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Noah Thomas' tattooed biceps are almost 18 inches around, to hear him tell it. His is full of advice for other weight lifters on how to build muscle. In at least one video, he demonstrates .

In another, Thomas talks about a side effect of having too much testosterone: high estrogen levels. Too much of this "female" hormone could lead to a host of well-known problems among bodybuilders -- gynecomastia, low sex drive.

But Thomas -- whom we couldn't reach for comment -- has a plan for fixing that.

"I heard Arimidex is useful," . "I don't think I'm going to get any support from my endocrinologist. ... I do think my psychiatrist might be willing to get that for me."

Arimidex, also known by its chemical name anastrozole, is an aromatase inhibitor -- a breast cancer drug. While steroids and growth hormone make headlines when athletes abuse them, breast cancer drugs are a lesser-known staple of doping regimens, for athletes and "weekend warriors" alike. Star therapies of the breast oncology world -- like tamoxifen (Nolvadex) and exemestane (Aromasin) -- provide an easy, non-injectable means of cutting estrogen's unwanted side effects.

And bodybuilders are packing other little-known pharmaceuticals into their routines -- some of which, like ghrelin mimetics and selective androgen receptor modulators (SARMs), are still under investigation in clinical trials and are not available on any regulated market.

Demand for Breast Cancer Drugs

Weightlifters don't seem to have a preference for either class of anti-estrogens. There are the selective estrogen receptor modulators (SERMs) like tamoxifen, or the aromatase inhibitors like anastrozole. Both classes mitigate the effects of estrogen, which is metabolized from testosterone. When testosterone levels are high, estrogen levels also tend to increase as a natural byproduct.

"All they do is block estrogen," Fred Rowlett, president of the , said of the nonchalant attitude weight lifters have about taking cancer drugs. "When you don't have estrogen, you gain nothing but muscle."

Rowlett's organization champions drug-free bodybuilding, and prescription anti-estrogens are on the group's , modeled on that of the . These breast cancer drugs are also on the prohibited performance-enhancing drugs lists from the and the .

Abuse of breast cancer drugs isn't limited to top athletes. "Weekend warriors" and enthusiastic gym-goers are driving demand, as . There are no data on how widely used anti-estrogens are in this community, but Rowlett says it's common practice.

Given that they're prescription drugs, the obvious question is how bodybuilders are getting their hands on them.

Rowlett says family practice physicians tend to write the scripts directly to those who are working out. There is also the potential for doctor shopping if one clinician refuses, as Thomas pointed out in his video.

And, of course, there's an underground market that anyone with Internet access can peruse. On its homepage, for under $40. Anti-Estrogens.com is a bit pricier, at .

It's unclear if the products are diverted, or if they're synthesized in a homegrown lab, à la Breaking Bad. Some may simply be scams to obtain credit card information, a common problem that many of the sites denounce and attempt to reassure potential buyers with customer service hot lines and other security measures.

A spokesperson for AstraZeneca, which makes Nolvadex and Arimidex, told 番茄社区app that diversion and counterfeiting of its products for this purpose "isn't something we're aware of." Pfizer, maker of Aromasin, didn't comment on whether they were aware of the diversion or counterfeiting of the drug.

Then there are the specialized supplements -- which don't require a prescription -- that claim to target estrogen and aromatase, readily and other sites. But like the rest of the unregulated supplement industry, there's no guarantee that these bottles contain what's on their labels.

Hungry for the Hunger Hormone

Researchers have been interested in ghrelin, called the hunger hormone for its ability to spark appetite, as a potential target for obesity treatment, but it's had more practical application in wasting disease. Ghrelin mimetics, such as GHRP6 and GHRP2, are still only in clinical trials, and none are commercially available on any market anywhere in the world.

They're readily for sale, however, on a vast amount of websites, along with other growth-hormone-releasing peptides such as ipamorelin and hexarelin. Ghrelin mimetics' potent stimulation of growth hormone secretion is the reason it's valued in muscle-building circles.

The hormones are all blatantly listed on sites like and , side-by-side with anabolic steroids and other performance-enhancing drugs. Some purport to be selling their peptides to scientists, but at the same time they tout "discreet shipping."

, of Baylor College of Medicine, who has been involved in studies of ghrelin mimetics, told 番茄社区app that scientists would never acquire their active drugs that way.

"You would never go to a site like this because there is no quality control so you never know if these products are contaminated or if they contain what they're supposed to," Garcia said. "Not even for animal experiments."

It's likely that these drugs are being made in underground labs, he added.

The same goes for nonsteroidal selective androgen receptor modulators (SARMs), which are also . A Google search of where to buy one of the most popular ones, enobosarm (Ostarine is the proposed trade name), returns plenty of results. As with ghrelin mimetics, most of the sites claim their products are for research purposes only and aren't intended for human consumption.

What's Regulated?

Since steroids make the Drug Enforcement Agency's list of controlled substances, inventive entrepreneurs have tried to get around legal issues by making supplements, prohormones, and designer steroids. There's much overlap between these categories, with prohormones being hormone precursors that can amplify the effect of existing hormones, while designer steroids are typically anabolic drugs that were never marketed for medicinal purposes.

Companies that produce these agents have been linked to top athletes, like Barry Bonds and BALCO, and, more recently, Biogenesis and several top baseball players including Alex Rodriguez and Ryan Braun.

Every now and then the FDA also cracks down on these agents -- typically after adverse event reports, as was the case with . A 28-year-old in North Carolina developed liver failure after weeks of using the product, which the FDA said contained at least one synthetic anabolic steroid.

Federal prosecutors have also gone after distributors of these supplements, with Bodybuilding.com -- the "largest Internet retailer of supplements in the world," according to a Department of Justice press release -- .

The feds had behind them the , which updated the earlier Anabolic Steroid Control Act in order to bring these supplements under the umbrella of illegal steroids.

But anti-estrogens, ghrelin mimetics, and SARMs aren't included in any of that regulation, and they're not on the controlled substances list.

Joseph Moses, a spokesperson for the DEA, told 番茄社区app that even though these drugs aren't controlled substances, they could be used in prosecution.

"If we seized them when we seized steroids that are controlled, we could bring them into court as evidence that the individual intended to use those substances or, if it's on a bulk level, to distribute them," Moses said.

Doctors who help weightlifters to obtain steroids via prescription can get in trouble with the law for illegal distribution, as was the case for a Pittsburgh Steelers doctor who so they could get their drugs. He was also charged with healthcare fraud -- which covered the drugs prescribed to combat the side effects of steroid use.

Guidelines from both the and The state that testosterone therapy should be limited to men with testosterone deficiency. The American Academy of Family Physicians also has a .

"Our policy is very clear," , president of the AAFP, told 番茄社区app. "We don't think anything should be prescribed for enhancing athletic performance," including prescription drugs that work against estrogen, he said.

"All of these medicines," he said, "should only be used for their intended medical purposes."

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