SARMs: The Illegal Supplements in Your Gym
Selective androgen receptor modulators (SARMs) were developed as drugs meant to deliver the muscle-building effects of steroids with fewer side effects, but none is FDA-approved for any human use and they are sold illegally as “research chemicals” or “not for human consumption” to dodge drug law. The promised muscle-selectivity is incomplete, gym doses far exceed anything trials studied, and the products are not pharmaceutical grade — FDA testing repeatedly finds them mislabeled or spiked with SARMs not on the label at all. The documented harms are serious: drug-induced liver injury (cholestatic injury is the most common pattern), severe testosterone suppression, and ischemic strokes and cardiac events reported in young athletes, which is why the FDA issued consumer warnings in 2017 and 2021. If you have used a SARM and develop jaundice, dark urine, a racing heart, testicular shrinkage, or major mood changes, see a doctor promptly and tell them what you took — recovery of normal hormone production can take months.
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
Published case reports and case series describe SARM-related drug-induced liver injury (DILI), severe hypogonadism with testosterone suppression that sometimes requires medical treatment, ischemic stroke in young athletes, and cardiac events including myocarditis (Flores 2020 PMID 33134761; Barbara 2020 PMID 32754621; Bedi 2021 PMID 34239744). A 2023 review in Therapeutic Advances in Drug Safety summarized the published literature and found cholestatic liver injury was the single most common pattern reported (Hilkens 2023 PMID 38028932). The FDA issued consumer warnings against SARMs in body-building products in October 2017 and again in 2021, citing risks of liver toxicity, heart attack, and stroke (FDA 2017; FDA 2021). FDA enforcement actions and product testing have repeatedly found SARMs in products labeled only as “workout” or “testosterone support,” sometimes at concentrations far above any studied dose, and sometimes containing SARMs not listed on the label at all (Van Wagoner 2017 PMID 28114673). Selling SARMs in human dietary supplements is illegal under the Dietary Supplement Health and Education Act (DSHEA), because SARMs are unapproved drugs, not dietary ingredients. The federal SARMs Control Act — reintroduced most recently in 2024 — would explicitly schedule SARMs as controlled substances if enacted.
If You Have Used SARMs
If you develop yellowing of the eyes or skin (jaundice), dark urine, severe fatigue, racing heart, testicular shrinkage, or major mood changes, see a doctor right away. Tell them you used a SARM — many clinicians have not seen these cases and will not ask. A reasonable first work-up is liver enzymes (AST, ALT, alkaline phosphatase, bilirubin), a lipid panel, and a full hormone panel (testosterone, LH, FSH, estradiol). Recovery of the hypothalamic-pituitary-gonadal axis after SARM use can take months and sometimes does not fully return to baseline.
Sources
- U.S. Food and Drug Administration. “FDA In Brief: FDA warns against using SARMs in body-building products.” FDA, October 31, 2017 (reaffirmed 2021). fda.gov
- U.S. Food and Drug Administration. “Public Notification: Multiple products tainted with SARMs.” FDA Tainted Products list, ongoing updates 2017–2024.
- Ganesan K, et al. “Selective Androgen Receptor Modulators (SARMs).” StatPearls / NCBI Bookshelf, updated 2024. PMID NBK557960.
- Flores JE, et al. “Drug-Induced Liver Injury Associated with Selective Androgen Receptor Modulators Use.” ACG Case Reports Journal, 2020. PMID 33134761.
- Barbara M, Dhingra S, Mindikoglu AL. “Ligandrol (LGD-4033)–Induced Liver Injury.” ACG Case Reports Journal, 2020. PMID 32754621.
- Bedi H, et al. “Drug-Induced Liver Injury From Enobosarm (Ostarine), a Selective Androgen Receptor Modulator.” ACG Case Reports Journal, 2021. PMID 34239744.
- Hilkens NA, et al. “Selective Androgen Receptor Modulators (SARMs) and Drug-Induced Liver Injury: A Narrative Review.” Therapeutic Advances in Drug Safety, 2023. PMID 38028932.
- Van Wagoner RM, et al. “Chemical Composition and Labeling of Substances Marketed as SARMs and Sold via the Internet.” JAMA, 2017;318(20):2004-2010. PMID 29183076.
- Solomon ZJ, et al. “Selective Androgen Receptor Modulators: Current Knowledge and Clinical Applications.” Sexual Medicine Reviews, 2019. PMID 30502023.
Reviewed against 9 peer-reviewed and regulatory sources (safety-category rigor).