BBC Big Question: Why Do Some People Die Young Despite Building Muscles Through Fitness Training?

In early July, Mailson Araújo posted a photo on social media from the gym, as he often did, showing off his muscles. He was a professional bodybuilder and a fitness influencer with tens of thousands of followers. Wearing a red tank top, he displayed arms so incredibly developed they seemed almost superhuman. Hours later, the 35-year-old Brazilian man died at his home in the northeastern state of Bahia after feeling unwell. Although Araújo’s cause of death has not been confirmed, he is one of several bodybuilders who have died suddenly. In late May, one of Brazil’s most prominent young bodybuilders, Gabriel Ganley, died from sudden cardiac death at age 22. Last year, two other Brazilian bodybuilders, aged 30 and 40, also died from heart-related conditions, one during a competition. Similar deaths have occurred worldwide, including American bodybuilder Dallas McCarver, who died at 26 in 2017, and German fitness influencer and bodybuilder Jo Lindner, who died at 30 in 2023. So why do some bodybuilders, who appear strong and healthy, die suddenly at relatively young ages?

A 2025 study detailed the risks of competitive bodybuilding. Researchers tracked around 20,000 amateur and professional bodybuilders who participated in events organized by the sport’s governing body between 2005 and 2020. Published in the European Heart Journal, the study found that professional bodybuilders were more than five times as likely to die from sudden cardiac death—when the heart suddenly stops beating—compared to amateur participants. Sudden cardiac death is rare among young, healthy individuals and is usually linked to underlying cardiovascular disease. The study identified 121 deaths in total, with 46 classified as sudden cardiac deaths. The average age at death was 45, but among athletes still actively competing, the average age dropped to 34.7.

Dr. Marco Vecchiato, lead author of the study and a researcher at the University of Padova in Italy, said multiple factors could contribute to these deaths, including the “widespread use” of performance-enhancing drugs, rapid weight loss before competitions, and “extreme strength training.”

Another 2025 study, published in the journal Circulation by Danish researchers, followed 1,189 men known to use anabolic steroids and compared them over 11 years with nearly 60,000 average men. The study found steroid users were nearly nine times more likely to develop dilated cardiomyopathy, a condition that weakens the heart muscle. Their risk of heart attack was three times higher, and their risk of heart failure more than tripled.

In addition to other health issues like reduced sperm count and erectile dysfunction, anabolic steroids can raise blood pressure, accelerate the buildup of arterial plaque, and cause structural changes in the heart itself.

In fact, in the European Heart Journal study, researchers reviewed autopsy reports of deceased bodybuilders. In many cases, reports showed cardiac hypertrophy and left ventricular hypertrophy—the thickening of the heart’s main pumping chamber—which can increase the risk of arrhythmias and heart failure. In some cases, toxicology analyses and public reports revealed abuse of anabolic drugs, substances often not included in standard autopsy testing.

Autopsy results of young bodybuilders who died often show cardiac hypertrophy. One of the most widely reported cases is that of American bodybuilder Dallas McCarver. One of the sport’s most recognizable stars, he died in 2017 at age 26. His autopsy revealed a heart weighing 833 grams—more than double the expected weight for an adult male.

A 2022 study analyzing autopsy reports of American bodybuilders found their hearts weighed nearly 74% more than normal on average, with left ventricular wall thickness up to 125% greater than expected.

In another independent study, researchers analyzed forensic reports from Italy and Spain involving bodybuilders linked to anabolic steroid use. Multiple cases showed young athletes in their 20s already exhibiting cardiac hypertrophy, severe myocardial thickening, and advanced coronary artery disease. One 24-year-old bodybuilder had over 75% blockage in a major coronary artery, despite having no known family history of heart disease.

Endocrinologist and sports medicine physician Dr. Clayton Macedo said: “The heart, like other muscles, is also a muscle.”

“I often say that just by looking at a patient’s biceps, I can roughly tell how big their heart is, because the heart grows along with the rest of the body’s muscles.”

Weight training without steroids can enlarge the heart, which is a benign and healthy adaptation. However, Luiz Eduardo Fonteles Ritt, president of the Bahia chapter of the Brazilian Society of Cardiology, said that when high-intensity weight training is combined with steroid use, the heart not only enlarges but may gradually lose its ability to contract normally.

He said: “This could progress to heart failure, eventually reaching an irreversible stage.”

However, in some cases, heart thickening may be due to genetic conditions.

Ritt said: “There is a gray area. It could be a genetically determined heart condition. It could be related to anabolic steroids. It could be due to training. Or it could be a combination of all three.”

“There is no such thing as safe anabolic steroid use”

Former bodybuilder Rodrigo Góes told BBC News Brasil that he competed naturally until age 30, after which he decided to start “cycling” steroids under medical supervision.

“Cycling” refers to taking anabolic steroids for a period, typically lasting several weeks, then stopping for a time to allow the body to recover.

Góes said: “The effects on the body are incredible.”

“Your muscles grow much faster than with natural training. Your body gets leaner, and muscle recovery is quicker. That’s exactly why it’s so tempting.”

However, even with what he described as cautious dosing and medical supervision, Góes experienced side effects such as hair loss, stress, insomnia, and severe night sweats.

But he said the most serious impact was psychological.

“I never got used to the whole injection process. In a way, I felt like a drug addict. It’s hard to say, but I felt like I was doing something wrong.”

Góes now actively advocates against steroid abuse.

“There is no such thing as safe anabolic steroid use. Doctors can only control the damage, but damage always exists.”

“I can tell just by looking at the biceps”

One challenge in quantifying the health damage caused by steroids is that many countries do not systematically track steroid-related deaths.

In Brazil, there are no official statistics on mortality related to anabolic steroids. Many other countries also do not routinely record steroid use as a contributing factor in deaths.

Instead, deaths are typically classified by direct causes such as heart attack, stroke, or cardiomyopathy, rather than the potential role of performance-enhancing drugs.

Forensic experts say that because anabolic steroids closely resemble hormones naturally produced by the body, they are often difficult to detect after death, making steroid use easy to overlook.

Combined, these factors make it extremely difficult to accurately determine how many deaths may be linked to performance-enhancing drugs.

Macedo said: “I deal with these cases every day.”

“I can tell just by looking at someone’s biceps. Unfortunately, when I see biceps like that, I usually already understand that their heart is damaged or beginning to be damaged. In most cases, the price comes later.”

Additional reporting: Luis Barrucho

We used artificial intelligence to assist in translating this article, which was originally in English. Before publication, a BBC journalist reviewed the translation.