This is just my theory on what's caused Ronnie's full-body atrophy, limb by limb. Again, I'm not privy to his non-public medical issues or his current HRT or AAS use (other than being positive he uses one or the other).
1) He has nerve damage LOCALLY in muscles that were injured. That would mean his left quad, left tricep, and left lat. They happened at different times and only became slowly noticeable in 2004. In TCOR, he mention a sore shoulder and a sore elbow. Supposedly after the 2006 Olympia, he admitted having arthritis in one of them.
2) He lifted heavier weight in general than most other IFBB pros. Not like in the videos. But enough to stress the joints after 25 years of doing it. Probably he has some residual tendon damage that's reduced his ROM to the point where he can't squeeze the muscle at the top like he used to in his prime (eg. doing 21s with cambered bar curls).
3) Obviously, he's used gradually higher doses of anabolic and growth agents, probably slin too, and his receptors are shot. They just don't respond to the meds anymore. Steroids are technically medication. If you use Aleve every day for 20 years, you think it'll work anymore? You'll get to 5 pills and even then it won't put the pain away.
4) He has or had a tackle box designed exclusively for legal supplements. In the 2007 video (taped the previous summer), he admitted using two different cholesterol pills and liver/kidney tablets. As far as I can remember, some were prescription. He's had health problems for a while.
5) As was mentioned, he had a spinal injury related to herniated discs in his lower back, possibly from heavy deads. That probably played a role.
6) He's freaking 49! Shit shrinks/falls apart at that age if you went to the extremes he did. The other guys that were big at his age like Vince Taylor or Strydom never came close to his freakiness.