Gabriel Ganley, a 22-year-old Brazilian bodybuilder and fitness influencer with 1.7 million followers, was found dead in his São Paulo apartment on May 23, 2026. He had spent the previous months preparing for Musclecontest Brasil while following a hormonal protocol he had started about a year before his death. During an interview with the Flow Podcast, Ganley openly admitted that he believed his actions would shorten his life by ten or fifteen years and that making such a decision at his age felt strange. Nevertheless, he continued.

Ganley initially gained a following by defending natural bodybuilding, and his audience grew because he seemed to represent proof that a naturally fit body could be enough. Ultimately, even he could not sustain that argument within his ecosystem.

The following day, Las Vegas hosted the Enhanced Games, a sporting competition where performance-enhancing substances are not only permitted, but also celebrated as the event’s foundation.

Medicines without a prescription

What the performance culture does not clearly advertise is that the substances at the centre of this debate are not supplements. Anabolic-androgenic steroids are synthetic derivatives of testosterone that have been developed and approved to treat specific medical conditions, such as hypogonadism, delayed puberty, and muscle-wasting conditions associated with cancer, HIV, and other chronic illnesses. In these contexts, they are administered in carefully controlled doses and accompanied by regular monitoring of cardiovascular markers, lipid profiles, haematocrit, and hepatic function.

Athletes competing in the Enhanced Games use these same substances under medical supervision and with ongoing clinical oversight. However, most users of these substances follow generic protocols found online or recommendations from individuals with no technical background.

This distinction is rarely communicated to the public and matters enormously.

Outside of this supervised context, these same compounds are used at doses reaching 10–50 times their therapeutic levels without monitoring or any of the safeguards that justify their legitimate use. The consequences are well-documented and severe. Chronic exposure to supraphysiological levels of anabolic-androgenic steroids is associated with hypertension, adverse lipid profiles, atherosclerosis, cardiomyopathy, and sudden cardiac death (the cited cause of Gabriel Ganley’s death).

Cases of fulminant myocardial infarction have been documented in young bodybuilders, with extensive coronary lesions identified at autopsy. Beyond the cardiovascular system, the misuse of these substances has been linked to hepatotoxicity, endocrine disruption, and psychiatric disorders, including aggression and depression. Dependence can also develop, with withdrawal symptoms that can persist long after cessation.

These are not rare side effects. Rather, they are the expected pharmacological consequences of using prescription-level compounds at non-clinical doses without clinical oversight.

The problem with the growing number of influencers who use and advocate for anabolic steroids, as well as events like the Enhanced Games, is that the cultural message they broadcast travels far beyond the supervised context in which it was produced. The young man watching at home does not understand the medical protocol or the risks. He absorbs the idea that it’s okay.

The infrastructure of inadequacy

This idea is being amplified on social media to an extraordinary degree. A 2025 study published in Body Image analysed data from 1,553 boys and men in Canada and the United States. The study found strong positive associations between viewing muscularity-oriented content on social media and probable muscle dysmorphia. This is a subtype of body dysmorphic disorder characterised by the persistent belief that one’s body is insufficiently muscular, regardless of its actual condition. These associations remained significant even when controlling for total time spent on social media, indicating that the type of content, rather than screen time alone, was the driving factor.

A 2023 report by the Center for Countering Digital Hate revealed that TikTok videos promoting steroid-like drugs received up to 587 million views in the United States over three years, 420 million of which came from users aged 18–24. The influencers in those videos routinely downplay health risks, direct followers to vendors through affiliate links, and present prescription-level pharmacology as a natural extension of fitness culture. Young men consuming this content are rarely informed about the conditions these substances were developed to treat, the monitoring required for their clinical use, or the documented consequences of unsupervised use at supraphysiological doses.

The collapse of body acceptance that drives the demand for these substances is not incidental to this system. It is what the system sells first because a person who believes their body is already enough has no reason to buy anything.

What needs to change

Muscle dysmorphia is significantly underdiagnosed. Part of the reason is that those experiencing it rarely appear visibly unwell. Another reason is the cultural normalisation of extreme fitness. They appear dedicated and successful, as the surrounding culture has trained them to do.

Additionally, clinical frameworks for body dysmorphic disorder were not designed with the culture of fitness influencers in mind, where health is a monetized product and prescription medicines are marketed as lifestyle choices. The target audience isn’t informed about what those medicines were originally designed to treat or the risks associated with taking them without proper safeguards.

On a podcast, Ganley said that he was knowingly shortening his life and that he would do it anyway. He was 22 years old, aware of the pharmacological reality, yet the surrounding culture had made that choice seem reasonable. This is not an individual judgment failure. It is a public health failure, and the field of mental health is uniquely positioned to address it.