SARMs (Selective Androgen Receptor Modulators)

Selective Androgen Receptor Modulators (SARMs) are a class of experimental drugs that selectively activate the androgen receptor (AR) in certain tissues (like muscle and bone) while minimizing activity in others (such as the prostate or skin). en.wikipedia.org. They were developed to provide the muscle- and bone-building benefits of anabolic steroids with fewer off-target side effects usada.orgpmc.ncbi.nlm.nih.gov. SARMs are small molecules (often non-steroidal) that can act as AR agonists in some tissues and partial agonists or antagonists in others, thus “modulating” the receptor’s activity in a tissue-selective manner. Originally inspired by the success of selective estrogen receptor modulators (SERMs) like tamoxifen, SARMs emerged in the late 1990s as a promising new category of anabolic agents. Over the past two decades, research into SARMs has expanded, exploring their potential to treat conditions such as muscle wasting (cachexia), osteoporosis, hypogonadism, and even certain cancers pmc.ncbi.nlm.nih.goven.wikipedia.org.

However, alongside legitimate research, SARMs have gained notoriety in the fitness and bodybuilding world as “legal steroid alternatives,” leading to widespread off-label use despite the lack of regulatory approval. This review provides a detailed, A-to-Z examination of SARMs – from their scientific mechanisms and types, to medical applications, illicit use in sports, safety and side effects, legal status around the world, and future directions. The goal is to offer a structured, comprehensive overview based on up-to-date scientific and regulatory information. Key points are organized into sections with clear headings, and tables are included to summarize SARM compounds and global regulatory statuses for quick reference. All information is drawn from reliable sources, including peer-reviewed studies, regulatory agency reports, and clinical trial data.

Scientific Background and Mechanisms of Action

Androgen receptors are nuclear hormone receptors that, when activated by natural androgens (testosterone or dihydrotestosterone), regulate gene expression to produce various physiological effects. These effects are broadly categorized as anabolic (e.g., increased muscle mass, bone density, red blood cell production) or androgenic (e.g. male sexual development, prostate growth, body hair growth) pmc.ncbi.nlm.nih.gov. Traditional anabolic steroids (synthetic androgens) are non-selective – they activate AR in many tissues roughly equally, which means while they build muscle, they also cause undesirable androgenic side effects (acne, prostate enlargement, virilization, etc.)pmc. ncbi.nlm.nih.gov. SARMs were designed to decouple these effects by binding the AR in a way that stimulates anabolic pathways in muscle and bone but has minimal impact on other tissues.

Figure: Mechanism of SARM action. SARMs (yellow triangle) bind to the androgen receptor (AR) in the cytoplasm, causing the AR to dissociate from heat-shock proteins (HSP) and translocate into the nucleus. In the nucleus, the SARM–AR complex binds to androgen response elements (ARE) on DNA and recruits co-regulator proteins, altering gene transcriptionpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. The specific conformational change induced by a given SARM can influence which co-regulators bind, thereby producing tissue-selective effects. In essence, different SARM molecules induce unique AR shapes and cofactor interactions, enabling partial agonism – strong activation in target tissues like muscle, but weak or antagonistic action in tissues like the prostatepmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. This selective AR modulation is analogous to how SERMs (e.g. tamoxifen) can block estrogen’s effects in breast tissue while stimulating estrogen receptors in bonepmc.ncbi.nlm.nih.gov.

Key Mechanistic Features of SARMs include:

• Tissue Selectivity: SARMs exploit subtle differences in AR co-regulator expression and DNA response elements between tissuespmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. For example, a given SARM–AR complex might strongly drive muscle protein genes but only weakly activate prostate genes. One experimental SARM (TSAA-291) showed equal muscle AR activation as dihydrotestosterone (DHT) but only ~50% of DHT’s activation in prostate cellspmc.ncbi.nlm.nih.gov, due to differences in cofactor recruitmentpmc.ncbi.nlm.nih.gov. This property is the crux of SARMs’ appeal – the ability to maximize anabolic effects (muscle, bone) while minimizing androgenic effects in other tissuesen.wikipedia.org.
• Partial Agonist/Antagonist Behavior: Unlike testosterone which is a full agonist everywhere, SARMs can act as partial agonists or even antagonists depending on the tissue. In muscle and bone (where anabolic effects are desired), most SARMs act as agonists to increase protein synthesis and bone formationpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. In androgen-sensitive tissues (like prostate or sebaceous glands), the same SARM may behave as a weaker agonist or competitive antagonist, thus avoiding excessive stimulationpmc.ncbi.nlm.nih.gov. This selective profile is sometimes described as “agonist in muscle, antagonist in prostate.” In practice, complete separation of anabolic and androgenic effects is difficult – most SARMs still have some androgenic activity at higher dosesen.wikipedia.orgen.wikipedia.org – but it is significantly reduced compared to anabolic steroidsen.wikipedia.org.
• Non-Steroidal Structure: Many SARMs are non-steroidal molecules (often based on an aryl propionamide scaffold) which means they are not substrates for 5α-reductase or aromatase enzymesen.wikipedia.org. Consequently, SARMs do not convert to dihydrotestosterone or estrogenic metabolitesen.wikipedia.orgen.wikipedia.org. This eliminates side effects like estrogen-mediated gynecomastia and DHT-related hair loss that are seen with testosterone or certain steroidal drugsen.wikipedia.orgen.wikipedia.org. (Note: A few SARMs, such as YK-11, have steroidal structures, but these are exceptions and less studied).
• Oral Bioavailability: SARMs were designed for oral administration and many have good oral bioavailabilitypmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. This is a practical advantage over testosterone (which often requires injections or transdermal delivery). Being orally active makes SARMs convenient and also avoids issues like injection site reactions or accidental hormone transfer that occur with topical testosterone gelspmc.ncbi.nlm.nih.gov.

In summary, SARMs leverage nuanced molecular biology to selectively stimulate AR-driven anabolism. This mechanistic innovation underlies their potential as safer anabolic therapies. The next sections delve into the specific SARM compounds developed, their effects, and how these mechanistic promises translate into real-world outcomes.

Different Types of SARMs and Their Specific Effects

Several SARM compounds have been developed or are under investigation. While they share a common mechanism (AR modulation), individual SARMs differ in potency, tissue selectivity, and pharmacokinetics. Below we highlight some of the prominent SARMs and their known effects (see Table 1 for summary):

