SARMs: The Illegal Supplements in Your Gym
Selective androgen receptor modulators (SARMs) were developed as drugs meant to build muscle with fewer steroid side effects, but none is approved by the FDA for any human use. In a 21-day trial of LGD-4033, testosterone fell and then returned to baseline after the drug was stopped. Published cases describe cholestatic liver injury after ligandrol and ostarine. The FDA warns that some bodybuilding products contain steroids or steroid-like substances linked to liver injury, heart attack, and stroke. A 2017 lab analysis of 44 products sold online as SARMs found that most were mislabeled. If you develop jaundice, dark urine, chest pain, or testicular shrinkage after using one, see a doctor and say what you took.
The Appeal and the Reality
SARMs were designed to switch on androgen receptors in muscle and bone while leaving the prostate and liver mostly alone. In theory, that means anabolic benefits without the worst side effects of testosterone and other synthetic androgens. In practice, the selectivity is incomplete. Recreational doses are far higher than what trials studied. Products are not pharmaceutical grade. And long-term safety data in healthy people barely exists, because no SARM ever completed FDA approval. The trials needed to prove safety were never done.
Documented Adverse Effects
Two published cases describe cholestatic liver injury after the SARMs ligandrol (LGD-4033) and ostarine (enobosarm) (Barbara 2020, PMID 32637435; Bedi 2021, PMID 34368386). Those reports do not show how often this pattern occurs. In a placebo-controlled trial, 76 healthy men took 0.1, 0.3, or 1.0 mg of LGD-4033 or placebo for 21 days. Total testosterone fell in a dose-dependent way and returned to baseline after the drug was stopped. Liver enzymes did not change in that short trial (Basaria 2013, PMID 22459616). The FDA’s consumer update on bodybuilding products, current as of September 2024, says some of these products contain steroids or steroid-like substances associated with serious liver injury, and that those substances have also been associated with heart attack, stroke, and testicular shrinkage. A 2017 analysis of 44 products sold online as SARMs found a SARM in 23 (52%). Another unapproved drug was found in 17 (39%). The amount on the label matched the lab result in 18 (41%) (Van Wagoner 2017, PMID 29183075). SARMs are unapproved drugs, so selling them as dietary supplements is illegal.
If You Have Used SARMs
If you develop yellowing of the eyes or skin (jaundice), dark or brown urine, severe fatigue, chest pain, shortness of breath, or testicular shrinkage, see a doctor and say what you took. The FDA lists those symptoms among the reasons to get medical advice after using a bodybuilding product that may contain a steroid or a steroid-like substance. A reasonable first work-up is liver enzymes (AST, ALT, alkaline phosphatase, bilirubin) and a hormone panel (testosterone, LH, FSH, estradiol). The 21-day LGD-4033 trial found that hormone levels returned to baseline after the drug was stopped. That single trial does not describe every case.
Sources
- U.S. Food and Drug Administration. “Caution: Bodybuilding Products Can Be Risky.” FDA consumer update, content current as of 20 September 2024. fda.gov
- Van Wagoner RM, Eichner A, Bhasin S, Deuster PA, Eichner D. “Chemical Composition and Labeling of Substances Marketed as Selective Androgen Receptor Modulators and Sold via the Internet.” JAMA, 2017;318(20):2004-2010. PMID 29183075.
- Basaria S, Collins L, Dillon EL, et al. “The safety, pharmacokinetics, and effects of LGD-4033, a novel nonsteroidal oral, selective androgen receptor modulator, in healthy young men.” J Gerontol A Biol Sci Med Sci, 2013;68(1):87-95. PMID 22459616.
- Barbara M, Dhingra S, Mindikoglu AL. “Ligandrol (LGD-4033)–Induced Liver Injury.” ACG Case Reports Journal, 2020. PMID 32637435.
- Bedi H, et al. “Drug-Induced Liver Injury From Enobosarm (Ostarine), a Selective Androgen Receptor Modulator.” ACG Case Reports Journal, 2021. PMID 34368386.
- Solomon ZJ, et al. “Selective Androgen Receptor Modulators: Current Knowledge and Clinical Applications.” Sexual Medicine Reviews, 2019. PMID 30503797.
Reviewed against 6 peer-reviewed and regulatory sources (safety-category rigor).