BEIRUT: The air inside Camille Chamoun Sports City Stadium is thick with the smell of sweat and body oil. A handful of men flex and pose onstage as the emcee shouts instructions over the roaring crowd.

Veins pop alarmingly as they grunt and strain with single-minded concentration. George, an ex-bodybuilder whose name has been changed to protect confidentiality, stands near the judge’s area at the annual Lebanese Bodybuilding Championship on Oct. 8. He studies the competitors intently.

“See that guy?” he whispers, pointing to a contestant who looks puny and underdeveloped next to the bulging bronzed giants on either side of him. “He doesn’t use steroids. It’s obvious. He just can’t compete.”

Performance-enhancing substances such as steroids and growth hormones are the elephant in the room at bodybuilding championships, gyms and playing fields across the globe. Many people take these substances, which are illegal in Lebanon and most countries, in order to achieve a variety of physiological effects including increased energy and rapid muscle growth. The most commonly used are anabolic steroids, which are usually injected into the bloodstream and mimic the effects of testosterone in the body, increasing protein synthesis in the muscles.

They also cause a variety of harmful or unpleasant side effects, according to Dr. Johnny Ibrahim, the official doctor of Lebanon’s national football team.

“Steroids develop the contractile muscles, including the heart,” he says. “The heart becomes bigger and then you can have hypertrophy of the heart. When you add the extra energy someone gets as a result of taking steroids, they can easily die from heart failure.”

“Other problems include hirsutism, or excess hair, heavy sweating and hormonal issues. You can also become impotent or infertile and some men develop increased breast size or psychological effects such as intense anger,” he says.

Ibrahim warns that the majority of these side effects are permanent: “The damage from steroids is irreversible.”

According to Jihad Haddad, medical secretary of the Lebanese Olympic Committee, steroids are fast becoming an epidemic in Lebanon.

“Anabolic steroids and growth hormone are a problem among bodybuilders, but also among athletes like rugby players and people just looking to improve their physique,” says Haddad.

Haddad, who administers tests that detect the presence of steroids in Lebanese Olympic contenders, says he has been seeing an increasing number of athletes test positive for these substances. “We did 169 tests, and we had about 10 percent positive results,” Haddad says.

According to George, easy access to these substances in Lebanon is partially to blame. “You can go to some pharmacies and get steroids,” he says. “It’s not difficult.”

Tarek Gherbal, athletic therapist at the American University of Beirut, says that although Lebanese pharmacies are making an attempt to more strictly regulate the sale of anabolic steroids, these substances are easily obtained over the black market.

“The problem is a growing black market trade,” says Gherbal.” The black market here is very developed, so the personal trainer at your gym … can get you substances that will give you immediate growth, without telling you any of the potential side effects or the harm it can do you.”

According to Gherbal, he has treated patients who have experienced some of these side effects and subsequently regretted their steroid use.

“A couple of patients I see in my clinic literally cry and say ‘I wish someone had told me that I would be facing this someday, I wouldn’t have shot a needle,’” he says.

George, who admits to having used steroids in the past, says that although he has never personally experienced any harmful side effects, he knows many bodybuilders who have.

“If you ask any heavy steroid user if they would go back and do it again, they’d say no,” he says.

George says that he started using steroids because he felt like he had reached the limit of what he could accomplish with training and exercise.

“I had reached my maximum natural potential,” he says. “I had been training for 10 years and I got to a certain level and I wanted to break that barrier.”

The competitive bodybuilding world is an environment in which steroid use is almost compulsory, according to George.

“If you’re a swimmer, taking steroids won’t improve your performance that much,” he says. “But as a bodybuilder, you take steroids to build muscle. The natural process of doing this is very slow and it has a limit. When you take steroids, it speeds up the process by five, six times … There’s no way you can compete without taking them.”

George says that while he understands why professional bodybuilders take steroids, he doesn’t think it’s worth the risk to someone just looking to become more muscular.

“If competition is your goal, you might want to take some risks,” he says. “But if you’re not even going to compete … why would you do it? It’s a huge price to pay.”

According to Ibrahim, the government has a responsibility to control the sale and use of performance-enhancing substances.

“There are a lot of people making money from this, and the problem is that the government isn’t taking care of it. These things are as dangerous as drugs,” he says.

Haddad says that steps are being taken to address the issue. A draft law that he helped to write was recently submitted to Parliament and is awaiting consideration. “Now we have introduced a law that will hopefully create a national anti-doping agency,” he says. “There will be regulations and anti-doping officers that collaborate with the police.”

Backstage at the bodybuilding competition, Noel Saliba, a muscular but proportional young man, looks cheerful despite his loss. Asked if he has ever used steroids, Saliba shakes his head emphatically. “No way,” he says, shooting a glance at one of his hulking fellow competitors. “The side effects are really bad, and I have a family.”

He smiles ruefully for a moment.

“But if I had taken them, I would have definitely won.”