• Ostarine (Enobosarm, GTx-024, MK-2866): The most clinically advanced SARM, originally developed by GTx Inc. Ostarine selectively targets muscle and bone ARs and has consistently shown increases in lean body mass (LBM) in trialspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. In a 12-week Phase II trial on older adults, Ostarine dose-dependently increased lean mass (up to +1.3 kg at 3 mg/day) and improved physical function (faster stair-climbing)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. Notably, fat mass decreased slightly in the high-dose grouppmc.ncbi.nlm.nih.gov. Ostarine also showed anti-catabolic effects in patients with cancer cachexia – both 1 mg and 3 mg doses preserved or increased muscle mass and performance compared to placebopmc.ncbi.nlm.nih.gov. Importantly, it caused minimal changes in prostate-specific markers and had only mild side effects (transient mild ALT increase, slight HDL reduction)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. These profiles make Ostarine a leading candidate for conditions like muscle wasting. (As discussed later, it’s also being investigated in AR-positive breast cancer therapy).
• Ligandrol (LGD-4033, VK5211, now known as vosilasarm): A potent non-steroidal SARM initially developed by Ligand Pharmaceuticals and later studied by Viking Therapeutics. Ligandrol is known for increasing muscle mass and strength even over short durations. In a placebo-controlled trial, 76 healthy men took LGD-4033 (0.1, 0.3, or 1.0 mg) for 21 dayspmc.ncbi.nlm.nih.gov. Even at these low doses, lean body mass increased in a dose-dependent manner (with no significant fat loss)pmc.ncbi.nlm.nih.gov. LGD-4033 was well tolerated; the main pharmacologic effects were the expected suppression of endogenous testosterone and sex-hormone binding globulin (SHBG) – dose-dependent, but reversible after stopping the drugpmc.ncbi.nlm.nih.gov. Free testosterone dropped only at the highest dose (1 mg)pmc.ncbi.nlm.nih.gov. LGD-4033 also caused a dose-related decrease in HDL cholesterol, again reversible post-treatmentpmc.ncbi.nlm.nih.gov. The strength gains were not explicitly stated in this study, but anecdotal reports and its inclusion on athletic doping violation lists suggest it significantly boosts performance. Ligandrol’s potency has made it one of the most common SARMs found in doping cases (e.g. a number of athletes have tested positive for LGD-4033 in recent years)en.wikipedia.org.
• Andarine (S-4): One of the earliest SARMs developed (by GTX), Andarine has moderate anabolic effects on muscle and was also noted to increase bone strength in animal models. It was investigated for treating benign prostatic hyperplasia (BPH) and osteoporosis. At lower doses, Andarine can reduce prostate weight (acting as a partial antagonist in prostate tissue) while still stimulating muscle and bone growthen.wikipedia.orgen.wikipedia.org. A unique side effect associated with S-4 is visual disturbance – users commonly report a temporary yellow tint to vision or difficulty with night vision. This effect is believed to stem from S-4’s partial agonism of an off-target receptor in the eye and is dose-dependent (and reversible). While Andarine never proceeded to late-stage trials, it remains popular in the bodybuilding community for recomposition (muscle gain with some fat loss) and is often stacked with other compounds. Its anabolic potency is considered lower than Ostarine or Ligandrol, but it still significantly improves lean mass in research settingsen.wikipedia.org.
• Testolone (RAD-140): A newer, highly potent SARM, RAD-140 demonstrated one of the strongest anabolic effects in preclinical modelspmc.ncbi.nlm.nih.gov. It increases muscle weight and bone density at relatively low doses in rats, with minimal prostate enlargementpmc.ncbi.nlm.nih.gov. RAD-140 has attracted interest for potential neuroprotective effects as well (the AR is expressed in the brain, and some data suggest androgens can protect neurons). A key current focus is on RAD-140’s use in androgen receptor-positive breast cancer – it has been studied for metastatic breast cancer where tumors express AR (as an analog to using anabolic steroids like fluoxymesterone that were historically used in breast cancer)en.wikipedia.orgen.wikipedia.org. The idea is that RAD-140 might provide an anti-tumor effect in AR-sensitive tumors without the side effects of steroidal androgens. As of 2023, at least one clinical trial of RAD-140 in breast cancer was ongoing. In the athletic arena, RAD-140 is known for dramatic strength and muscle gains, and like others, it’s banned (several UFC fighters and other athletes have been sanctioned for RAD-140 positives). Common anecdotal effects include rapid muscle fullness and some aggression (likely from its androgenic stimulation in the CNS). No formal human trial results have been published yet, so its safety profile in humans is inferred from animal data and user reports.
• S-23: An investigational SARM regarded as one of the most potent in anabolic effect. S-23 strongly suppresses endogenous testosterone and sperm production, which was leveraged in animal studies exploring male contraceptionpmc.ncbi.nlm.nih.gov. In rats, S-23 effectively reduced spermatogenesis and testes size, indicating it could serve as a reversible male birth control pill (when combined with exogenous testosterone to maintain other functions)pmc.ncbi.nlm.nih.gov. Its potency means it can significantly increase muscle and bone mass, but the side effects (like hormone suppression) are correspondingly greater. S-23 has not entered formal human trials, but is sold online. Users report that S-23 can cause darkening of urine and other side effects at high doses, possibly reflecting strain on the kidneys or liver. Due to its strong suppression of the HPG axis, post-cycle therapy is considered absolutely necessary after S-23 use to help recover natural testosterone. While promising as a contraceptive SARM, further safety evaluation is needed.
• Others: Numerous other SARMs are at various research stages. BMS-564929 was a SARM developed by Bristol-Myers Squibb for muscle wasting; it showed high AR selectivity but was injected rather than oral. AC-262536 is a lesser-known SARM that has mild anabolic effects and is sometimes marketed in the gray market. MK-0773 (Merck) was a SARM that reached Phase II trials in women for sarcopenia (age-related muscle loss) but did not proceed, possibly due to insufficient functional benefits. SR9011 and SR9009 (Stenabolic) are often mistakenly called SARMs but in fact are Rev-Erb agonists (they affect metabolic regulators, not AR)usada.orgen.wikipedia.org. Likewise, MK-677 (Ibutamoren) is not a SARM but a growth hormone secretagogue, and GW501516 (Cardarine) is a PPARδ agonist “exercise mimetic” – these compounds are sometimes sold alongside SARMs or spiked into “SARM” productspubmed.ncbi.nlm.nih.goven.wikipedia.org. It’s important to distinguish true AR-modulating SARMs from these unrelated substances marketed in the same niche.

Table 1: Examples of Selective Androgen Receptor Modulators (SARMs) and Their Characteristics

SARM (Alias)	Key Intended Effects & Uses	Development Status
Ostarine (Enobosarm, MK-2866)	Increases lean muscle mass and strength; prevents muscle wasting (anti-catabolic). Studied for cancer cachexia, sarcopenia, and AR+ breast cancer. Also improves bone density to a degree.	Most studied SARM – completed Phase II & III trials in cachexia (Phase III did not meet all endpoints)pmc.ncbi.nlm.nih.gov. Ongoing Phase II for breast cancer (Fast Track designated)en.wikipedia.orgen.wikipedia.org. Not yet approved.
Ligandrol (LGD-4033, VK5211/vosilasarm)	Potent anabolic for muscle and bone. Increases LBM and muscle strength; potential therapy for muscle wasting (e.g. recovery from hip fracture).	Completed Phase I/II trials in healthy volunteers (improved LBM)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. A Phase II in hip fracture patients showed LBM gains, but no approved use yet. Not approved (development ongoing).
Andarine (S-4)	Moderate anabolic effects on muscle; significant effects on bone density in animal models. Investigated for benign prostate hyperplasia (to shrink prostate) and osteoporosis. Off-label use for recomposition (muscle gain & fat loss).	Early development only (Phase I). Never advanced to Phase III. Not approved. Widely available on gray market. Banned in sportspmc.ncbi.nlm.nih.gov.
Testolone (RAD-140)	Very potent anabolic SARM for muscle/bone. Preclinical use in increasing muscle mass; being studied for AR-positive breast cancer (as an AR agonist therapy). Promising neuroprotective potential in models.	Preclinical to Phase I stage. Ongoing trials for breast cancer metastases (Phase I/II)en.wikipedia.orgen.wikipedia.org. Not approved. Common in black market; WADA banned.
S-23	Extremely potent SARM; causes substantial muscle gain but also severe HPG axis suppression. Investigated as a male contraceptive (suppresses sperm/testosterone) in animal studies.	Preclinical research (no human trials yet). Not approved for any use. Available as research chemical only. Banned in sports.
Others (e.g. MK-0773, AC-262536, etc.)	Various other SARMs with niche developments (e.g., MK-0773 for female sarcopenia; BMS-564929 injection for muscle wasting). Some show anabolic promise but with less development progress.	None have reached approval. A few completed small Phase I/II trials with mixed results. Many have been discontinued or are only in lab research stage.

Note: YK-11, often discussed on forums with SARMs, is actually a steroidal AR agonist and myostatin inhibitor – essentially a hybrid of a SARM and prohormone. It is not as well-characterized as the SARMs above and is not in legitimate clinical development. Similarly, compounds like MK-677 (Ibutamoren) and Cardarine are frequently sold in “SARM stacks” but are not AR modulators. All such substances, however, are prohibited in sports if detected.

Legitimate Medical Uses of SARMs

One of the driving motivations for SARM development is the treatment of medical conditions that cause muscle or bone loss. Currently, no SARM has regulatory approval for clinical usepmc.ncbi.nlm.nih.goven.wikipedia.org, but several have been or are being investigated in clinical trials for specific indications:

• Muscle Wasting (Cachexia and Sarcopenia): Perhaps the most promising area is combating muscle wasting syndromes. This includes cancer cachexia (the severe muscle loss seen in late-stage cancer), chronic illness cachexia (e.g. in heart failure, COPD, kidney disease), and age-related sarcopenia. SARMs like Ostarine have shown significant ability to increase lean body mass and improve physical function in these populationspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. For example, Ostarine’s Phase II trial in cancer cachexia patients showed muscle gains and improved stair-climbing power vs placebopmc.ncbi.nlm.nih.gov. However, in two large Phase III trials (the POWER trials in non-small cell lung cancer patients), Ostarine did not achieve statistically significant improvement in physical function despite increasing lean masspmc.ncbi.nlm.nih.gov. This highlights a key challenge: regulators (like the FDA) require functional outcomes (strength, walking speed, etc.) in addition to weight gain to approve a drug for cachexiaen.wikipedia.org. SARMs improve muscle size, but translating that into clear clinical benefit remains an area of active research. Nonetheless, the potential for a relatively safe oral agent to prevent muscle atrophy is of great interest. Other SARMs (LGD-4033, etc.) have also been studied in healthy older adults, with gains in muscle mass observed, though improvements in strength/endurance were modesten.wikipedia.org. Ongoing studies are examining if combining SARMs with exercise or nutritional support yields better functional outcomesen.wikipedia.org.
• Osteoporosis and Bone Disorders: Androgens are known to enhance bone density. SARMs, by targeting bone AR, could stimulate bone formation. In animal models, SARMs increase bone mineral density and strengthen.wikipedia.org. A compound named LY305 (developed by Lilly) showed promising bone growth results in a Phase I trialen.wikipedia.org. Unlike current osteoporosis medications that mostly prevent bone loss, SARMs might actively build new bone. SARMs could be especially useful in osteoporosis in men or in women who cannot tolerate other therapies. No SARM has reached Phase III in osteoporosis yet, but ostarine and others improved bone markers in earlier trials (for example, ostarine increased markers of bone formation in postmenopausal women during a muscle study)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. SARMs may also help heal fractures faster by promoting anabolic activity in bone. This remains a future direction, as safety issues (like potential androgenic effects on other tissues) must be resolved before using SARMs long-term in generally older osteoporosis patients.
• Hypogonadism (Testosterone Deficiency): Testosterone replacement therapy (TRT) is standard for male hypogonadism, but TRT can cause prostate enlargement, polycythemia, infertility, and other issuespmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. SARMs present an intriguing alternative: they could selectively address symptoms of low testosterone (low muscle mass, fatigue, low bone density) without heavily stimulating the prostate or testes. In theory, a SARM could improve muscle and libido in a hypogonadal man without suppressing fertility – something TRT cannot do (TRT suppresses sperm production via feedback). Early research hinted at this possibility: Ostarine trials in men showed increases in muscle and decreases in fat without significant change in prostate-specific antigen or prostate volumepmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. However, SARMs do still suppress the pituitary to some degreepmc.ncbi.nlm.nih.goven.wikipedia.org, so they might not fully preserve fertility. Nonetheless, companies have considered SARMs as a new form of androgen therapy for men, especially those who want the benefits of TRT but cannot take testosterone (for example, men with prostate cancer history, where you’d want to avoid direct testosterone). As of now, no SARM is approved for hypogonadism, but this remains a potential application if long-term safety can be demonstrated.
• Benign Prostatic Hyperplasia (BPH): It may seem counterintuitive (since we often avoid androgen stimulation in BPH), but certain SARMs were tested for BPH treatment. The idea is that a SARM could act as an AR antagonist in prostate tissue while still providing anabolic support elsewhere. For instance, a SARM called OPK-88004 advanced to a Phase II trial for BPHen.wikipedia.org. In rat models of BPH, SARMs reduced prostate weight (like a 5α-reductase inhibitor would)en.wikipedia.org. OPK-88004’s trial was terminated due to challenges in measuring prostate size changes, but the concept was that SARMs might relieve BPH symptoms without the sexual side effects of current BPH drugs. This selective antagonism in prostate is a tricky balance; whether SARMs can truly help treat BPH in men without causing systemic androgen blockade is uncertain, and other therapies have taken precedence for now.
• Breast Cancer: Surprisingly, anabolic agents have a history in treating certain breast cancers. Some breast tumors have androgen receptors (AR) that, when activated, can inhibit tumor growth (especially in estrogen receptor-positive cancers)en.wikipedia.org. Anabolic steroids were used in the past for breast cancer but were discontinued due to virilizing side effectsen.wikipedia.org. SARMs could be a modern revival of this strategy – providing AR activation to tumor cells with fewer side effects. Enobosarm (ostarine) has been studied in AR-positive, estrogen receptor-positive metastatic breast cancer. A Phase II trial found that enobosarm had an 80% clinical benefit rate in patients with high AR-expressing tumorsen.wikipedia.orgen.wikipedia.org. This led to the FDA granting Fast Track designation in 2022 for enobosarm in this breast cancer subtypeen.wikipedia.org. Current trials are combining enobosarm with other treatments (e.g. the immunotherapy pembrolizumab) to see if AR stimulation can improve outcomes in tough cases like triple-negative breast cancer that still express ARpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. If successful, this would be a totally new use-case for SARMs – as part of oncology regimens. RAD-140 and another SARM called RRD-251 (branded as vosilasarm) have also been investigated in preclinical breast cancer modelsen.wikipedia.org.
• Other Potential Uses: Researchers are continually finding new potential niches for SARMs. For example, stress urinary incontinence (SUI) in women – the levator ani muscle in the pelvic floor is androgen-responsive, and a trial tested whether Ostarine could strengthen pelvic musculature to reduce SUI in postmenopausal womenpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. (The Phase II “ASTRID” trial in SUI did not meet its endpoints and was shelvedpmc.ncbi.nlm.nih.gov.) There is interest in SARMs for muscular dystrophies like Duchenne MD: a SARM (GLPG0492) improved muscle performance and reduced fibrosis in a mouse model of Duchenne muscular dystrophypmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. SARMs have even been hypothesized to help in chronic illnesses where muscle wasting occurs (HIV/AIDS, end-stage organ disease)usada.org. Experimental studies have looked at SARMs in Alzheimer’s disease (to counter frailty and possibly cognitive effects of low androgens)pmc.ncbi.nlm.nih.gov, and as part of male contraceptive regimens (S-23 as noted, potentially combined with a low-dose testosterone to maintain some male functions while preventing sperm production)pmc.ncbi.nlm.nih.gov. These diverse investigations underscore SARMs’ broad therapeutic promise. However, until safety is proven, these remain theoretical or early-stage uses.

In summary, SARMs could address an array of medical problems – if they can deliver on selectivity and safety. So far, results are mixed: clear anabolic effects have been demonstrated (especially for increasing muscle mass), but translating that into approved treatments has been challenging. The next sections will examine why – by looking at off-label misuse, safety concerns, and regulatory responses which all impact the path of SARMs from lab to clinic.

Off-Label and Fitness/Bodybuilding Uses

Even though SARMs are not approved medications, they have exploded in popularity in the fitness and bodybuilding community over the past decade. Their appeal lies in offering steroid-like muscle gains purportedly with fewer side effects and legal complications. Here we explore how SARMs are used (and abused) outside of medical settings:

