.
When you “knock out” the receptors these androgens normally bind to, and there is no presence of estradiol produced by aromatase, cardiac growth (i.e. heart growth) does not take place.
However…when you “knock out” the aromatase enzyme, mice studies have shown that the androgens stimulate MORE hypertrophy of the heart muscle.
That’s not where the story ends, especially since you’re using supra-physiologic doses of AAS.
The cardiac remodeling that then takes place involves a peptide known as angiotensin II, which belongs to the Renin-Angiotensin-Aldosterone System (RAAS).
Angiotensin II is responsible for increasing blood pressure by constricting your blood vessels, and is also involved in pathologic cardiac remodeling.
In this remodeling process, an overproduction of collagen (a structural protein found in connective tissues) takes place and the excess gets stored in your heart and arteries.
So let’s recap…
When you have elevated Angiotensin II levels and low estradiol levels, you have uncontrolled hypertension.
That right there is the perfect recipe for cardiac pathology in bodybuilders because you have lost the protection to EVERY organ system offered by estradiol.
When bodybuilders use high-dose androgens and aromatase inhibitors, the cardiac pathology becomes even more extreme in terms of hypertrophy and collagen infiltration.
Put another way, Angiotensin II is a bodybuilder’s worst enemy.
Angiotensin II also increases the synthesis and release of 20-HETE in the kidneys, which is also a potent vasoconstrictor and pro-hypertensive within the blood vessels of the heart.
Blocking Aromatase Prevents Estrogen From Exerting Cardio-protective Effects
Estradiol (E2) is able to counter the pathologic hypertrophy induced by androgens by binding to estrogen receptor beta (ERβ), and the collagen remodeling by binding to estrogen receptor alpha (ERα).
Allow me to summarize what happens with each receptor in greater detail.
When estradiol binds to ERβ in heart muscle cells, it can:
- Prevents cardiac fibrosis (impaired heart performance)
- Stops cardiac hypertrophy (induced by Angiotensin II) from taking place
When estradiol binds to ERα in heart muscle cells, it can:
- Stimulates repair of the inner lining of blood vessels, while increasing nitric oxide production
- Leads to increased expression of genes responsible for angiogenesis (formation of new blood vessels)
In summation, E2 binding to ERβ and ERα in heart muscle cells is essential to maintain cardiac health.
High doses of androgen will lead to adaptive cardiac hypertrophy that is somewhat reversible, but only if pathologic fibrosis does not occur.
But in the absence of E2 binding, the adaptive hypertrophy from androgens is magnified and begins the progression to pathologic remodeling.
Fibrosis will occur if nothing is done to resolve the underlying stimulus early on during androgen abuse.
Or as Dr. Howell put it: “When high dose androgens are coupled with aromatase inhibitors, progressive fibrosis becomes a critical pathological event in the progression to cardiac hypertrophy and loss of cardiac function.”
Excessive Oxygen Demands From An Unnatural Amount Of Muscle Tissue
As a logical consequence of the first two outcomes, you end up putting a LOT of residual strain on your heart.
Because you’re using supra-physiologic doses of AAS, you are carrying an additional 50-100 pounds of lean muscle tissue (relative to what your natural genetic weight would be).
This leads to an unnatural demand for oxygen from the tissue:
“Myocardial oxygen demand is the amount of oxygen that the heart requires to maintain optimal function, and myocardial oxygen supply is the amount of oxygen provided to the heart by the blood which is controlled by the coronary arteries.”
How long do you think your heart can keep up with the endless need to supply every tissue with the required amount of oxygen for optimal function?
It can’t pump enough blood, and it cannot do so fast enough to keep the body going.
And the end result is some kind of heart failure.
The Bodybuilder Lifestyle Makes All The Heart Problems So Much Worse
With hours of heavy resistance training, you are further inducing the cardiac hypertrophy mediated by Angiotensin II and the excessive doses of androgens used.
This has been a consistent finding in case studies involving bodybuilder deaths:
“Our findings support an emerging consensus that the effects of vigorous weight training, combined with anabolic steroid use and increased androgen sensitivity, may predispose these young men to myocardial injury and even sudden cardiac death”
In virtually every single story of a bodybuilder passing away, a heart problem always seems to be at the very root of what caused their untimely death:
“…in all cases the autopsy findings together with the histological examination have highlighted cardiac causes of death.
