Additional Risk Factors
    Surprisingly few bodybuilders suffer or die from tumors. Reports appear in the literature of liver tumors associated with AAS use, though most involve patients being treated for kidney disease or other conditions. Bodybuilders shouldn’t feel a false sense of security though, as liver tumors have been reported in this group.18 Further, liver damage is a common side effect of most oral AAS.19 Liver damage almost certainly contributed to Munzer’s death, as he died from uncontrolled bleeding. The liver produces many of the clotting proteins necessary to stop blood loss.

    The excessive use of growth hormone (GH), insulin-like growth factor-1 (IGF-1) and other exotic growth factors is almost certain to lead to the development of a malignant cancer eventually.20,21 The anemia drug erythropoietin (Procrit, etc.) has been linked to an increased rate of cancer in patients suffering from anemia. Erythropoietin is used extensively by competitive cyclists, runners and other endurance athletes.20 In addition to promoting tumor growth, GH also interferes with blood sugar control. Some bodybuilders use extremely high doses of GH, which interferes with insulin’s function by elevating fatty acid levels in the blood, risking the onset of severe insulin resistance or even frank diabetes.22

    Low doses of GH, sufficient to induce moderate fat release from stored body fat, are believed to be relatively safe, but in the polypharmaceutical environment of bodybuilding, even 4 IU to 8 IU per day, has been associated with the onset of a diabetic state (see reported stack in side note).23 It should be noted that not everyone responds to GH in the same way. Some people have a vigorous IGF-1 response, while others don’t see much increase in IGF-1 levels. Those who don’t have a corresponding increase in IGF-1 appear to be at greater risk of certain GH-relatedside effects.24