• Performance Enhancement and Bodybuilding: SARMs are widely used by recreational bodybuilders, weightlifters, and even some competitive athletes as muscle-building supplements. Users report that an 8–12 week “SARM cycle” can increase lean muscle mass, strength, and endurance, often with less water retention and less severe acne or hair loss than an anabolic steroid cycle might cause. Popular SARMs in this scene include Ostarine (for cutting phases to preserve muscle while losing fat), Ligandrol and RAD-140 (for bulking to add significant muscle), and S-4 or S-23 (for strength and hardness). Athletes are attracted by the notion that SARMs won’t cause as much testosterone suppression or gynecomastia as steroids – though this is only partially true, as we’ll discuss in side effects. Another reason is convenience: SARMs are usually taken orally via a dropper or capsule, avoiding injections. They also were, for a time, harder to detect on drug tests when they first appeared, giving some athletes a perceived doping advantageusada.orgen.wikipedia.org.
• Availability and Marketing: A large gray market supplies SARMs worldwide. They are sold online as “research chemicals” or in some cases as mislabeled dietary supplementsusada.orgen.wikipedia.org. Websites often advertise SARMs for “research use only,” with a small disclaimer, while prominently touting benefits like “build muscle” or “fat loss”abc.net.auabc.net.au. This is an attempt to dodge regulations by not explicitly marketing them as supplements or drugs (more on the legal status in the next section). Nonetheless, SARMs have been openly available from numerous Internet retailers, and even some brick-and-mortar supplement shops have carried them, putting them on display next to protein powdersabc.net.auabc.net.au. The cost is significant – for example, a typical 30 mL vial (a one-month cycle) might cost $50–$100 USD. Despite the price, demand has grown: reports from Australia in 2018 noted sales skyrocketing from 10 to 100 vials a day at one supplierabc.net.auabc.net.au. The user base ranges from competitive bodybuilders to recreational gym-goers looking for an edge in physique or strength beyond what conventional supplements can offer.
• Doping in Sports: All major sports anti-doping organizations have banned SARMs since 2008 (classified under “other anabolic agents” on the WADA Prohibited List)usada.orgen.wikipedia.org. Yet, positive tests for SARMs in athletes have steadily risen worldwideusada.orgen.wikipedia.org. From the first confirmed case in 2010 to hundreds of cases in the 2010s, SARMs have ensnared athletes in sports including Olympic events, professional leagues, and NCAA college sportsen.wikipedia.org. Ostarine (enobosarm) and Ligandrol are the two most frequently detected, accounting for a majority of SARM positives globallyen.wikipedia.org. Athletes in high-profile organizations – the UFC, NFL, NBA, and others – have been sanctioned for SARM useen.wikipedia.org. Some claimed inadvertent ingestion via tainted supplements, which is plausible given how often supplements are spiked with SARMs (as discussed in the Market/Purity section)usada.orgpubmed.ncbi.nlm.nih.gov. Nevertheless, the doping community has recognized SARMs as potent performance enhancers. They can increase strength and lean mass with less androgenic weight gain (no bloating from estrogen) and possibly faster recovery. For a period, SARMs were thought to be difficult to detect, but anti-doping labs have since developed robust tests in urine and even hairen.wikipedia.org. Athletes now risk multi-year bans if caught using these “research chemicals.” The temptation remains high, so WADA and national anti-doping agencies continue to update testing protocols. The message from anti-doping authorities is clear: any SARM use is prohibited, even if a doctor theoretically prescribed it (which isn’t legal anyway)usada.orgusada.org.
• Usage Patterns: Among non-athlete users, SARMs are often cycled similarly to steroids. A common approach is an 8-12 week cycle of one or more SARMs, followed by a post-cycle therapy (PCT) using drugs like tamoxifen or clomiphene to help restore natural testosterone. For example, someone might do an 8-week cycle of RAD-140 + Ostarine, then take a PCT to mitigate testosterone suppression. Many users stack SARMs with other compounds (even traditional steroids or growth hormone), despite no clinical data on such combinationsen.wikipedia.org. On bodybuilding forums and Reddit, extensive “logs” and anecdotal reports are shared, along with advice on liver support supplements or hormone recovery protocolspmc.ncbi.nlm.nih.gov. One study analyzing Reddit posts found that users frequently reported self-directed dosing regimens and side effect experiences, underscoring the unregulated experimentation happening in real timepmc.ncbi.nlm.nih.goven.wikipedia.org. It’s worth noting that over 90% of SARM users report being happy with the results and 64% say they would use them again even though the majority experienced some side effectsen.wikipedia.org. This indicates a perceived benefit (muscle/strength gains) that, for many, outweighs the downsides – at least in the short term.
• Perceived Advantages: Users often cite that SARMs feel “cleaner” than steroids. They report good muscle pumps and steady gains without extreme aggression or mood swings (although some compounds like S-23 or RAD-140 can still cause irritability due to their androgenic effect in the brain). There is also no need for injections, which lowers the barrier to use. Additionally, because SARMs don’t aromatize to estrogen, users don’t have to concurrently take an aromatase inhibitor to prevent gynecomastia – a common requirement on high-dose testosterone or Dianabol cycles. Finally, SARMs haven’t carried the same legal stigma as steroids, so many young users assume they are a safer, legal alternative. However, this is often a false sense of security, as we will see in the safety section (SARMs do have significant side effects and unknown long-term risks, and legally they are increasingly controlled).

In essence, SARMs have established a firm footing in the enhancement subculture. They are used by those seeking anabolic benefits with the belief of reduced harm. Unfortunately, the unregulated nature of these products and the lack of medical oversight means many users are effectively running uncontrolled experiments on themselves. The next section will compare SARMs head-to-head with anabolic steroids, to clarify differences in effects and risks.

Comparisons with Anabolic Steroids

It is instructive to compare SARMs to traditional anabolic-androgenic steroids (AAS), since SARMs were created to serve a similar function (anabolism) but with improved selectivity. Key points of comparison include efficacy, side effect profiles, and safety:

• Anabolic Potency: In terms of pure muscle-building and strength gains, the stronger anabolic steroids still outperform SARMs in most cases. A moderate dose of testosterone or Dianabol will typically pack on more muscle than a standard SARM cycle of Ostarine or LGD-4033. For example, studies and user reports suggest the lean mass gained from SARMs is significant but lower than that obtained with comparable doses of AASen.wikipedia.org. High-end SARMs like RAD-140 or S-23 may approach the anabolic effect of steroids, but at the cost of more side effects. That said, SARMs clearly do work as anabolic agents (e.g., +1-3 kg lean mass in trialspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov), just not usually to the extreme degree seen with high-dose AAS (which can add 5-10+ kg muscle with potent agents, albeit much of that is water/glycogen). Therefore, for elite bodybuilders seeking maximum mass, SARMs are often considered supplemental or introductory, whereas steroids remain the “gold standard” for sheer effect magnitude.
• Selective Action and Side Effects: The hallmark difference is androgenic side effects. Anabolic steroids, being non-selective, activate AR broadly and cause classic side effects: acne, oily skin, male-pattern baldness (in those genetically prone), prostate enlargement, virilization in females, and so onpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. SARMs, in contrast, greatly reduce these androgenic effects. In clinical trials of SARMs, there have been no reports of prostate growth or virilizing side effects at typical dosespmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. For instance, a 3 mg dose of Ostarine for 3 months in elderly men did not change their prostate-specific antigen (PSA) levels or cause any prostate issuespmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. Similarly, no significant increase in body hair or deepening of voice has been observed in women given SARMs in trials (contrast this with steroid use in women, which readily causes virilization). Moreover, SARMs do not cause estrogenic side effects because they cannot aromatize into estrogenen.wikipedia.orgen.wikipedia.org. Thus, side effects like gynecomastia, water retention, and high blood pressure (from estrogen) are absent with SARMs. This is a major advantage – for example, many steroid-using men must take an aromatase inhibitor or SERM to manage estrogen, whereas SARM users generally don’t face gynecomastia. Note: Some side effects like acne or hair thinning can still occur with SARMs in high doses, as these might be related to local AR activation in skin/hair follicles, but they are reported less frequently than with AAS.
• Hormonal Suppression: Both AAS and SARMs suppress the body’s hypothalamic-pituitary-gonadal (HPG) axis via negative feedback, reducing natural testosterone production. However, SARMs tend to suppress endogenous hormones less than equivalent anabolic steroid dosespmc.ncbi.nlm.nih.goven.wikipedia.org. For example, 1.0 mg of LGD-4033 daily for 3 weeks caused a drop in total testosterone and SHBG, but levels fully recovered after the trial with no need for interventionpmc.ncbi.nlm.nih.gov. In contrast, 3 weeks of moderate Dianabol or testosterone use would significantly shut down testosterone and likely take much longer to recover, possibly needing post-cycle therapy. One reason is that SARMs don’t convert to estrogen; high estrogen is a big contributor to HPG suppression with AAS. SARMs also vary: Ostarine is noted as one of the least suppressive SARMs – even at doses much higher than clinical trials, it only modestly lowers FSH/LH in menen.wikipedia.org. Stronger SARMs (S-23, RAD-140) at high doses can be very suppressive, approaching steroid-like suppression. But generally, the recovery from SARM cycles is perceived as easier. Importantly, SARMs do not typically require co-administration of hCG or other gonadal supports that often accompany long-term steroid use to maintain testicular function. Nonetheless, some suppression and temporary testicular atrophy can occur with SARMs (especially with more potent ones or longer cycles)coach.org.ukcoach.org.uk – it’s not absent, just attenuated relative to steroids.
• Liver and Cardiovascular Effects: Oral anabolic steroids (particularly 17α-alkylated ones like oxandrolone, stanozolol) are notorious for causing liver stress, elevated liver enzymes, and in rare cases liver tumors or peliosis hepatispmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. SARMs, despite being oral, have a different metabolism and so far have not shown the same degree of liver toxicity in trialspmc.ncbi.nlm.nih.gov. Mild, reversible elevations in ALT (liver enzyme) have been observed in a minority of subjects on various SARMspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov, but severe liver injury is not common in clinical settings. However, outside of trials, case reports have linked over-the-counter SARM products to serious liver injury (including one case of fulminant liver failure requiring transplant after high-dose RAD-140 use)scholar.usuhs.eduscholar.usuhs.edu. We discuss those risks later. On the cardiovascular side, anabolic steroids adversely impact cholesterol (lower HDL, raise LDL) and can contribute to hypertension and cardiac remodeling (enlarged heart muscle). SARMs also lower HDL cholesterol – this appears to be a class effect of activating AR in the liverpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. In trials, Ostarine at 3 mg/day lowered HDL by ~27%pmc.ncbi.nlm.nih.gov, and other SARMs similarly caused HDL reductionspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. The long-term impact of this HDL drop is unclear; some argue that androgen-induced HDL changes may not translate to the same cardiovascular risk as chronically low HDL in the general populationpmc.ncbi.nlm.nih.gov. SARMs tend to improve some metabolic parameters like fasting blood glucose and insulin sensitivitypmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov, which could be cardioprotective. Overall though, the cardiovascular risk profile of SARMs is incomplete – they likely carry less risk than high-dose steroids (which can cause drastic cholesterol changes and raise RBC count, etc.), but the FDA has still warned SARMs may increase risk of heart attacks or strokesusada.org. At minimum, they share the negative HDL effect of AAS, though usually to a lesser extent and without significant blood pressure increases noted in trials.
• Legal Status and Accessibility: Anabolic steroids are Schedule III controlled substances in the US and similarly controlled in many countries, making non-prescribed possession illegal. SARMs, as of 2025, occupy a legal gray area (detailed in the next section). In the US and most places, they are not scheduled controlled substances (yet), which historically made them easier to buy onlineen.wikipedia.org. This difference meant users perceived less risk of legal trouble ordering SARMs compared to illicit steroids. However, this is changing (new laws are being proposed to control SARMs). In sports, both are equally banned by WADA. But in society, a casual gym user ordering Ostarine might feel they’re doing something “technically legal,” whereas ordering Dianabol pills clearly violates drug laws. This distinction has influenced usage patterns: some who’d never buy illegal steroids have tried SARMs thinking they are a “safe legal alternative.” In reality, selling SARMs for human use is illegal in many jurisdictions even if they are not scheduled (for instance, selling SARMs as supplements violates FDA law)usada.orgen.wikipedia.org. So the legal gap is narrower than many believe – more on that below.
• Drug Testing and Detectability: Steroids and SARMs are both detectable in urine tests, but detection windows and methods differ. Early on, SARMs had no established test, enabling some athletes to cheat. Now, specialized mass-spectrometry tests can catch even trace amounts of SARMs, and they can be detected for weeks after use (some long-acting injectable SARMs, if developed, could be detectable for even longer)en.wikipedia.org. Steroids, depending on the ester, can be detected for months (e.g., nandrolone metabolites). On balance, neither offers a guaranteed way to evade testing now. Hair testing can even reveal SARM use for months prioren.wikipedia.org.

In summary, SARMs were engineered to offer an improved safety profile over anabolic steroids. They succeed in drastically reducing virilization, prostate effects, and estrogen-related side effects. They also cause somewhat less HPG suppression and liver strain. However, they are not harmless or as potent as high-dose AAS for muscle-building. Both classes share some risks (cardiometabolic impacts, hormone suppression), though to differing degrees. It’s important to note that many lessons learned from decades of steroid research are still being learned with SARMs, which are newer. As we turn to health risks, keep in mind that “safer than steroids” does not mean “safe” – it simply means the risk-to-benefit ratio might be more favorable, if SARMs are used under proper medical guidance (which currently, they generally are not in the real world).

Legal and Regulatory Status Globally

The legal and regulatory landscape for SARMs is complex and evolving. Initially, SARMs were not explicitly illegal in many countries, but as their use grew, regulators and lawmakers have taken action. Below we detail the status in key jurisdictions and in sports:

