The stage lights were hotter than I expected.
I stood backstage at the National Physique Committee men’s physique competition, oiled and jittery, wearing board shorts that felt simultaneously too small and somehow exactly right for the moment. The air smelled like spray tan, metal, and the sweet chemical sharpness of pre‑workout drifting off the guys pumping up with resistance bands. Around me, men half my age stretched their lats, practiced quarter turns, and checked their abs in a smudged mirror. They moved with the loose, easy confidence of people who had done this a dozen times. I was 45 years old, a board‑certified internist, the founder of a functional medicine practice, and a man who had spent two decades telling other people how to take care of their bodies.
Under those lights, it hit me: I was far from my exam room, and I was not the expert here.
When I tell colleagues or patients that I competed in a bodybuilding show at 45, the assumption almost always lands in the same place. Midlife crisis, they joke. Ego. Chasing youth. I understand the reflex. A middle‑aged physician, tanned and flexing on stage, fits neatly into a familiar stereotype. The truth was less dramatic and more uncomfortable: I had reached a point where the gap between what I asked of my patients and what I demanded of myself had become too wide to ignore.
For years, I watched people struggle with their bodies from the other side of the clipboard. I prescribed medications, ordered labs, adjusted thyroid doses and testosterone levels. I coached on sleep hygiene and stress reduction. I tweaked diets with a mix of physiology and motivational interviewing that I was proud of. I knew the literature on sarcopenia and metabolic syndrome. I could sketch out a periodized training plan on the back of a progress note.
But there was a safe distance baked into all of it. At the end of the day, I could step out of the room, grab something quick from the break room, stay up too late finishing notes, and my own body rarely entered the conversation. I believed in lifestyle change in the way most clinicians do — strongly, but abstractly.
So I decided to close the distance.
I hired a coach. I started training six days a week before sunrise, in a gym so empty I could hear the plates clank on the bar from across the room. My heart would be pounding before most of my patients’ alarms had gone off. I ate from plastic containers between patients — chicken that tasted like the inside of the Tupperware, rice measured by the gram, vegetables so plain they blurred into texture more than flavor. At 9 p.m., when I used to be answering emails or finishing charts, I turned off the lights and went to bed.
I learned what it meant to wake up hungry and still eat exactly what was on the plan, not what I wanted. I learned how loud the vending machine in the staff lounge can sound when you’re deep into a calorie deficit. I learned what it's like to brush your teeth at night so you won’t be tempted to eat anything else. Most of all, I learned what my patients mean when they say, “I’ve been trying for months, and I feel like nothing is happening.”
The physiology of midlife is not news to an internist. After 40, testosterone drifts down. Muscle protein synthesis slows. Recovery stretches out. One short night of sleep can wreck an entire week of training. I had read all of that in journals. It's different when you are the one whose legs feel like concrete two days after a heavy squat session, whose resting heart rate spikes on the wearable after a week of poor sleep, whose progress photos stall despite doing everything “right.”
That friction — between effort and delayed payoff — is where most of my patients live. In acute care, action is the currency. You do something, and often you see something change within hours or days.
Prep for a bodybuilding show operates on a different clock. You can stack perfect days — training done, macros hit, sleep on point — and wake up to the exact same body staring back at you. There is no stat lab to reassure you. No CT to confirm a diagnosis. Just the mirror, the scale, and a decision: Do I keep going when nothing appears to be happening?
Show day arrived like a long‑scheduled procedure. I shaved, tanned, ate my carefully planned rice and protein. Backstage, the pump‑up room felt like a strange fusion of locker room and OR holding area: men pacing, stretching, checking their numbers; a low buzz of nerves under forced small talk. When my class was called, I walked toward the stage with my number pinned slightly crooked to my shorts, the tan already starting to itch.
The lights were blinding. I couldn’t see faces, just a wall of brightness and the blur of movement in the front rows. I hit the poses my coach had drilled into me in a small studio weeks before: front stance, quarter turn, quarter turn, abs tight, back wide, smile that didn’t feel natural but somehow held. My left calf started to tremble and refused to stop. Sweat gathered at the small of my back. Somewhere in the haze I heard someone whistle, and for a split second my brain went completely blank. Then it was over. We filed off, lined up, returned for comparisons. In the end, I placed in my class. The trophy is a small thing — plastic and metal, a figure frozen in a flex — but it sits on a shelf in my office for a reason.
The real shift didn’t happen on that stage. It happened in the exam room after: I noticed I was listening differently.
When a patient told me, “I’ve been doing everything for three months and I don’t see a change,” I didn’t immediately reach for a new lab or a different medication. I asked what those three months had actually looked like. I asked about the near‑misses: the days they almost skipped the gym, the nights they almost gave in to takeout, the times they slid but came back anyway. I recognized the slump in their shoulders, the tightness in their voice, because I had felt it walking past my own pantry.
I noticed my advice had shifted too. I still talk about protein intake and progressive overload, about sleep and stress and hormones. But now, when I say, “There will be weeks when the data doesn’t move, and you’ll have to keep going anyway,” I am not quoting a study. I am remembering the Tuesday I almost quit because the scale was up two pounds after a flawless week. And I noticed, unexpectedly, that my patients responded differently.
Some had seen the competition photos. Others had heard about it through the casual grapevine that runs through any clinic. They would look at the picture on my phone, then at me in the chair, and I could see something recalibrate. When I suggested early morning workouts, they didn’t roll their eyes. When I said, “Let’s give this six months,” they nodded in a way they hadn’t before. The authority in my words wasn’t abstract; it had been earned in a gym, before sunrise, with no witnesses and no shortcuts.
A colleague asked me recently, genuinely, “Why bodybuilding? Why put yourself through that?” I told him that for most of my career, I had been an expert on the human body from a safe, comfortable distance. I could interpret labs, adjust meds, and talk about lifestyle from behind a desk. What I couldn’t do — until I stood on that stage — was inhabit the same slow, frustrating, unglamorous process I was asking of my patients.
Medicine trains us to act, to fix, to know. It does not always train us to be students of our own biology. I don’t think every physician needs to step on a bodybuilding stage. But I do think there is something powerful in becoming, even briefly, a patient of the same demands we place on the people we serve.
When patients hear about the competition, they still ask the same question: “How did you do it?” I tell them the truth, which is simpler and less heroic than they expect: You do it the way any hard thing gets done. One early morning when no one is watching. Then another. And another. Most days, there are no lights and no trophies — just a body that changes slower than you’d like and a choice to keep showing up anyway.
