The Natural Decline: Sarcopenia and Muscle Loss
As the body ages, even the most rigorously trained athletes cannot entirely escape the gradual loss of muscle mass, a condition known as sarcopenia. While consistent resistance training can mitigate this process significantly, it cannot be stopped entirely. Hormonal changes play a major role, particularly the natural decline in testosterone and growth hormone levels. Studies show that strength training can still produce results in older adults, but their muscles become less responsive over time, meaning it takes more stimulus to achieve the same growth.
- Reduced Protein Synthesis: Anabolic resistance, a phenomenon where the body's ability to turn protein into new muscle is diminished, increases with age.
- Decreased Motor Neurons: There is a progressive loss of motor neurons that activate muscle fibers, which contributes to overall muscle weakness and atrophy.
- Change in Fiber Type: Aging leads to a reduction in fast-twitch (Type II) muscle fibers, the primary type targeted by hypertrophy-focused training, resulting in lower explosive power and size.
Cardiovascular and Metabolic Consequences
For many bodybuilders, especially those who used performance-enhancing drugs, the cardiovascular system can face serious long-term consequences. High-intensity training combined with steroid use can cause structural changes to the heart that persist long after drug cessation.
In May 2025, a study published in the European Heart Journal revealed a significantly higher risk of sudden cardiac death (SCD) among male bodybuilders, particularly professionals. The study, which observed over 20,000 athletes, found the average age of death was just 45, with SCD accounting for nearly 40% of cases. Autopsies of some individuals showed heart enlargement (cardiomegaly) and ventricular hypertrophy.
Chronic abuse of anabolic-androgenic steroids (AAS) has been linked to severe cardiotoxicity, including concentric left ventricular hypertrophy and coronary artery disease. These issues can be compounded by metabolic problems, as years of severe caloric restriction, followed by bulking cycles, may increase insulin resistance and impair metabolic function over time.
Musculoskeletal and Joint Health
Years of lifting heavy weights take a cumulative toll on the body's joints, tendons, and ligaments, leading to a higher incidence of degenerative conditions later in life.
- Osteoarthritis: High-impact, high-volume training can accelerate the degradation of joint cartilage, increasing the risk of osteoarthritis.
- Tendon and Ligament Damage: Repetitive strain on tendons, especially in the shoulders, elbows, and knees, can lead to chronic inflammation, tendonitis, and an increased risk of tears.
- Bone Density Issues: While strength training is beneficial for building bone density, competitive bodybuilders who undergo prolonged periods of low body fat and severe dietary restrictions may actually suffer from reduced bone quality. In one case study, an 87-year-old bodybuilder had superior muscle mass but significantly poorer bone mineral density compared to untrained peers.
The Psychological Aftermath: Body Image and Identity
For retired bodybuilders, the physical changes that accompany aging can be profoundly distressing, impacting their body image and sense of identity. Many athletes develop muscle dysmorphia (bigorexia), perceiving themselves as small despite being very muscular. This body dissatisfaction can persist or worsen in retirement as their physique naturally shrinks.
- A significant psychological challenge is the grieving process associated with losing one's athletic identity.
- Changes in body composition can lead to depression, anxiety, and a sense of purposelessness.
- Bodybuilders who used AAS may suffer from prolonged depression and dependence issues upon cessation.
- Addressing mental health alongside physical health is crucial for a successful transition into post-competition life.
Skin Changes and Overall Appearance
Extreme muscle hypertrophy causes the skin to stretch considerably. As bodybuilders age and their muscle mass diminishes, their skin loses elasticity due to reduced collagen and elastin production, resulting in sagging. This effect, sometimes described as resembling an ex-obese person's loose skin, is a natural consequence of the body's changing volume. The premature breakdown of collagen from excessive training can also lead to more pronounced wrinkles. For many, significant loose skin may only be corrected through cosmetic surgery.
Comparison of Aging in Natural vs. AAS-Using Bodybuilders
| Aspect | Natural Bodybuilder | AAS-Using Bodybuilder |
|---|---|---|
| Muscle Loss (Sarcopenia) | Natural, gradual decline, but mitigated by continued training. Body becomes a smaller, leaner version of its younger self. | More rapid muscle atrophy upon cessation of drugs, leading to a more dramatic loss of mass. |
| Cardiovascular Health | Regular strength training can provide significant long-term cardiovascular benefits, like improved blood pressure. | Higher risk of severe cardiotoxicity, including heart enlargement and coronary issues, which can persist long-term. |
| Musculoskeletal Health | General age-related joint and overuse injuries. Lifelong strength training promotes stronger bones and connective tissues. | Increased risk of tendon and ligament injuries due to muscle strength outpacing connective tissue resilience. Joint wear may be exacerbated. |
| Hormonal Profile | Gradual, natural decline in testosterone. Continued training helps maintain higher levels compared to sedentary peers. | Long-term suppression of the hypothalamic-pituitary-gonadal (HPG) axis, leading to prolonged hypogonadism upon stopping AAS use. |
| Psychological Health | Potential for body image issues related to loss of peak conditioning, but generally less severe than in AAS users. | Higher incidence of severe mood swings, paranoia, and dependence issues, which may lead to significant mental health challenges in retirement. |
The Continuing Journey: How Retired Bodybuilders Adapt
Many former bodybuilders successfully transition to a healthier, more sustainable lifestyle, focusing on function and longevity rather than peak size. Strategies include reducing training volume and intensity while maintaining consistency, focusing on balanced nutrition, and prioritizing rest and recovery. Continued resistance training remains a powerful tool to combat sarcopenia, improve bone density, and support metabolic health, even for those starting later in life. The key is adapting goals to a new stage of life and embracing a healthier relationship with one's body, rather than chasing an aesthetic ideal that is no longer sustainable.
Conclusion
For bodybuilders, aging is a complex process shaped by decades of intensive training and, for many, performance-enhancing drug use. While natural athletes can enjoy significant health benefits from their lifelong commitment to resistance training, mitigating muscle loss and maintaining functional strength well into older age, those with a history of AAS abuse face higher risks of long-term cardiovascular, neurological, and hormonal issues. Regardless of past practices, a shift in focus from extreme aesthetics to overall health and functional fitness is crucial for a healthy and fulfilling retirement. Embracing a modified training routine, prioritizing nutrition, and addressing the psychological challenges of a changing physique are key to navigating what happens to body builders as they age.
