The discussion around PED use has become impossible to ignore in modern combat sports and fitness culture.

During an appearance on the 2 Bears, 1 Cave podcast, Stanford neuroscientist Andrew Huberman discussed several physical characteristics he believes can sometimes be associated with testosterone replacement therapy and anabolic steroid use.

The conversation came up while discussing the Liver King controversy, and Huberman explained that although some people are simply genetic outliers, there are certain combinations of signs that may raise suspicion.

“There’s some telltale signs, okay, and you know, when people have a huge physique and they’re hypervascular, sure, there’s some possibility of a genetic () there.”

1. Changes in the Face

One of the first things Huberman pointed to was facial appearance.

He explained that increased testosterone can lead to higher estrogen levels in some people, which may contribute to water retention and changes in the face.

“One thing that you’ll notice is when people go on TRT, they’ll, these creases get deeper from some of the edema, the tissue retention that comes from the increase in estrogen associated.”

He then described the area around the nose and cheeks:

“You look at the creases between the nose and the cheeks, how deep those creases are, so almost like the cheeks are trying to crawl up on the nose.”

Of course, facial fullness by itself proves nothing. Genetics, age, hydration, body fat and many other factors can create a similar appearance.

2. Very Developed Delts and Traps

Huberman then moved to the shoulders and trapezius muscles.

These areas can respond strongly to androgen signaling, which is one reason they are often discussed when people speculate about PED use.

“There’s a lot of androgen receptor in the deltoids and traps.”

For BJJ athletes in particular, that needs to be viewed with caution. Grappling, wrestling and years of pulling, clinching and resistance training can naturally build large traps and shoulders.

So again, this is a possible indicator, not proof.

3. A Prominent Vessel on the Side of the Head

Another marker Huberman mentioned was a visibly bulging vessel along the side of the head, especially when someone has not just finished exercising.

“There’s the left side vein, or it’s a major artery, when somebody’s talking and they’re not having just finished some physical exercise, and they’ve got this left side vein kind of bulging out of the side.”

He connected this appearance with elevated blood pressure.

“That’s the elevation in blood pressure.”

Huberman added that, in his experience, this can appear frequently in people using high levels of testosterone or heavier performance-enhancing drug protocols.

“In almost everybody that’s on high levels of TRT or full-blown kind of s****** use.”

Visible blood vessels, however, cannot diagnose high blood pressure. Blood pressure has to be measured directly, and vascularity can also be affected by genetics, leanness, temperature and exertion.

4. Red or Ruddy Skin

Huberman also discussed a noticeably red or flushed complexion.

“There’s the ruddiness of the skin, people get a little bit red because of the increased blood flow.”

Testosterone and anabolic drug use can affect blood pressure and red blood cell production, which may contribute to this appearance in some users.

He also mentioned that some physique athletes use vasodilating medications before photoshoots to enhance muscle fullness and vascularity.

That can make the look even more dramatic.

5. Extreme Leanness and Vascularity

The fifth sign involved athletes who look exceptionally dry, lean and vascular.

Huberman linked this in some cases to the use of drugs designed to suppress estrogen.

He warned that taking estrogen too low can create its own problems.

“If your estrogen is pushed too low, as a male or female, your libido crashes.”

He then described the extreme bodybuilding look:

“So a lot of the bodybuilders that look like they’re wrapped in Saran wrap, ask them how they’re feeling. It’s not, you know, often not great, behind their libido.”

This is an important point because estrogen plays a significant role in male health as well. Crushing estrogen is not automatically beneficial simply because someone wants to appear leaner or drier.

Huberman Says PED Use Is More Common Than Many People Think

Huberman also pushed back on the idea that performance-enhancing drug use is rare among people with elite-level physiques.

He referred to Hollywood and professional sports, suggesting that pharmaceutical assistance is more widespread than the public may realize.

He said that some professional athletes have told him that testosterone use may even be permitted in specific injury situations.

“If you had an injury, you can take up to 200 milligrams of testosterone a week.”

The exact rules around testosterone vary significantly between sports, leagues and anti-doping organizations, so this should not be interpreted as a universal policy.

Still, his wider point was that performance enhancement exists far beyond professional bodybuilding.

Why This Matters in BJJ

For Brazilian Jiu-Jitsu, the subject is especially relevant.

PEDs can influence far more than appearance. They may affect recovery, training volume, strength, muscle retention and the ability to tolerate heavy workloads.

That matters in a sport where elite athletes may train multiple times a day and where recovery can become a major competitive advantage.

At the same time, nobody should be accused of using steroids simply because they have large traps, a red face or visible veins.

Those physical traits can occur naturally.

The only reliable way to establish prohibited PED use in competition is through proper testing.

The Bigger Issue Is Transparency

Huberman’s larger argument was really about honesty.

The concern is not simply that people use testosterone or other substances. The issue becomes more complicated when someone markets an extraordinary physique as entirely natural while selling supplements, training programs or lifestyle advice based on that image.

That can create unrealistic expectations for the public.

In combat sports, the same debate also extends to fairness.

If one athlete is natural while another is using performance-enhancing substances, the consequences can potentially affect not only physique but strength, endurance, recovery and competitive preparation.

That is why the PED debate in BJJ is unlikely to disappear anytime soon.

Huberman’s five markers are not a diagnostic test, and appearance alone should never be treated as proof.

But his comments highlight something that athletes and fans increasingly recognize:

The body can sometimes tell a story but only proper testing can tell you for sure.

What do you think: should professional BJJ introduce stricter PED testing, or should grappling remain largely untested?

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