Why professional wrestlers are more likely to die young

Pro wrestlers from the 1980s and 1990s are dying young — and there's a medical reason why

Published March 14, 2021 10:00AM (EDT)

Wrestling fighters Jack Swagger (L) and Rey Misterio (R) fight during the WWE Smackdown Wrestling (Alfredo Lopez/Jam Media/LatinContent via Getty Images)
Wrestling fighters Jack Swagger (L) and Rey Misterio (R) fight during the WWE Smackdown Wrestling (Alfredo Lopez/Jam Media/LatinContent via Getty Images)

Long before the decades-long storylines and godlike battles of the Marvel Cinematic Universe, professional wrestling fulfilled the role of mythical stage play for mass culture. Yet unlike Hollywood actors, who have the benefit of special effects and stunt doubles to limit their exertion, pro wrestlers' bodies suffer a severe physical toll for their career. Indeed, statistics show that wrestlers are far more likely to die young compared to their counterparts in other entertainment fields.

Why is this? The answer is a mix of medical reasons related to the sport, and ancillary reasons related to the lifestyle. Indeed, causes of death for wrestlers tend to center around suicide, drug overdose, or heart attacks. Concussions or traumatic brain injury are also commonplace.

Some of the psychological toll on wrestlers stems from the nature of life on the road. After the adoring crowd leaves the arena, wrestlers may find themselves sitting alone in a quiet hotel room, the third or fourth one of the week. Then, there's the effects of the rollercoaster of celebrity: as with many famous people, drugs are often a substitute for the feelings of adoration and esteem that have long since passed.

But medically speaking, pro wrestlers have one major condition in common that often shortens their lives. It is at the center of the Venn diagram, the face beneath the cloak of the Grim Reaper. It is anabolic steroids.

Steroids, synthetic hormones that promote muscle growth, are near-ubiquitous among wrestlers, who use them to enhance both strength and physical appearance. In high school health class, many of us were treated to the stereotypes of anabolic stereoid usage — say, a a football player eager to be a star who turns to the needle, only to become a victim of "roid rage," his face broken out with acne, his testicles shrunk.

While scientific evidence and popular media have often linked anabolic steroids to so-called 'roid rage, it is actually one of the least common side effects of anabolic steroid abuse. More common (but less dramatic) side effects include cardiovascular disease and an enlarged heart. In a 2017 Massachusetts General study published in the American Heart Association's journal Circulation, researchers used imaging tests to compare the hearts of anabolic steroid users to non-users. Echochardiograms showed that the steroid users had significantly weaker hearts than those who had never used steroids. And among the steroid users, the men that were current anabolic steroids users had significantly worse heart function than those who had stopped using steroids. The authors also found that steroid users had significantly more plaque build-up in their arteries than non-users. The longer the men reported taking steroids, the worse their arteries were.

A similar 2019 study by the European Society of Cardiology also found steroid users suffered from thickened heart walls and decreased ejection fractions, meaning less blood was being pumped out to the brain, the body, and back to the heart itself.

Even as far back as 2014, a study published by Eastern Michigan University determined that nearly 40% of premature deaths of professional wrestlers were from cardiovascular disease. This number did not include deaths from drug overdose.

That means that at baseline, wrestlers abusing steroids to look good for the cameras are laying a foundation for early-onset cardiovascular disease. Add in the potential for cocaine use associated with a rock-star lifestyle on tour over 300 days a year, and it's a perfect recipe for a fatal heart attack. That's because cocaine causes the heart to beat faster and blood pressure to rise. At the same time, it constricts the blood vessels that supply the muscles of the heart. As a result, the muscle cells of the heart begin to weaken and die. If those vessels are already beginning to clog from steroid use, it doesn't take much to disrupt their blood flow.

There are psychological repercussions from steroids, too. Indeed, documented side effects or associations of anabolic steroid abuse include depression and mania. These mood disorders can have compounding effects on the previously described issues of cardiac disease. The emotional instability of steroid users may lead to drug abuse; that can mean cocaine-induced heart attacks in an already diseased heart, or mania from chronic marijuana use.

Depression or mania alone, even without drug abuse, can result in suicide. These mood disorders may be further exacerbated by brain injury secondary to repeated concussions. A recent 2019 study in rats also showed that mild traumatic brain injury can be worsened when concurrent anabolic steroid use is suddenly stopped. "Neuroendocrine whiplash" is how the authors described it — and it particularly affects the amygdala, an area of the brain associated with emotional regulation.

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Because of ethical dilemmas, longitudinal scientific research studies on steroid use have not been completed. As a result, those who began using steroids in the 1980s and 1990s and have continued to use them are just now entering their fifties and sixties. As a result, we don't fully know what is in store for them. Long-term cardiovascular disease, or even endocrine effects like cancer from uncontrolled testosterone and estrogen, may just be beginning to rear their ugly heads.

Charles Yesalis, a well-known steroid expert, tried three times to get funding for a long-term study into steroid use, and three times was denied. After the third strike, the Professor Emeritus at Pennsylvania State University quit trying. Yesalis previously defined "'roid rage" as "spontaneous violent behavior of [a] magnitude that the law becomes involved." Yet despite documented increased in aggression from testosterone and anabolic steroids, particularly in animal models, humans have social conditioning such that we are often able to rein in the heightened aggression that stems from steroid abuse — at least in public.

Yesalis also cautions that definitive connections are hard to make since, in his research, steroid users are also prone to drug and alcohol use. In this sense, it can be hard to separate the health effects of the different substances in this witch's brew.

The tragedy of so many wrestlers is partly an economic one: they are the victim of a larger media machine, the corporations and big businesses that profit off their physiques and indirectly their steroid usage. The tragedy of wrestlers hasn't become a mainstream political conversation: over the years there have been glimpses of lawsuits and congressional hearings, but the topics at hand are generally  competitive fairness or legality, not discussions of science or steroid usage.

This story is not unique to wrestling, and not all wrestlers fall into this trap; but unfortunately, professional wrestling seems to have a subjective death rate higher than other sports. Watch an old pro wrestling match from the 1980s or 1990s, and there's a high chance that many of the athletes are dead; the same is not true for football or baseball games of the same era.

By Jonathan Gelber

Jonathan Gelber, MD, is a surgeon and specialist in sports medicine. He is the author of "Tiger Woods’s Back and Tommy John’s Elbow: Injuries and Tragedies That Transformed Careers, Sports, and Society." Follow him on Twitter at @JonathanGelber.

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