Muscle mass gain (bodybuilding self-use)
Self-prescribed glucocorticoids or other hormones for muscle gain in the fitness community. Based on confusion between glucocorticoids (prednisolone, dexamethasone) and anabolic-androgenic steroids (testosterone, nandrolone). Glucocorticoids produce the opposite effect: muscle catabolism, steroid myopathy, and weakness.
12 drugs
Also known as: Bodybuilding steroid use
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DBeta-alanineNot recommended · Non-essential beta-amino acid, carnosine precursor. Supplement with IOC 2018 proven efficacy for 1-4 minute anaerobic performanceBeta-alanine is sold in pre-workout formulas as a «muscle gain» product. Evidence in skeletal muscle hypertrophy is weak: Trexler 2017 (Amino Acids) meta-analysis showed no significant beta-alanine effect on lean body mass vs placebo with standard resistance training. Beta-alanine works on delaying muscle fatigue in 1–4 minute anaerobic exercise, not hypertrophy. For muscle gain IOC 2018 and ISSN 2015 list creatine monohydrate (3–5 g/day), adequate protein (1.6–2.2 g/kg body weight), progressive overload and caloric surplus.
- DBeta-hydroxy beta-methylbutyrate (HMB)Not recommended · Leucine metabolite, sport supplement and for sarcopenia. AEMPS does not register as medicineHMB is sold as a «muscle gain» product on the muscle proteolysis inhibition hypothesis. ISSN 2013 position stand recommended HMB 3 g/day for beginning resistance trainees and the elderly; in trained athletes hypertrophy effect is minimal. Sanchez-Martinez 2018 (Clin Nutr) systematic review showed no significant HMB effect on lean body mass in trained athletes. IOC consensus statement 2018 classified HMB as «evidence inconclusive» with potential benefit in resistance training beginners and sarcopenia in the elderly. For muscle gain IOC 2018 lists creatine monohydrate (3–5 g/day), adequate protein (1.6–2.2 g/kg), progressive overload and caloric surplus first-line; HMB is an additional option, not a substitute.
- DBetaine (trimethylglycine, TMG)Not recommended · Methyl donor; agent for the alternative homocysteine remethylation pathwayTMG is sold in sports nutrition shops as a «muscle mass» supplement. Most studies show lean mass gain comparable to placebo. NIH ODS states explicitly: data are conflicting, insufficient for recommendation. AEMPS has not approved the drug for this use. Evidence-based muscle gain rests on progressive overload, 1.6–2.2 g/kg protein and adequate sleep, not a TMG sachet in water.
- DL-arginineNot recommended · Conditionally essential amino acid, NO precursor. Sport and cardio-biohacking supplement. AEMPS does not register as medicineL-arginine is widely marketed to bodybuilders as a way to raise growth hormone and speed up muscle gain. Intravenous arginine does raise growth hormone, but oral doses do not reproduce this effect: the amounts needed for a meaningful hormone response tend to cause nausea and diarrhoea. Meta-analyses and systematic reviews find no gain in strength, endurance or muscle mass in trained people. In one trial, arginine taken before resistance exercise actually lowered the growth hormone rise compared with placebo. EFSA did not accept the claims linking L-arginine to muscle mass or physical performance.
- DL-ornithineNot recommended · Urea cycle amino acid, adjunct for hyperammonaemiaL-ornithine is marketed as a supplement that raises growth hormone and helps build muscle. A single large dose (around 170 mg per kg of body weight) can briefly raise blood growth hormone and IGF-1, but the rise is short-lived and does not translate into real gains in muscle size or strength. Controlled trials and sports-nutrition reviews have not shown an ergogenic effect in people who train. The European authority EFSA has not approved any claim that L-ornithine benefits muscle or physical performance, and a shift in a single hormone marker does not substantiate such a claim. For gaining muscle, resistance training and adequate protein intake are the reliable approach, not L-ornithine.
- FD-aspartic acid (DAA)Not recommended · D-enantiomer of aspartic acid, sport and biohacking supplement. AEMPS does not register as medicineDAA is sold in pre-workout formulas and «testosterone boosters» as a muscle gain product on the hormone-mediated hypertrophy hypothesis. No evidence base: Willoughby 2013 and Melville 2017 RCTs in trained men showed no clinically meaningful DAA effect on lean body mass and strength. For muscle gain IOC 2018 and ISSN 2015 list creatine monohydrate (3–5 g/day), adequate protein (1.6–2.2 g/kg), progressive overload and caloric surplus; DAA is not in the IOC-approved sports supplement list.
