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 found that the majority of athletes would eagerly accept the deal. It become known as "Goldman's Dilemma."Would you accept this deal? Many competitive bodybuilders and even non-competitive lifters have.Champion bodybuilders are known only to the relatively-small community who follow this fringe sport. So you have to wonder why so many seem eager to risk their lives and health for success.Is it for money? Fame? Or do they roll the dice just to build more muscle and drop more fat than the next guy?Gross abuse of anabolic steroids (AAS), growth hormone, insulin, and diuretics are some of the major factors believed to be responsible for a disproportionate number of lean and muscular corpses.In a sport that, at its core, requires eating well, losing fat, and exercising, why do we see so many bodybuilders dying from similar causes at unusually-young ages? "Most guys think nothing bad will ever happen to them. But you watch. You'll be seeing more and more serious heart problems, and worse, once these guys hit 40."– Mike Matarazzo, pro bodybuilderMatarazzo had triple-bypass open heart surgery at 38, a heart attack at 41, and died at age 47 while waiting for a heart transplant.He was at his competitive peak in his early-30s, when "mass monsters" dominated bodybuilding, and he claimed to eat up to seven pounds of red meat per day at his biggest.But in the years prior to his drastic physical decline, Matarazzo was one of the few pros who talked openly about what he felt was the underlying cause – the level of anabolic steroids and related drugs necessary to become a top-ranked pro.Matarazzo's public callout of the negative effects of drug use may sound far fetched to some, but there's anecdotal and scientific evidence to support his belief.It's an undeniable fact that numerous top-level bodybuilders have died from some variation of "natural causes" – often a heart attack or some form of organ failure – before they hit 40 years old.A handful never even saw 35. Some top pros almost reach 50, but even less get to 55 without a major health scare. Try to find a dozen healthy IFBB pros who successfully competed in the '90s. You won't have much luck.When a bodybuilder dies at an early age from organ-related failure, this is the kneejerk response you'll hear from bodybuilding fans:"He had a preexisting condition and would've had that same problem whether he was a bodybuilder or a school teacher!"But the big question is, are preexisting conditions made worse by excessive drug use? And would these competitors have lived much longer without using them?Or is it the heavy use of these drugs combined with the rigors of bulking and cutting for multiple contests that eventually leads to health issues?There certainly may be cases where underlying natural causes were a key factor in a death, but it seems to be a common and unfortunate go-to excuse whenever a physique athlete dies.Bodybuilding began to separate from physical fitness in the 1950s. Building muscle gradually became a greater goal than athleticism, strength, and power. The fact that anabolic steroids were finding their way into gyms in the 1960s was no coincidence.Achieving lower body fat with a higher body weight meant packing on more muscle. And the more that look was rewarded, the more competitors pursued it. Health became an afterthought.It may be more accurate to say steroids don't kill people, steroids kills people. It's probably even more true that other bodybuilding-related drugs bring higher risks than anabolic steroids.Insulin, HGH, and various diuretics supposedly gained traction in the '90s, and they tend to have a greater risk-to-reward ratio. In the early '90s, bodybuilding saw a significant shift in "the ideal" physique.Dorian Yates set a new standard and his contemporaries tried to follow suit as the sport was introduced to the term "mass monster," describing never-before-seen massive bodyweights and the same deep definition that comes with extremely low body fat.The long term results of the era are what we've been seeing over the past couple decades: consequences that are catching up with more and more bodybuilders as reports of health issues – from mild to fatal – have appeared.No, not every pro has had issues. And it's not always the biggest guys or only the top-ranking pros who struggle, but their drug use is consistent enough to draw some conclusions. A 2014 study looked into a connection between anabolic steroids and cardiovascular function. The results suggest that heavy steroid users are more likely to have irregular heart function and a higher mortality rate compared to natural lifters.A 2012 report from the reviewed nearly 50 different studies looking at the effects of anabolic steroids and cardiovascular/metabolic function. It came to a similar conclusion: Steroid use can be a valid and significant factor in heart-related death.Another study in the looked into the prevalence of kidney disease among steroid-using bodybuilders over two years and found signs of disease in the majority of lifters, some of it irreversible and irreparable.Unlike bodybuilding, the deaths of other professional athletes aren't as strongly linked to performance enhancing drugs. Physical wear and tear such as collisions in contact sports or recreational drug use are said to be greater contributing factors.Performance enhancing drugs (PEDs) is the term the public associates with anabolic steroids, even though it's a general category that can include anything from insulin to EPO, a blood "doping" endurance booster, and various non-steroid stimulants.We know that PEDs are widespread in professional sports like baseball, football soccer, and MMA. But even non-traditional sports like cricket, NASCAR, cycling, and pro-wrestling "entertainment" sports have all made headlines with various reports of PED use.Professional athletes seeking every possible advantage and recovery method shouldn't surprise us, even when it's directly prohibited by their sport's rules and the law.In 2014, the Public Library of Science published a report investigating the mortality rate among active pro wrestlers. Data was collected from 1985 to 2011 and demonstrated that wrestlers were three to four times more likely than the general population to die between 30 and 50 years old.Cardiovascular disease and drug overdose were found to cause an overwhelming majority of the deaths, with wrestlers being 15 times more likely to experience a cardiovascular-related death and a shocking 122 times more likely to die from drugs compared to non-athletes.In the last 15 years, roughly one in five wrestler deaths were connected to recreational drug overdose.A 2012 study in the investigated mortality rates among NFL players and actually saw that they were, overall, almost half as likely to die as comparably-aged non-athletes.Though the football players were, not surprisingly, associated with significantly higher rates of neurological and musculoskeletal disease.Thirty years ago, the average non-professional athlete was uninterested in using steroids. But today, if you walk into most weight rooms you're likely to be standing around a handful of AAS users, whether they look the part or not.A quick browse online will show you tons of recreational lifters discussing plans for their first, second, third, or fourth steroid cycle. These guys aren't trying to earn a paycheck with their muscle, nor are they trying to win any contests. They're just average lifters wanting to look better.With steroids, there's , there's , and there's , and they're very different things.Those who misuse AAS are those who'd get results from healthy eating and lifting. Those who abuse AAS are the ones stacking eight compounds a week like they think their 290-pound idol does. The latter are the lifters who generally end up as statistics. In the 1960s, publisher Peary Rader wrote an editorial to address the issue of steroids in bodybuilding and to warn readers not to get involved with the drugs.In the 50+ years since his article, plenty of bodybuilders have misused or abused steroids and other PEDs and have paid the ultimate price:These bodybuilders are thankfully still alive at the time of this writing, but have suffered major health issues.