Selective androgen receptor modulators (SARMs) are a class of drugs thought to have effects similar to anabolic steroids. Marketed via social media to youths and young adults via social media as a simple way to boost testosterone and muscle, these drugs can cause serious harms. The FDA has issued a caution about these products, noting SARMs are not dietary supplements, but actually unapproved drugs. Meanwhile, documented harms are accumulating in the medical literature. SARMs are yet another consequence of a weakly-regulated marketplace and unscrupulous vendors who see a business opportunity.
SARMs were developed as alternatives to anabolic steroids
SARMs are a group of compounds that influence the androgen receptors within the body. Androgens, such as testosterone and dihydrotestosterone (DHT), are hormones causing effects such as muscle development, bone density, and sexual desire and performance. Androgens require binding to specific receptors in the body to exert their effects. SARMs modify the responsiveness of androgen receptors in muscles and bones, increasing the action of testosterone and DHT. This may lead to accelerated muscle growth, reducing (but not eliminating) the work associated with bodybuilding and muscle building.
SARMs were developed with the idea of triggering anabolic steroid benefits, without expected negative side effects. Marketed as “legal” alternatives to steroids, SARMs have gained popularity despite lacking approval from regulatory bodies like the FDA. While many products have been synthesized and are called SARMs, none have been brought forward to market or been approved by the FDA, so far. While marketed as dietary supplements, they are actually unapproved drugs. The FDA has been vigorously pursuing those that sell these products, with recently-announced jail terms for vendors. There’s also been high profile suspensions from sport, such as Cleveland Cavaliers forward Tristan Thomas who violated NBA rules by taking a SARM named LGD-4033.
SARMs are not safe
While marketed at being safer, allowing one to avoid the well known harms of anabolic steroids, the FDA reports a list of possible side effects with SARMs:
- Increased risk of heart attack or stroke
- Psychosis/hallucinations
- Sleep disturbances
- Sexual dysfunction
- Liver injury and acute liver failure
- Infertility
- Pregnancy miscarriage
- Testicular shrinkage
Importantly, there is a lack of any long-term safety data with SARMs, so there is no information confirming the safety of SARMs, particularly in young adults, who have a lifetime ahead of them. A 2023 systematic review noted that SARMs have been associated with serious health risks such as drug-induced liver injury, rhabdomyolysis, tendon rupture, and adverse cardiovascular outcomes.
SARMs are being promoted on social media
In late 2023, the Center for Countering Digital Hate produced a report that identified that TikTok videos that promoted SARMS (sometimes directing users to sites where they could purchase the products) had been seen at least 587 million times in the US over three years – including 420 million views from users aged 18-24 years. Today, if you search for SARMS on TikTok, you won’t find anything – searches are not permitted. The same can’t be said for Instagram, where I found hundreds and hundreds of posts and video. Thanks Zuck!
Like other supplements, you cannot trust the label
I and others have discussed supplement quality at length in past posts. When it comes to SARMs, because they are not approved and therefore regulated, little can be inferred from the label. A 2017 paper looked at 44 products marketed via the internet. It found that only 52% of products actually contained SARMs, while 39% contained another unapproved drug. Only 41% had a quantity of SARM that matched the labelled amount. 25% of products contained undisclosed drugs. 9% did not contain an active substance.
Conclusion
I’ve written extensively about the dietary supplement industry. Among these products, sports supplements are perhaps the most likely products to be adulterated. Because there is no justification to market SARMs as dietary supplements, regulators like the FDA have been more aggressive in trying to limit their illegal sale. With the help of the social media giants, and despite their documented harms, SARMs continues to find a market.