- FInsulinNot recommended · Insulins and analogues (general card; individual products require separate cards)Insulin is used illicitly by bodybuilders for mass gain based on its anabolic effect via IGF-1-like action and stimulation of muscle amino-acid uptake. The effect on mass is small and the risk of fatal hypoglycaemia is high. Cases of hypoglycaemic coma and sudden death in healthy bodybuilders are reported. Hypoglycaemia is recognised late – during training or sleep. WADA lists insulin as prohibited. Using insulin in a healthy person with normal beta-cell function is Russian roulette with several rounds in the cylinder.
- FInsulin aspartNot recommended · Rapid-acting insulin analogueIn gym regimens rapid insulin is injected after training together with carbohydrates, on the idea of driving glucose and amino acids into muscle. No regulator has approved that use, there are no studies of muscle gain in people without diabetes, and in someone with intact insulin secretion the gap between a working and a dangerous dose is minimal. Aspart starts within 10–20 minutes and peaks in the first hours: hypoglycaemia comes fast and unfolds during the workout or in sleep. Cases with seizures, coma and irreversible brain damage in healthy men are documented. Eating carbohydrates does not insure against it – absorption cannot keep pace with the injection. If insulin has been recommended for muscle growth, consider seeking a second opinion from an endocrinologist.
- FInsulin glargineNot recommended · Long-acting insulin analogueIn gym regimens insulin glargine is used as a background between shots of rapid insulin, on the expectation of an anabolic effect and amino acid transport into muscle. No regulator has approved that use in Spain or Russia, and there are no clinical studies of muscle gain in people without diabetes. The danger is not theoretical: in a person without diabetes an eyeballed dose drops glucose hours after the injection, and the long action of glargine stretches hypoglycaemia across the night and the second half of the day. Severe hypoglycaemia in athletes has ended in seizures, coma and death. Loading with sugar does not protect: the glucose rise is shorter than the drug's action. If insulin has been suggested for building mass, consider seeking a second opinion from an endocrinologist.
- FPrednisoloneNot recommended · GlucocorticoidsPrednisolone for muscle gain reflects a fitness-community confusion between glucocorticoids and anabolic-androgenic steroids. These are entirely different drug classes. Glucocorticoids (prednisolone, dexamethasone, hydrocortisone) act on muscle catabolically: they break down muscle protein, induce steroid myopathy, and cause weakness predominantly in proximal groups. Anabolic muscle action belongs to testosterone, nandrolone, and other AAS – separate drugs with their own risks. Prednisolone for «bulking» produces the opposite: loss of muscle strength, fat mass gain, and Cushingoid fat redistribution.
- FSalbutamol (Albuterol)Not recommended · Short-acting beta-2 adrenergic agonists (SABA)Bodybuilders take Salbutamol expecting an anabolic beta-2 agonist effect. Controlled human trials do find a weak, sex-dependent anabolic signal: some studies report increased myofibrillar protein synthesis and small lean-mass gain. The effect splits by sex. Women show body recomposition, men show no lean-mass gain, and in neither case does it amount to clinically meaningful muscle gain for bodybuilding. Salbutamol also lowers VO2max and reduces quadriceps strength in women. Its acute effect is limited to anaerobic power, with no gain in maximal strength. No international guideline recommends Salbutamol for muscle gain in healthy people. WADA bans oral Salbutamol, and high doses carry a risk of arrhythmia and sudden death.
- FTribulus terrestris (puncture vine)Not recommended · Plant «testosterone booster» and aphrodisiac of Bulgarian folk medicine, supplement. AEMPS does not register as medicineTribulus is sold in pre-workout formulas and «testosterone boosters» as a muscle gain product. No evidence base: no quality RCTs with lean body mass and strength endpoints. For muscle gain IOC 2018 and ISSN 2015 list creatine monohydrate (3–5 g/day), adequate protein (1.6–2.2 g/kg), progressive overload and caloric surplus; tribulus is not in the IOC-approved sports supplement list.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit