What to Know About Taking Bodybuilding Supplements

Hardcore supplements are kind of like the X-rated movies of 1990s video stores—you'll mostly find them in back corners. On their labels, shirtless men pose between big block letters promising “performance,” “drive,” and “muscle.” Some show pictures of three-headed dogs… if you’re into that sort of thing. And of course, they go by the moniker “hardcore.” It’s clear they are for people who long ago graduated from creatine.

As far as supplements go, though, “hardcore” is really more of an umbrella term than an actual type of supplement. The term refers to any supplement that’s intended to increase levels of anabolic, or tissue-building, hormones—usually in men, says Kelly Pritchett, assistant professor of nutrition and exercise science at Central Washington University.

The focus of most hardcore supplements is increasing testosterone or human growth hormone, two hormones that play a major role in muscle-building. “I have seen claims like, ‘a legal alternative to steroids,’” she says. Testosterone has also gained a lot of attention in the past few years as a way to improve sexual stamina and performance.

“As far as these supplements are concerned, everyone has low testosterone,” says Mark Moyad, director of preventive and alternative medicine at the University of Michigan and author of The Supplement Handbook. “They have these quizzes, ‘Do you feel grumpy today?’ ‘Have you had trouble staying awake in the last week?’ Hell, who hasn’t?”

Each type of hardcore supplement has its own unique purpose and list of ingredients. The most prevalent type—called testosterone boosters—are (you guessed it!) supposed to raise testosterone levels. Some list proprietary blends as their active ingredients, which means there is no real way to know what you’re taking, Pritchett says. For example, Nugenix’s Testosterone Booster lists “Nugenix Free Testosterone Complex” as an active ingredient and Force Factor's Test X180 Ignite includes "Manliness Ignition Matrix" and "Fat Incineration Complex." Other products claim that their benefits are due to an array of vitamins, minerals, and herbal ingredients like Tribulus terrestris and tongkat ali.

Similarly, prohormones promise to increase testosterone and/or human growth hormone levels, but claim to do so even more directly. The idea is that you take prohormones and then, depending on which one you take, they convert in the body into the desired hormone. For example, many prohormone supplements contain metabolic byproducts of dehydroepiandrosterone (DHEA). DHEA is a hormone that helps the body produce other hormones, including testosterone, Moyad explains.

Other hardcore supplements include cycle support and post-cycle therapy supplements that claim to help the body restore hormone production after taking prohormone supplements. Because, as Moyad notes, when your body gets all of the hormones it needs from outside sources, it sees no reason to produce its own. So testosterone production stops, and that’s when testicles shrivel up. Some companies say that cycling also reduces the chances of liver toxicity from taking prohormones. With cycling, people basically take the hormone-boosting supplements in short phases to try to max out the muscle gains while minimizing the long-term damage, he says.

Some companies also sell estrogen-blockers meant to blunt the conversion of testosterone into estrogen because, yes, the body does naturally convert some of its T into E to promote bone health. It’s not altogether uncommon for guys to try to jack up their testosterone levels only to sprout man boobs. That’s where estrogen-blockers come in.

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Lastly, some companies sell SARMs, aka selective androgen receptor modulators, under the hardcore bracket, saying they mimic the effects of testosterone—but without all of the side effects that can make cycling and estrogen-blockers necessary. Most experts we contacted, however, were skeptical of their efficacy.

“It’s just nonsense,” says Mark Molitch, professor of endocrinology at the Northwestern University Feinberg School of Medicine. “None that I have seen raise testosterone or growth hormone. It’s all marketing.” To take one example, a Journal of Ethnopharmacology study concluded that the popular testosterone-booster ingredient Tribulus terrestris doesn’t actually increase testosterone production in young men.

Further, no independent and peer-reviewed research exists to prove that any other hardcore supplements work, Moyad says. “I would love, as much as anyone, for there to be a pill that would do all of the things these supplements claim,” he says. “But there’s nothing showing that they actually do.”

Michael J. DiMaggio, general counsel and chief legal officer with Nutrabolt, the company behind Cellulor P6 Ultimate testosterone booster, says that while many of the company’s supplements have been studied through a grant with Texas A&M University, those products have not included hormone-altering ones. “Nutrabolt has not conducted studies on ‘hormone levels,’” he says.