• United States (FDA and DEA): In the US, no SARM has been approved by the Food and Drug Administration for any indicationpmc.ncbi.nlm.nih.goven.wikipedia.org. This means it is illegal to market SARMs as dietary supplements or medications. The FDA has issued multiple warnings about SARMs in bodybuilding products, asserting that SARMs are unapproved investigational new drugs and are not legal ingredients in supplementsusada.orgusada.org. In 2017, the FDA publicly warned consumers to stop using body-building products containing SARMs due to potential life-threatening side effects (highlighting risks of heart attack, stroke, and liver damage)usada.org. The agency has enforced actions like warning letters and product recalls against companies selling SARM pills. While personal possession of SARMs for “research” might not be explicitly penalized, obtaining SARMs for personal use is technically illegal under federal drug regulations, since they are unapproved drugsscholar.usuhs.edu. Many suppliers operate in a gray zone by labeling products “Not for Human Consumption.” The Drug Enforcement Administration (DEA) has also been involved: there have been prosecutions of people selling SARMs as misbranded drugs, with at least one criminal conviction in the U.S. for a SARM distribution schemeen.wikipedia.org. Lawmakers have tried to tighten laws – the SARMs Control Act was introduced in Congress (2018, and again in 2019) to classify SARMs as Schedule III controlled substances (the same category as anabolic steroids)grassley.senate.govgambonelaw.com. As of 2025, these bills have not become law, but they signal strong intent to crack down. The regulatory stance by FDA is clear: SARMs are treated as dangerous, unapproved drugs, and the sale of SARMs in supplements is considered adulteration and is subject to enforcementusada.orgusada.org. Practically, one can still find SARMs online in the US, but the noose is tightening. Doctors in the US cannot prescribe SARMs (since they are not approved drugs)usada.org. If a patient wants to use a SARM in a clinical trial, they’d need to enroll in one or get a compassionate use exemption, but otherwise any “prescription” is not legitimate. In summary, the US treats SARMs as investigational drugs: you might legally buy them as a chemical, but selling them for consumption is illegal and authorities are actively working to stop consumer access.
• Europe and UK: In the European Union, no SARMs are approved by the European Medicines Agency (EMA)en.wikipedia.org. SARMs are considered unauthorized medicinal products if sold for human use. The UK, no longer in the EU but similar in approach, has taken a firm stance: SARMs are not approved for human consumption and are regarded as controlled substances for practical purposes. In the UK, it is illegal to sell or supply SARMs without a proper license from health authoritiescoach.org.uk. The UK Food Standards Agency also classifies SARMs as “unauthorised novel foods,” meaning they cannot be legally sold as supplements or added to foodscoach.org.ukcoach.org.uk. In 2020, the UK even banned the manufacture or distribution of raw SARM materials, though finished products can only be sold for research with authorizationcoach.org.uk. Essentially, UK law requires that SARMs not be marketed for ingestion – doing so can lead to criminal chargescoach.org.uk. Some sources claim SARMs fall under the UK Misuse of Drugs Act Class C, but as of 2025, SARMs are not individually listed in the UK’s controlled drug schedules (unlike anabolic steroids which are Class C). Instead, enforcement is done via medicines and novel food regulations. There have been coordinated efforts like Operation Raw Deal Europe (involving agencies across Europe) to seize illegal SARMs. In Italy, authorities have studied numerous seized SARM products and found quality issuesacademic.oup.com, leading to efforts to control them. Overall in Europe, the pattern is: not authorized as medicines, and illegal to sell as supplements. Possession laws vary – an individual possessing a small amount for personal use might not face criminal charges in many EU countries, but any kind of commercial distribution is illegal.
• Canada: Health Canada considers SARMs unauthorized drugs as well. They have issued public advisories warning about SARMs in workout supplements, explicitly naming products and websites (like “sarms.ca”) that were selling themfirstwordpharma.com. Health Canada has seized SARM-containing products from stores and online fulfillment centersfirstwordpharma.com. They emphasize the same health risks (heart attack, stroke, liver injury) in their warningsrecalls-rappels.canada.cabiospace.com. In Canada, one cannot legally market or distribute SARMs as dietary supplements or drugs, since none have been approved. That said, SARMs are not listed under Canada’s Controlled Drugs and Substances Act either. So, possession for personal use occupies a gray area, but selling them will invoke regulatory action. Practically, Canada treats SARMs much like the US does: not allowed for consumer sale, subject to seizure and fines if you try to import or sell them.
• Australia: Australia has some of the strictest controls on SARMs. The Therapeutic Goods Administration (TGA) in 2012 classified SARMs as Schedule 4 substancesabc.net.au – meaning prescription-only medicines. No approved product exists, so any supply is unapproved. The TGA and Australian Sports Anti-Doping Authority (now Sport Integrity Australia) have actively targeted SARM distribution. Penalties in Australia are severe: supplying SARMs can incur a civil fine up to $1 million AUD, and criminal penalties up to 5 years in prisonabc.net.au. Even possession of SARMs without a prescription is illegal in several states (in New South Wales, simple possession could mean up to 6 months jail)abc.net.auabc.net.au. The TGA works with border officials to intercept SARM importsabc.net.au. They also made it clear that labeling products “for research only” does not exempt them – if a product is known to be used to affect physiology (build muscle), it is deemed a therapeutic good regardless of labelingabc.net.au. Notably, Australia scheduled Cardarine (GW501516) as Schedule 10 (prohibited outright) due to its cancer riskabc.net.auabc.net.au, reflecting their aggressive stance. Several high-profile enforcement actions occurred: e.g., Evolution Supplements was fined $11 million for illegally advertising SARMs and other substancestga.gov.au. Another supplement retailer, Redback SARMs, was fined for advertising themmiragenews.com. Australia effectively treats SARMs on par with anabolic steroids – heavy regulation and enforcement.
• Other Countries: New Zealand classifies SARMs as prescription medicines as well. Asia: Many Asian countries haven’t specifically scheduled SARMs, but general import laws on unapproved drugs apply. In China, interestingly, many SARMs are manufactured as chemical reagents. China has cracked down on some novel drugs but as of recently, SARMs could be produced legally there as long as not sold for human consumption domestically. Russia and Eastern Europe: not much clear legislation specifically on SARMs, though athletes are caught doping with them just the same. Latin America: Similarly, SARMs are not well-known in law, but are likely subject to general health authority controls. However, it’s safe to say that in nearly all major jurisdictions, selling SARMs as supplements or medications is illegal. They occupy the same space as things like prohormones or peptide hormones did – not explicitly controlled in criminal law in some countries, but definitely not legal to sell for ingestion.
• World Anti-Doping Agency (WADA): On a global sports regulation level, SARMs are uniformly banned in competition and out-of-competition for all athletesusada.org. WADA added SARMs to the prohibited list in 2008 under the “S1 Anabolic Agents” category (other anabolic agents sub-section)usada.org. There is no threshold or permissible use (except possibly via a Therapeutic Use Exemption in a clinical trial setting)usada.org. WADA specifically lists examples such as Andarine, Ostarine, Ligandrol, RAD140, and others in its prohibited list documentationwada-ama.orgwada-ama.org. Any athlete who tests positive for any SARM faces sanctions typically ranging from 2 to 4 years for a first offense, unless they can prove exceptional circumstances. As mentioned, more than 50 U.S. athletes and over 200 international athletes have been sanctioned for SARM positives in the last decadeusada.org. From a sports policy view, SARMs are treated exactly like anabolic steroids – as serious doping compounds.

The table below summarizes the regulatory status of SARMs in selected regions:

Table 2: Regulatory Status of SARMs in Key Regions

Region/Country	Regulatory Status of SARMs
United States (FDA)	No SARMs approved for any usepmc.ncbi.nlm.nih.gov. Illegal to market as dietary supplements (considered adulterated drugs)usada.org. FDA has warned against their useusada.org. Not scheduled under CSA (as of 2025), but SARMs Control Act legislation introduced to schedule themgambonelaw.com. Sales for human use can be prosecuted under federal law (misbranded/unapproved drug)en.wikipedia.org. Personal importation is risky and product may be seized. All SARMs banned by sports bodies (USADA/WADA)usada.org.
European Union (EMA)	No approvals by EMAen.wikipedia.org. SARMs are considered unauthorized medicinal products; illegal to sell or advertise for human consumption. Enforced via medicines law and novel food regulations. Several EU countries have conducted seizures of illegal SARMsacademic.oup.com. Not scheduled as controlled substances EU-wide (varies by country), but essentially treated as unlicensed drugs. WADA ban applies in sports.
United Kingdom	No medicinal license for SARMs – not authorized for human usecoach.org.uk. Illegal to sell or supply without a Home Office or MHRA licensecoach.org.uk. Regarded as unauthorized novel foods (cannot be marketed as supplements)coach.org.uk. The sale, purchase, or use for bodybuilding is effectively illegal and subject to enforcementcoach.org.uk. Not listed under Misuse of Drugs Act as of 2025, but could be considered a medicine. UK authorities have shut down retailers illegally selling SARMs. Sports: banned by UKAD/WADA.
Canada	No Health Canada approval. Health Canada warns SARMs are unauthorized drugs with serious health risksrecalls-rappels.canada.ca. Illegal to advertise or sell as supplements – authorities have seized products and warned companiesfirstwordpharma.com. Not scheduled under Canadian controlled drugs law, but importation for personal use is not allowed; shipments have been interceptedfirstwordpharma.com. Treated similarly to other unapproved performance drugs. WADA ban in sports.
Australia	Classified as Schedule 4 (Prescription Only Medicine) by TGAabc.net.au. No approved products, so any possession without prescription and any sale is illegal. Strict enforcement: heavy fines (up to $1M) and jail for illegal supplyabc.net.au; even personal possession can carry penalties (varies by state)abc.net.au. TGA actively working to stop importsabc.net.au. Essentially, SARMs are treated on par with anabolic steroids under Australian law. Sports: banned (ASADA/Sport Integrity Australia follows WADA code).
International Sports (WADA)	Banned in all sports competitions since 2008usada.org. Listed under “S1.2 Other Anabolic Agents” on WADA Prohibited List, with specific examples given (e.g., andarine, ostarine, ligandrol, RAD140, etc.)wada-ama.org. No threshold allowances – any detected amount is an anti-doping rule violation. Testing methods can identify multiple SARMs in urine and even long-term metabolite traces. Athletes face sanctions typically 2-4 years for use.

As the table shows, the global trend is moving toward greater regulation of SARMs. Initially sold in a quasi-legal space, they are increasingly recognized by governments as a public health and integrity threat, much like anabolic steroids and prohormones were. Users should be aware that purchasing SARMs online might lead to legal consequences (products seized, fines, or worse), depending on their country’s laws. Moreover, athletes at any level risk career-ending sanctions if they test positive.

It’s worth noting one more point: because SARMs are not approved anywhere, there is no official quality control or manufacturing oversight. When you obtain SARMs outside of a trial, you’re getting them from underground labs or research chemical suppliers. This dovetails into the next section about purity and market concerns, which is a direct consequence of their legal status.

Health Risks, Side Effects, and Long-Term Safety

While SARMs were designed to be safer than traditional steroids, they are not without risks. In fact, because SARMs are often used without medical supervision, there have been numerous reports of adverse effects. Below we detail the known and potential health risks, side effects, and concerns about long-term safety:

• Hormonal Suppression and Reproductive Effects: SARMs suppress the body’s production of testosterone and other reproductive hormones via the HPG axis feedback. Men using SARMs can experience a drop in luteinizing hormone (LH), follicle-stimulating hormone (FSH), and total testosterone levels, especially at higher dosespmc.ncbi.nlm.nih.goven.wikipedia.org. This leads to testicular atrophy (shrinking of testicles) and reduced sperm count during usecoach.org.ukcoach.org.uk. For example, one study noted significant reductions in LH and FSH in men taking Ostarine (3mg) for 12 weekspmc.ncbi.nlm.nih.gov. The suppression is often reversible after discontinuation, but recovery can take several weeks or a couple of months, and in some cases users require post-cycle therapy (e.g., SERMs like tamoxifen) to help restore normal levels. Fertility can be impacted – there are cases of low sperm counts in men who have used SARMs for extended periods (similar to steroid-induced infertility). Women taking SARMs may experience menstrual disturbances, and although SARMs are touted as “non-virilizing,” high doses could potentially cause androgenic effects like voice changes or clitoromegaly (this has not been well-documented, but is a risk given any AR agonism in females). Importantly, since SARMs might not suppress testosterone as uniformly as steroids, some users have a false sense of security and skip PCT – which can lead to prolonged hypogonadism (low testosterone state) if their hormones don’t rebound. Long-term HPG axis effects are unknown; if someone cycles SARMs repeatedly, could it cause lasting endocrine dysfunction? Caution is warranted, as some bodybuilders who used SARMs heavily reported needing medical intervention to regain normal hormone function.
• Hepatotoxicity (Liver Damage): The liver is a central organ that metabolizes these compounds. Clinical trials of SARMs have generally shown only mild, transient elevations in liver enzymes (ALT/AST) in a minority of subjectspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. For instance, in the Ostarine 3mg trial, 7 out of 8 subjects who had ALT elevations saw them return to normal by trial’s endpmc.ncbi.nlm.nih.gov. However, outside of controlled trials, there have been serious liver injuries reported. A systematic review in 2023 identified at least 15 case reports of drug-induced liver injury (DILI) linked to recreational SARM usescholar.usuhs.eduscholar.usuhs.edu. These include acute hepatitis and even liver failure. One notable case: a young man developed cholestatic liver injury after using high-dose RAD-140 (Testolone) and required a liver transplantpmc.ncbi.nlm.nih.gov. The mechanism isn’t fully clear – SARMs are not 17α-alkylated, so classic steroid toxicity pathways don’t apply, but it may be an idiosyncratic reaction or dose-related toxicity of the SARM or other adulterants. Also, since many “SARM” products are mislabelled (some contain prohormones or other hepatotoxic chemicalspubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov), the liver damage might be due to those contaminants. Regardless, the FDA and health agencies warn that SARMs can cause liver damageusada.orgbiospace.com. Anyone using SARMs should monitor liver enzymes. Signs of liver stress (jaundice, dark urine, abdominal pain) need immediate medical evaluation. Until long-term studies confirm safety, we must assume chronic SARM use could lead to liver issues, especially if combined with alcohol or other hepatotoxic substances.
• Cardiovascular Risks: As mentioned, SARMs cause a reduction in HDL (“good”) cholesterolpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. Low HDL can be a risk factor for cardiovascular disease. The FDA explicitly cites increased risk of heart attack and stroke as a concern with SARMsusada.org. Why stroke/heart attack? Possibly due to adverse changes in lipids, potential increases in blood pressure (some users report mild blood pressure elevation on certain SARMs, though not as commonly as on steroids), or unknown effects on the heart. An example: in one trial of GSK’s SARM (GSK2881078), two participants developed rhabdomyolysis (severe muscle breakdown that can harm the kidneys) during intense exercisescholar.usuhs.edu, which can be life-threatening if untreated. Rhabdomyolysis itself can be damaging and could contribute to cardiac or renal complications. There is also a theoretical risk that SARMs, by enabling users to train harder and gain muscle, might outpace the adaptation of tendons or the cardiovascular system, leading to injuries or strain (one case of Achilles tendon rupture was reported in a SARM userscholar.usuhs.edu). Without long-term epidemiological data, we don’t know if SARM users have more heart attacks. However, given the androgenic stress even SARMs impose (e.g., lowering HDL, possibly increasing hematocrit modestly, etc.), it’s prudent to assume cardiovascular risk is present. Middle-aged or older users with underlying heart conditions could be especially at risk. Until proven otherwise, SARMs should be considered potentially harmful to heart health, albeit likely less so than high-dose steroids (which have well-documented cardiotoxicity). More research is needed to clarify this, but caution is urged – especially since some SARM users also stack stimulants or other drugs that compound cardiac stress.
• Psychological and Neuroendocrine Effects: There is emerging evidence that SARMs can affect mood and behavior. Mood swings, irritability, and aggression have been self-reported by a significant subset of userscoach.org.ukcoach.org.uk. A study of discussions on social media found many users describing increased agitation or depressive feelings on-cycle and especially during the hormonal crash post-cyclepmc.ncbi.nlm.nih.gov. Over half of users in one survey noted a negative impact on mood or mental well-beingcoach.org.ukcoach.org.uk. The mechanism is likely related to fluctuating hormone levels – as endogenous testosterone drops, some experience depressive symptoms similar to steroid withdrawal. Also, AR stimulation in the brain can influence neurotransmitters. SARMs may not cross the blood-brain barrier as readily as some steroids, but they do have CNS effects (e.g., RAD-140 is being studied for neuroprotection, indicating it acts in the brain). Insomnia is another complaint some users have, as well as libido changes – interestingly, some report increased libido on certain SARMs (perhaps due to slight androgenic activity), while others report decreased libido, especially coming off cycle when natural testosterone is low. Cognitive effects haven’t been deeply studied; however, any profound hormone modulation could in theory impact concentration and cognition. The bottom line is that SARMs are not free of psychological impact – users should be aware of potential mood volatility or changes in mental health. If severe mood issues or signs of androgen withdrawal occur, medical help should be sought.
• Androgenic Effects (Hair, Skin, Prostate): SARMs largely avoid direct androgenic stimulation of the prostate and skin, but they are not 100% devoid of androgenicity. Acne flares have been reported by some users, indicating that sebaceous glands (which cause acne) might still be stimulated in susceptible individuals. Hair loss (on the scalp) is less commonly reported than with DHT-derivative steroids, but people with a genetic predisposition to male-pattern baldness have anecdotally reported some hair shedding on potent SARMs like S-23 or RAD-140. This suggests that at high tissue concentrations, SARMs can activate AR in hair follicles to some degree (or possibly increase conversion of testosterone to DHT indirectly by altering hormone balance). Prostate effects: Trials so far show no enlargement or prostate symptom increase on SARMs in the short termpmc.ncbi.nlm.nih.gov. One might even think SARMs could treat prostate issues as partial antagonists. However, if a SARM is abused at high dose, it’s conceivable that it could start activating prostate AR as well – we just don’t have data on very high doses in humans. Until more is known, men with a history of prostate cancer or severe BPH should avoid SARMs, as any androgen could potentially stimulate those conditions. Another androgenic aspect is voice deepening; not relevant for male users, but women who have experimented with SARMs (particularly high doses or strong ones like RAD-140) risk virilization symptoms. Although SARMs are touted as selective, any androgen receptor agonist given enough dose could cause some male-characteristic development in females. There’s scant documentation of this, since women using SARMs is relatively uncommon (aside from clinical trials in postmenopausal women for muscle or incontinence, which reported no virilizationpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov). Nonetheless, female athletes should be cautious; a “mild” SARM might seem safe, but individual sensitivity varies.
• Metabolic Effects: On the positive side, SARMs have shown beneficial metabolic effects in trials – improved insulin sensitivity and lower blood glucosepmc.ncbi.nlm.nih.gov, as well as lowered triglyceridespmc.ncbi.nlm.nih.gov. This profile suggests SARMs could reduce risk factors for diabetes or cardiovascular disease in some users. However, this has to be balanced against the negative HDL changes. Also, rapid changes in muscle mass or diet (often SARM users consume high-calorie, high-protein diets) can have other metabolic impacts (e.g., strain on kidneys). There hasn’t been evidence of SARMs causing kidney damage directly, except in the case of severe rhabdomyolysis which can injure kidneys acutelyscholar.usuhs.edu. Over the long term, carrying more muscle (which increases basal metabolic rate) is usually beneficial for metabolism – but if gained via an unapproved drug, it’s hard to weigh long-term consequences.
• Unknown Long-Term Safety: Perhaps the greatest concern is the lack of long-term studies. Many SARM clinical trials lasted 3–6 months at most. We do not know what years of intermittent SARM use might do. Potential long-term risks that have been speculated include: oncologic risks (could chronic AR stimulation promote certain cancers? On one hand, high testosterone can exacerbate prostate cancer; on the other, SARMs might actually reduce prostate stimulation – it’s unstudied for long durations). Another worry: organ damage – maybe subtle heart muscle changes or kidney effects that wouldn’t be seen in short trials. The development of fibrosis in organs or changes in gene expression that accumulate over time are unknowns. A specific example: cardiac muscle has androgen receptors; high doses of anabolic agents can cause cardiac hypertrophy. It’s not clear if SARMs at moderate doses over years would do so – they might, if used chronically. Also, what about the brain? Would long-term SARM use affect cognition or increase the risk of neurodegenerative diseases? Completely unknown. Because SARMs are often used by younger individuals (teens, 20s) in an unregulated way, we have an entire cohort of “guinea pigs” for whom the outcomes won’t be visible until maybe their 30s or 40s. It took decades to fully realize some of the steroid-related cardiac risks. SARMs haven’t been around long enough in widespread use to see analogous patterns, if they exist. This uncertainty is itself a risk – users are assuming safety that isn’t proven.
• Quality/Purity Risks: One cannot mention health risks without noting that many adverse effects might come from impure or misidentified products. Studies have shown that a large fraction of products sold as SARMs contain other drugs or incorrect dosagespubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. For instance, if someone thinks they’re taking 20 mg of Ostarine but it actually contains a prohormone steroid, they could experience unanticipated side effects or overdose. Likewise, presence of toxins or heavy metals in unregulated powders is possible. Thus, some health scares attributed to “SARMs” might be due to contaminants – which doesn’t lessen the seriousness for the user, but it complicates pinpointing cause. It means any health risk is amplified by the Wild West nature of the market (discussed more in the next section).

