Situated within a framework of a globalized gym and fitness culture, this chapter aims to investigate and compare how fitness doping can be understood in relation to, and how it is affected by, different national and local contexts. Representing different forms of welfare state regimes, the comparative analysis focuses on policy, practice, and prevention in the United States and Sweden. The findings indicate, among other things, how national level policy and implementation reflect local priorities, understandings, and values. Sweden’s choices form a pattern that reflects the priority of protecting the common good over individual pursuits. Conversely, the US does not do any policing outside formally governed competitions in sports or in criminal contexts. Further, US bodybuilders do not feel targeted for their appearance in the same ways, illustrating the priority of individual choice. The chapter also discusses how each country implements anti-doping in ways consistent with global policies, but is also informed by various local understandings and values. This interplay between supranational structures and locally diverse implementation is not only complex, but can seem contradictory, as each locality remains partly within a global system of anti-doping in sport, and operates partly outside this context.