Sure, health woes and a lengthy hospital stay will devastate one's physique, but still, a serious weight trainer (like, say, one who earns professional status in the world's leading bodybuilding federation) should retain a SEMBLANCE of a muscular build. If only in fundamental structure and muscle density.
In my over 30 years being involved intimately with muscle sports, it truly pains me to say, but, yeah, these "elite" bodybuilding twerps really are "all drugs".
The endless examples to prove this have become too much to deny.
I think the internet has been the biggest exposer of bodybuilding truths. The veil of mystique has been forever lifted.
Lift like any other college-age male and eat a relatively large amount of food (clean or semi-clean), but invest fully in a regime of anabolic drugs and hormones, and have a good response to said aids and a optimal natural skeletal/muscular structure, and you're 90 percent there to a pro card.
Just the way it is.
The greatest achievement is basically the sheer willingness/stupidity (take your pick) to risk it all with frightening drug/body abuse.