Bodybuilders and Women Share a Common Problem

Massive bodybuilders and ordinary women — two completely different groups, yet they face the same challenge.

It’s hard to imagine two groups more different: massive, hairy, testosterone-fueled monsters whose weight plates no longer fit on the barbell, and regular women.

But unlike everyone else, these two groups are united by one big problem — let’s talk about it!

This Happens to Everyone​

In the first weeks of a training cycle, you feel great: full of strength and energy, ready to conquer new heights. But over time, month after month, year after year, you start to feel fatigue, a lack of energy, and worsening skin, hair, and nails. Hair may fall out, sleep quality deteriorates, and getting out of bed in the morning becomes harder. Frequent night trips to the bathroom and other issues arise. Most people blame age or training fatigue.

It’s believed that rest is enough to fix this — but in reality, most of these symptoms are caused by hypoxia or lack of oxygen in the cells. Over time, this weakens the body and can lead to serious, life-threatening diseases.

There are countless conditions that can arise from chronic tissue hypoxia, each with its own dominant symptoms:

For women, anxiety is often the first symptom, which can later develop into depression and severe panic attacks. Science has already proven:

• Chronic hypoxia or dysfunctional hypoxia adaptations can contribute to the pathogenesis of anxiety and depressive disorders. Harnessing controlled responses to hypoxia to increase cellular and psychological resilience emerges as a novel treatment strategy for these diseases. [1]
• Chronic hypoxia alters brain chemistry to increase vulnerability to depression. [2]
• This is especially important for women since about twice as many women experience depression compared to men. [3]

Skin, hair, and nail deterioration is often the first visible sign. Hypoxia can also affect reproductive function, because if the ovaries and cycle don’t get enough oxygen, they can’t function properly.

For men, symptoms may include:

• Snoring
• Shallow sleep
• Frequent nighttime bathroom trips
• Irritability instead of typical anxiety

Testosterone is also burned up in the fight against stress, leading to:

• Lower libido
• Erectile dysfunction

All of this points to oxygen deficiency in the body, and it’s crucial to find out why it’s happening.

How Hypoxia Works​

When hypoxia sets in, the brain lacks oxygen, and the body tries to compensate. It has two options:

• Increase heart rate
• Raise blood pressure

This speeds up blood circulation to compensate for low oxygen saturation.

This is why some people develop hypertension due to oxygen deficiency. Treating this with pills is pointless because the high blood pressure is just a symptom — your body is trying to improve oxygen delivery.

In bodybuilding, it’s common to take beta-blockers for high heart rates, which slows the heart down. But this literally kills your body by worsening hypoxia.

I’ll explain exactly what hypoxia is, why it happens, and — most importantly — how to fight it. Be sure to read to the end, where I’ll share practical solutions.

Do You Have Hypoxia?​

A common question:

“I checked my blood oxygen level, it’s 99%, so I don’t have hypoxia, right?”

Not necessarily.

99% oxygen saturation only shows that 99% of your hemoglobin is bound with oxygen. But it doesn’t tell you if there’s enough hemoglobin for all your cells, or if oxygen is reaching where it’s needed — your mitochondria, the power plants inside your cells responsible for producing energy.

You can’t assess cellular hypoxia from oxygen saturation or even an MRI.

The best way to detect hypoxia is by recognizing symptoms and getting a blood test.

Symptoms of Hypoxia​

• Resting heart rate has increased — for example, it used to be 60 bpm, now it’s 70-80 bpm. This may indicate a lack of oxygen in the brain, forcing the heart to compensate.
• Blood pressure has increased — if you had low pressure (90/60) and now it’s consistently around 120/80, this is also a sign your body is trying to compensate for hypoxia.
• Poor sleep quality — if you previously felt rested after 7-8 hours but now need 9-11 hours and still don’t feel refreshed, this could indicate hypoxia. Sleep becomes shallow, and proper recovery doesn’t occur.
• Snoring in young, lean people — this can also indicate hypoxia, as the body increases breathing intensity to absorb more oxygen.
• Frequent nighttime bathroom trips — if these are new, they may be due to oxygen deficiency. Bladder muscles lose endurance from lack of oxygen, making it harder to hold urine through the night.
• Increased anxiety, depression, frequent panic attacks, and irritability.
• Headaches, migraines, and poor recovery after workouts — if you used to recover in 2 days but now need 3-4 days, this could be a sign of hypoxia.
• Hair loss, dry skin, brittle nails — hair may begin falling out in clumps, and these are all signs of widespread oxygen deficiency affecting every cell in the body.

Main Causes of Hypoxia​

Many people mistakenly believe their hypoxia is caused by a deviated nasal septum, mouth breathing at night, or poor nasal airflow. There is even an entire industry built around gadgets that claim to solve these issues.



In reality, this is complete bullshit.

While certain conditions like tight trapezius muscles or spinal misalignment can reduce oxygen transport to the brain, about 70% of hypoxia cases are directly related to blood quality.

So let's talk about the 4 real main causes of hypoxia:​

1. Iron Deficiency

The first and primary cause of hypoxia is iron deficiency or disrupted iron metabolism. This is particularly relevant for women, who lose iron monthly due to menstruation. Even with a balanced diet, restoring iron levels can be incredibly difficult.

Men, despite having no regular blood loss and often following good diets with adequate physical activity, are not immune to iron deficiency either. Intense training, unhealthy habits like smoking or excessive alcohol consumption, and chronic conditions like stomach ulcers can all deplete iron stores.

To properly assess iron metabolism, a comprehensive blood test is required. It’s important to look beyond just hemoglobin and check:

• Hemoglobin levels
• Red blood cell count
• Hematocrit
• Red blood cell size and oxygen saturation
• Platelet count and size

Additionally, there are two particularly critical markers:

• Ferritin — the body’s long-term iron reserve, used when immediate supplies are low.
• Transferrin — the protein responsible for transporting iron in the bloodstream. This shows whether the iron present in your body is actually being delivered where it’s needed or just aimlessly circulating.

It’s important to stress that serum iron levels are almost useless for diagnosing real iron deficiency. They only reflect the iron currently in circulation, which fluctuates depending on what you’ve eaten, whether you’re stressed, or even what you’ve had to drink. Your body can temporarily mobilize iron in response to short-term needs, so serum iron tells you nothing about your long-term reserves or overall metabolic health.

1. Vitamin B Deficiency

The second major cause of hypoxia is B vitamin deficiency. These vitamins are water-soluble, which means they don’t accumulate in the body in sufficient quantities. We get them from food, they do their job, and then they’re quickly excreted.

With high physical and emotional stress, B vitamins are used up even faster, making deficiency a constant problem. It’s extremely difficult to maintain optimal levels through diet alone.

B9 (folate) and B12 are particularly important because they influence the size of red blood cells, which directly affects how efficiently oxygen is delivered to tissues. When there’s a shortage of B vitamins, red blood cells become oversized — and these larger cells have trouble squeezing through tiny capillaries to deliver oxygen where it’s needed.

B6 deficiency adds to the problem by slowing down liver function, which disrupts the interplay between iron, protein, and other essential factors that determine blood quality.

B1, B2, and B3 play a crucial role in energy production within mitochondria — the cellular power plants responsible for creating energy. Without enough of these vitamins, endurance and energy levels decline sharply.

It’s important to understand that simply checking B vitamin levels in blood is almost pointless. Most blood tests only show transport forms of B vitamins — numbers on paper that reflect how much is floating in your blood at the moment, without any indication of whether these vitamins are actually being delivered into cells and performing their vital functions.

Much more important than just seeing raw vitamin levels is understanding whether they actually work inside your cells. To do this, you need a complete blood count (CBC) to evaluate:

• MCV (mean corpuscular volume), which should ideally be around 89-90. Larger red blood cells often signal a B vitamin deficiency.
• Homocysteine, a byproduct linked to B vitamin metabolism. Optimal homocysteine is around 4.5-6.5. Elevated homocysteine is a direct sign of deficiencies in B6, B9, and B12.

Some labs now offer tests for active forms of B vitamins, but these tests remain controversial and aren’t yet universally accepted.

1. Protein Deficiency

The third cause of hypoxia is disrupted protein metabolism. Many people may not feel they have any protein deficiency at all, since they don't experience obvious symptoms, but in reality they simply don't eat enough protein to fully cover all the body's needs, but physically their body doesn’t have enough free protein available because most of it gets diverted to cover immune defense, muscle repair, and regeneration of skin, hair, and nails.

This constant protein redistribution reduces the liver's ability to function properly and worsens overall blood quality.

If the immune system is overloaded, the body simply doesn’t have enough resources to maintain healthy blood composition, and protein metabolism issues are no longer prioritized. It’s also important to remember that problems with digestion and absorption of protein are common and often go unnoticed.

Protein directly affects oxygen levels in the blood. Red blood cells that transport oxygen and carbon dioxide are made of protein. For iron to function properly, it needs a protein carrier — transferrin. Without enough transferrin, iron will not be absorbed or delivered where it’s needed. And to form a red blood cell, protein is absolutely essential.

To assess protein metabolism, you need to check the following blood markers. These indicators, taken together, will give you a complete picture:

• Total protein
• Albumin
• Urea
• Uric acid
• Creatinine
• ALT
• AST

Sometimes total protein can appear normal, for example, at 75-80 g/L, but this doesn’t mean protein is being used efficiently — for muscle growth, for example. Often, total protein is inflated due to immune proteins, meaning there’s not enough free, functional protein available for building red blood cells and maintaining overall health. Standard tests only show total protein, masking the fact that the body may be critically short on usable building blocks while overloaded with immune-response proteins.

1. Liver Dysfunction

The fourth cause of hypoxia is, of course, the liver. Sometimes you may have enough iron, protein, and B vitamins, but for various reasons, these substances don’t interact properly and fail to do their jobs. The liver plays a central role in this, performing numerous functions that can be broadly divided into two categories:

• Protein synthesis — producing the essential substances your body needs, including transferrin and albumin.
• Detoxification — metabolizing, neutralizing, and removing toxins from the body.

It’s important that these two functions — protein synthesis and detoxification — are balanced. However, in reality, the liver’s detoxification function often takes over, consuming 70-90% of the liver’s resources, leaving very little capacity for protein synthesis. When that happens, even if you technically have enough iron, protein, and vitamins, your body can’t use them properly, and key processes break down.

If this is the case, you need to figure out why the liver is so overloaded with detoxification work. There are several possible reasons:

• Chronic viral infections
• Toxic exposures (environmental pollutants, medications, alcohol)
• Food allergies — sometimes an ordinary product you eat daily forces the liver into constant emergency mode, trying to neutralize and remove it

To fully assess liver function, you need to run a comprehensive panel of tests:

• ALT
• AST
• GGT
• Alkaline phosphatase
• Total and direct bilirubin
• Albumin (which we already discussed in the context of protein metabolism)

Only by evaluating all these markers together you can get a complete picture of your liver’s condition and identify whether your liver is silently undermining your body’s ability to oxygenate, recover, and perform at its best.

Returning to the Title — So What Do Delicate Women and Brutal Gym-Goers Have in Common?​

Both women and men — especially those deep into bodybuilding — can face very similar issues with hypoxia and liver function, though the reasons behind them are often quite different.

For women, it’s often tied to regular blood loss, peculiarities of the digestive system, restrictive diets aimed at weight control, and a very common genetic mutation that we’ll talk about later. In most cases, women simply can’t get everything they need from food alone, so they end up relying on supplements.

For athletes, the situation is even more complicated — and here’s why:

• Hard training burns through both protein and B vitamins at an accelerated rate.
• Steroid use raises homocysteine levels, which increases the demand for B vitamins even further.
• Typical bodybuilding diets are built around chicken, fish, and pork, because beef — especially quality steaks — is just too expensive for regular consumption. The problem is, digesting massive amounts of protein puts a serious strain on the digestive system, and white meat is naturally low in iron and B vitamins.
• And here’s a key point: remember how at the very start of a steroid cycle, you feel amazing — full of energy and ready to conquer the world — but after a while, the fatigue starts creeping in? Let’s break down exactly why that happens.

Everyone knows that steroids increase hematocrit — the concentration of red blood cells in the blood. Some compounds, like Boldenone, significantly increase this marker, while others raise it more gradually. But here’s the catch — no steroid lowers hematocrit. Every single one boosts red blood cell production. Right behind Boldenone on that list is Testosterone, and let’s be honest — there’s no getting around testosterone in any cycle. Why testosterone must be in every cycle?

So, what’s actually happening inside your body during a steroid cycle? In those first weeks, more oxygen is flooding into your tissues, making you feel unstoppable. Red blood cells start being produced at an accelerated rate, and this process just keeps gaining momentum. But all that red blood cell production comes at a cost: your body starts burning through iron, B vitamins, and liver enzymes at a breakneck pace. Eventually, red blood cells start coming out misshapen and oversized, your blood thickens, and now it can’t squeeze through the narrowest capillaries to deliver oxygen where it’s needed most.

Your tissues might still be getting enough oxygen to survive, but it’s nowhere near enough for optimal performance — especially under heavy training loads.

The brain takes the hardest hit. It’s fed by an intricate web of tiny capillaries that simply can’t handle overly thick blood, especially if those red blood cells are irregularly shaped. The brain’s response is classic survival mode — it cranks up blood pressure, speeds up your heart rate, demands more nutrients (which is why some athletes crave sugar like crazy), and triggers symptoms like anxiety, irritability, depression, and sleep disturbances.

This is exactly why so many athletes on cycle show a bloodwork profile with high hemoglobin, low ferritin, and elevated homocysteine — a textbook sign of this process playing out.

This state tanks your quality of life and massively increases your cardiovascular risk. Athletes start feeling weak, apathetic, foggy-headed, depressed, irritable — with zero desire to train or do much of anything.

This hits women especially hard, along with high-level athletes carrying a lot of muscle who also rely on PEDs. For them, this pattern is incredibly common and demands attention — both in terms of training adjustments and nutritional support.

What Can You Do?​

First — add cardio. Regular cardio is one of the simplest and most effective ways to improve oxygen and carbon dioxide transport. Better oxygen delivery to your brain and muscles means better energy, clearer thinking, and fewer of those sluggish, foggy days.

Don’t forget about sleep. When you’re dealing with hypoxia, your sleep can stretch longer, but that doesn’t mean it’s high-quality. If you make sure your bedroom is cool and well-ventilated, it can seriously improve your sleep quality. And if things are really bad, there’s always the option of an oxygen mask at night — it might sound extreme, but plenty of heavyweight bodybuilders use it.

Bloodwork should become your routine. Keep an eye on inflammation markers, especially C-reactive protein (CRP) — you want it as close to the lower limit of normal as possible. And don’t ignore potential allergies, even if they seem minor. Lingering allergic reactions only fuel the hypoxia fire.

B vitamins are absolutely essential — there’s no way around it. If your body is short on even one of them, the entire metabolic chain can start to collapse. And let’s be real — most drugstore B-complexes are junk. They usually only contain B1, B6, and B12, which isn’t enough. You need the full spectrum: B1, B2, B3, B6, B9, and B12. Miss any one of these, and your metabolism will struggle.

Also, the form matters — a lot. If you’re part of the 70% of the population with some degree of folate cycle mutation, your body just can’t properly process some of the standard B vitamins. That’s why methylated forms are non-negotiable. They’re already active and ready for your cells to use.

Regular B vitamins in their standard forms often just circulate in the bloodstream, but never actually penetrating into cells or being properly absorbed where they’re needed. That’s why methylated B vitamins are absolutely worth the extra cost. They’re harder to find (you won’t see them on regular pharmacy shelves because they aren’t big money-makers), but if you care about your health, they’re worth tracking down.

And of course — the liver. This one deserves its own attention. Every case is different, so there’s no one-size-fits-all fix, so for now, the one thing I can confidently recommend to almost everyone is ro start every morning with a glass of hot water, and do the same before each meal. This simple habit helps your bile flow better, which in turn improves digestion and makes nutrient absorption much more efficient.

Want to take it further? Here are a few things that can seriously help:

• TUDCA — helps thin bile and prevent gallstones.
• Products containing liver-supporting complexes like milk thistle, cordyceps, and SAMe — these can literally help restore your liver and bring its enzyme systems back to balance.
• And of course, regular B vitamin intake is absolutely essential — whether you’re a woman with regular periods or a man whose life revolves around steroids and training, I consider it mandatory.

[1] https://www.sciencedirect.com/science/article/pii/S014976342200207X

[2] https://discovery.med.utah.edu/2018/chronic-hypoxia-exposure-worsens-depression/

[3] https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20047725