It's one thing if these supplements don't work, Moyad says, but legality and safety issues are entirely more concerning.

“All you have to do is look at the pharma side of things to understand the risks,” he explains. “You look at testosterone-increasing drugs that are trying to get FDA approval, and they are getting rejected. Trials are finding that they increase heart rate and blood pressure and lower good cholesterol—and this is in people who qualify to take these pills. This isn’t in people who have normal testosterone to begin with and are taking unproven supplements without a doctor’s supervision." (Of course, this is in drug formulations that have actually been proven to increase testosterone levels; again, hardcore supplements haven't.)

Testosterone boosters might not be routinely given to guys in labs, but some of the individual ingredients are. “During the product-development process, we evaluated the evidence of safety, efficacy, and legal compliance of all the ingredients, including the testosterone support ingredients before we chose to include them in the formula,” DiMaggio says. “Our evaluation included a review of all available literature and published clinical studies, including the ingredients' effects on testosterone levels in healthy adult men.”

However, Moyad notes that ingredients can act very differently in the body when taken in isolation than they do when combined with dozens of others in supplement form.

Meanwhile, in 2017, the Food and Drug Administration warned consumers against the potential side effects of supplements containing SARMs. “Body-building products that contain selective androgen receptor modulators, or SARMs, have not been approved by the FDA and are associated with serious safety concerns, including potential to increase the risk of heart attack or stroke and life threatening reactions like liver damage,” it reads. While SARMs are advertised as supplements, the FDA statement explains that they are actually drugs—and unapproved ones at that.

“SARMs are not legal ingredients for dietary supplements,” adds the US Anti-Doping Agency, noting that SARMs are prohibited by World Anti-Doping Agency regulations. “Athletes should be aware that SARMs ingredients could be listed on dietary supplement product labels under various names, and should be cautious when consuming such products.”

That goes for other hardcore supplements like prohormones and testosterone-boosters, too. After all, while the 2004 Anabolic Steroid Control Act classifies 59 specific substances as anabolic steroids and Schedule III controlled substances that cannot legally be obtained without a prescription, a lot of companies include ingredients that teeter on the line of legality. For example, the act lists 5[alpha]-androstan-3,17-dione as anabolic steroids that you cannot get without a prescription. However, 2a 3a-epithio-17a-methyl-5a-androstan-17b-Ol is sold online in some prohormone hardcore supplements. Even if you know nothing about chemistry, you’ve probably noticed “androstan” in both. “Many supplement ingredients look similar to illegal ingredients because they are similar,” Moyad says. And that’s when the label contains what a product actually says it does. According to a 2017 study published in JAMA, 39 percent of the SARMs-containing supplements contain unapproved drugs such as banned growth hormones or steroids. The contents of more than half of the supplements studied didn’t match their labels. That makes knowing the legality and safety of any hardcore supplements you take incredibly tricky, Pritchett says. If you're absolutely determined to take them, Pritchett recommends looking on websites of third-party organizations such as NSF International, Informed Choice, or USP to make sure that any supplements you’re considering contain what they say they do, and nothing else. “Unfortunately, these certifications are typically only associated with products marketed to athletes, as each lot is required to undergo additional testing for substances prohibited by sports organizations,” DiMaggio says. Our ‘Sport’ line, for instance, is certified by a third-party testing organization.” If you’re an athlete, you should also check with a program like NSF International’s Certified for Sport to make sure that the supplement and its ingredients won’t bar you from competition. To be even more thorough, you can call up the supplement company, Moyad says. “Ask, ‘Can you send me the full-text study of this specific product tested in humans?’” he advises. “I’m not talking about a product with similar ingredients, I’m talking about that exact product.” Then, if you decide to go forward with any supplement, it’s important to treat any hardcore supplements like a “clinical trial for one,” Moyad says. He recommends having a full physical, including blood pressure, cholesterol, and liver enzyme levels taken prior to starting any supplements. Then, after two to three months, retest to see if and how those numbers have changed. Any worsening of levels is reason enough to stop the supplements right away.

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