Only in one case a mechanical cardiovascular cause of death was found (a bilateral pulmonary embolism from deep venous thrombus of lower extremities).
In numerous cases, a common finding was a left ventricular hypertrophy, frequently associated with fibrosis and myocytolisis.”
I think the takeaway so far is fairly obvious.
Supra-Physiologic Dosages of Anabolic Steroids Cause Damage To The Cardiovascular System
Putting aside the estrogen talk for a moment, the androgens being used by bodybuilders come with their own host of damaging side effects.
Here are some of the possible cardiotoxicity outcomes I was able to dig up…
- Loss of heart function
- Cardiomegaly (an enlarged heart that arises from the heart being overworked or damaged)
- Hardened arteries
- Reduced ability to pump blood uniformly throughout the body
One key point to mention is that the majority of the cardiac changes can be reversed, or even prevented.
The exception that will not reverse is collagen infiltration between cardiomyocytes (heart muscle cells) and arteries that leads to pathologic remodeling.
And that’s not even getting into how the other biological systems in your body are impacted…
- Scarred liver tissue (sometimes, the tissue damage cannot be reversed)
- Excessive production of clotting factors (increasing your risk of a stroke)
- Altered cognitive function (higher chance of contracting dementia)
- Compromised immune system
The interesting part about all this is that the literature enabled the identification of specific toxicity phenotypes in each of these categories.
Each form of toxicity also has a direct injury component through reactive oxygen species and oxidative tissue damage.
How Physicians Can Start Saving Bodybuilders’ Lives
The funny part about solving this issue is how remarkably simple the solution is…
You need to give your body a few weeks to fully adapt to the exogenous administration of testosterone.
All of the symptoms you experience will eventually be resolved and you will be at a new normal.
The only way you would end up having a legitimate insensitivity to testosterone is if you had an extremely rare genetic disorder where your androgen receptors are mutated.
We’re talking about 0.001% of the population — if this is you, you would have known by the time you/ were 5 as your “development” would have been way off.
You need to stop obsessing about hour-to-hour mood changes, and instead evaluate your mood over a longer period of time (I’m talking about 2-3 months here).
Testosterone is NOT a magic bullet and it will not change everything.
This is why tip-of-the-spear physicians encourage new patients on therapeutic testosterone to “ride it out” for a few weeks before making any changes.
Any necessary changes would rarely IF EVER consist of adding an AI to suppress or modulate your estradiol levels.
The right changes are cleaning up your lifestyle (reducing systemic inflammation) and most importantly dropping visceral body fat.
With all this in mind, there are two immediate steps clinicians can take to reduce harm in anabolic steroid users…
1) Take an Angiotensin-converting enzyme (ACE) inhibitor or an Angiotensin Receptor Blocker (ARB).
The two enzymes ACE and ACE2 are responsible for regulating your body’s production of Angiotensin II.
As you already know, elevated levels of Angiotensin II are detrimental to the function of the heart and kidney.
Angiotensin II is made from cardioprotective Angiotensin I through ACE, and so we want to use ACE inhibitors to block this conversion.
Conversely, using an ARB will prevent Angiotensin II from binding to its receptors and exerting its effects.
2) AVOID using AI’s altogether, (if removal due to extreme psychogenic need purposes is impossible)only using them for very short periods of time (2-3 weeks MAX) where goal is permanent titration of therapy)
If you are a man working with a Doctor who has you on an AI, find another Doctor ASAP.
If you are a Bodybuilder utilizing AI’s to limit your ‘perceived side effects’ from supra-physiologic levels of AAS, make sure you read this article over and over again.
I have also written prolifically on the dangers of using AIs on this website.
In addition, you will be doing yourself a massive disservice if you don’t watch the podcast I did with Dr. Scott Howell on the harm of aromatase inhibition.
Make sure you read through all these materials as many times as necessary to understand the danger you are placing upon your biological systems and lifespan.
Having helped many bodybuilders regain control of their health without sacrificing their physique goals, Dr. Howell gets my highest recommendation.
Email him at [email protected] for inquiries regarding harm reduction consultations and DNA analysis.
And as always…
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