But what is the cost? Many pay the ultimate cost.
When a bodybuilding or physique competitor dies you see a lot of "internet experts" expressing opinions about how it happened. I will explore some of the potential reasons why these tragedies occur.
The Real Killers
InsulinTaken by mainly bodybuilders, this is the most anabolic substance, period. It drives nutrients and hypersaturates your muscles, leading to unforeseen and amazing growth.
There is one catch If you mess up you die. The end, period, dead. That's right, if you mistime the dose or lack proper carbohydrate intake to offset the insulin surge throughout your body, you go hypoglycemic, go into a coma, then die.
Sure, many bodybuilders use this and don't die, but it only takes one mistake. Ever stub your toe on the bed? Yeah, it happens despite walking past the bed 556 times prior to the stub, but it happens.
On this end, if you accidentally stub your toe, or mis-measure and mistime your insulin once, you don't just sprain your toe, you die. Pretty messed up, right? All for what, 10 more pounds?
DiureticsTaken before a contest, this is a primary culprit.
In studies not involving prepping bodybuilders, who are even more at risk for negative health effects, they were more likely to die from hypertension issues.  Combine that with the health a prepping bodybuilder is in to begin with, you have the perfect storm.
And the perfect storm is
Blood pressureAlthough steroids and androgens have not directly caused any deaths, they do have deleterious effects on blood lipid profiles, cholesterol profiles and blood pressure. When you combine this with the dangers of diuretic use, you have a bad combination.
Unhealthy bodyfat levelsBeing contest lean isn't healthy, whether on drugs, natural or in any state. Your body is in survival mode and unable to withstand normal stressors, let alone the stress of drugs and diuretics.
StressThe stress of getting onstage is undeniable. This also plays a role in higher blood pressure and an unfavorable survival environment.
Who is to Blame?Honestly, the only one to blame is the person competing. Sure, the "prep guru" - aka the chemist - is the one who usually instructs this insanity, but it takes the person doing it to listen.
While we can blame judging for rewarding conditioning, in non-tested physique competitions, anything goes. We let dudes put oil, aka synthol, in their muscles, and it isn't even muscle! We allow calf implants Basically anything goes and you do whatever it takes to win.
Coaches are the ones doing it, yes. But let's be real, people are usually hiring ass clown fake-scientists with no background in medicine or even a basic certification in a crappy personal training program.
No hate, but what the heck is Hany Rambod's experience? He doesn't even look like he eats anything other than McDonald's yet he is responsible for "protocols" for the top athletes. He gets the job done, yes, but what makes him qualified?
So while he is at the top, has no real certifications after his name to speak of, imagine how crappy tier 2 is in the "guru" market?
Feed the InsanityAs long as we have physique competitions, we will have risks. As long as we have people who want to win and will take it to any level it takes, even diuretic and insulin abuse, we will have deaths.
So is there a cure to this madness?
There isn't, unless the athletes take it upon themselves to be responsible. There is no money in the sport, but the allure of being the best is worth dying for. Get used to it. Each year we see another major tragedy, but it won't be the last. Unfortunately, that's not a game.