Looks Can Kill: A Doctor’s Journey through Steroids, Addiction and Online Fitness Culture

Looks Can Kill: A Doctor’s Journey through Steroids, Addiction and Online Fitness Culture by Riam Shammaa with Patricia Pearson addressed the dangerous steps men and women are willing to take in order to pursue their ideal fitness goals. Whether in pursuit of a heavily muscled physique for a bodybuilding show or a sinewy and taut body for a bikini competition, men and women are taking drastic measures to achieve the perfect look.

I was glad to read what the bodybuilding and fitness literature has always denied. Shammaa, a doctor with expertise in musculoskeletal and sports medicine, calls out all the competitors who enter these physique competitions as users and abusers of appearance-enhancing drugs (AED). We are not talking merely about performance-enhancing drugs like anabolic steroids, but the entire medicine chest of substances that physique competitors ingest or inject in order to strive for their impression of the perfect look, such as insulin, diuretics, human growth hormone and estrogen blockers.

Shammaa states it plainly: there is no way that anyone can achieve these kinds of physiques naturally. End of. Physique competitors in their quest for bodily perfection must take more and more drugs to offset the deleterious side effects of whatever pills or substances they’re taking. Without medical or pharmacological degrees, physique competitors are learning about these drugs on-line via “bro science” and are dosing themselves. Since they are likely obtaining their drugs illegally, they are taking even more chances with their health regarding what they are injecting or ingesting.

As one who follows the competitive bodybuilding scene I am aware of the winners of the major shows yet I am also aware of the overwhelming number of injuries and deaths that have occurred. If any other professional athletic association recorded so many deaths among its elite competitors, not only of retired champions but also among active members, there would be a tribunal to find out why. The elephant in the room is the pharmacological playground known as appearance-enhancing drugs. Yet nothing is done about it because without the AED, every physique association would be out of business and there would be no fitness industry.

One of the book’s contributors was not afraid to state the brutal truth: the only reason elite bodybuilders and physique competitors have managed to get on stage is solely on account of not having died yet. Those who win the top titles are the luckiest ones who have cheated death (so far). Imagine if anyone had said that about players in the World Series or the Super Bowl.

Shammaa addresses muscle dysmorphia, which refers to the distorted impression of oneself as less muscular than one actually is. He uses other street terms for this disorder, including megarexia, which I had never heard of before, yet did not include bigorexia, which is the most common term, at least in terms of Google hits. The rise of social media and photo sharing has led to the epidemic of perfect lives and perfect bodies, no doubt leading to the quest to be more muscular or leaner than others. Shammaa wrote:

“Bodybuilding and fitness competitions become a kind of breeding ground for muscle dysmorphia, because they hold you to–and indeed expect you to achieve–extremely unrealistic standards of what healthy musculature should look like.”


“Instagram is a powerful platform for reinforcing shame, as are Pornhub and other visual media sites.”

I sped through this book, not only because I was interested in the subject matter but also because of the way it was written. Shammaa discussed some anatomical and metabolic processes in language that made it easy for the layperson to understand. In fact, one remark I made early in my notes is that Shammaa tended to oversimplify things. I wondered who he was writing this book for.

Eating disorder specialist psychiatrist Dr. Leora Pinhas summed it up the best:

“If our aim was health, none of us would look like that.”

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