To summarize, the safety profile of SARMs is still being elucidated, but known side effects include: hormone suppression (with potential infertility and sexual side effects), liver enzyme elevations and possible liver injury, negative changes in cholesterol (with unknown cardiac outcomes), mood and psychological changes, and some risk of other androgenic or idiosyncratic effects (like tendon injury or rhabdomyolysis in rare cases)scholar.usuhs.edupmc.ncbi.nlm.nih.gov. Long-term consequences remain a big question mark. Health authorities universally caution that the unregulated use of SARMs is dangeroususada.orgbiospace.com. Users who have chosen to take them are strongly advised to do so under medical monitoring (periodic blood work for hormones, liver function, lipids, etc.) and to be honest with healthcare providers about their use, so that any emerging side effect can be properly addressed.

Current Clinical Research and Future Directions

Research into SARMs is ongoing, both in clinical trials for potential medical indications and in basic science for next-generation AR modulators. Here we outline the current state of SARM research and what the future may hold:

• Ongoing Clinical Trials: As of 2025, several SARMs are in clinical development. Enobosarm (Ostarine) remains the frontrunner – it is being tested in a Phase II trial for metastatic breast cancer (AR+/ER+ subtype) after showing promising tumor response rates in Phase IIen.wikipedia.orgen.wikipedia.org. The FDA granted it Fast Track designation for this useen.wikipedia.org, indicating both the potential and the unmet need. If these trials succeed, enobosarm could become the first SARM to gain approval, specifically for cancer therapy. Enobosarm is also in a trial for stress urinary incontinence in women (though earlier efforts did not meet endpoints)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. Ligandrol (LGD-4033/vosilasarm) was evaluated in Phase II for muscle recovery after hip fracture in elderly patients – initial results showed increased lean mass but no significant functional improvement, leading to some uncertainty in its developmenten.wikipedia.org. It’s unclear if Viking Therapeutics (the company) will pursue further trials for sarcopenia or cachexia with vosilasarm; they shifted focus to other drugs, but the SARM program remains in their pipeline. RAD140 (Testolone) is in early trials, likely Phase I, for solid tumors (breast cancer) and possibly safety studies in healthy volunteers, though published data are not yet available.
• Newer SARMs and Molecules: Beyond the “classic” SARMs, researchers are developing next-generation AR pathway modulators. One approach are Selective Androgen Receptor Degraders (SARDs) – compounds that bind to AR and cause its degradation. These could be useful especially in prostate cancer (where you want to shut off AR signaling). A related concept is PROTACs (Proteolysis Targeting Chimeras) targeting AR. These aren’t SARMs in the traditional sense (they are anti-androgenic rather than anabolic), but show the versatility of AR-targeted drug design. In terms of anabolic SARMs, there is work on non-steroidal vs. steroidal SARMs. Steroidal SARMs (like YK-11) theoretically could be refined to achieve selectivity while using the steroid scaffold. Non-steroidals have been more popular due to oral bioavailability and IP patent reasons. APEDs in development: Some companies (e.g., Chinese and Korean firms) have SARMs in preclinical or clinical stages – one example is DAA-105 in Korea for muscle wasting, or Korean LGD analogs. The field is competitive but somewhat secretive since many trials by big pharma did not make it to publication if results were lackluster.
• Addressing Past Failures: A few high-profile failures have occurred – e.g., enobosarm’s Phase III trials in lung cancer cachexia (POWER1 and POWER2) failing to meet primary endpointspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. These taught researchers that just gaining muscle isn’t enough; drugs need to show improved patient outcomes (like better quality of life or survival). Future trials might incorporate comprehensive endpoints (strength measures, patient-reported outcomes) and perhaps combine SARMs with other therapies (nutritional support, exercise programs). There’s also interest in using SARMs as part of multimodal therapy – for instance, in cancer cachexia, combining a SARM with an anti-inflammatory or appetite stimulant to address multiple aspects of wasting.
• Further Medical Applications: Some areas where future SARM research might expand include chronic kidney disease (CKD) – CKD patients often lose muscle, and a SARM could help them maintain strength (one concern is such patients often have anemia, and anabolic agents help with erythropoiesis too). Chronic obstructive pulmonary disease (COPD) is another, where muscle wasting occurs; indeed, Ostarine was considered for COPD cachexiausada.org. HIV/AIDS cachexia is a potential target as well, reprising the role anabolic steroids once played in that setting. Duchenne Muscular Dystrophy (DMD) – as mentioned, SARMs showed benefit in mouse modelspmc.ncbi.nlm.nih.gov; a human trial would be compelling if safety in children could be assured. Male contraception is a unique future use: SARM + testosterone combinations are being explored to suppress sperm output without causing hypogonadal symptoms. The advantage over current male contraceptive trials (which use progestins + testosterone) is that SARMs could maintain muscle and libido on their own while blocking sperm, possibly with fewer side effects. S-23 or similar analogs might lead that charge, but human trials are probably a ways off.
• Analogs and Optimization: Medicinal chemistry efforts continue to refine SARMs for better selectivity. For instance, tweaking molecules to reduce HDL impact or liver enzyme elevation is one goal. Another is to circumvent potential drug interactions – SARMs like Ostarine are metabolized by CYP3A4, so if a patient is on multiple meds, there could be interactions. GSK’s SARM trials specifically looked at co-administering a CYP3A4 inhibitor (itraconazole) to map interactionspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. Knowing this, future SARMs might be designed with metabolism not heavily dependent on polymorphic enzymes. Additionally, alternative delivery methods are being explored. One paper mentioned efforts to develop transdermal SARMspmc.ncbi.nlm.nih.gov. A skin patch delivering a SARM to a local area (say, a patch over a muscle group or general systemic patch) could theoretically maximize muscle targeting and spare the liver by avoiding first-pass metabolismpmc.ncbi.nlm.nih.gov. It might also reduce the impact on HDL by limiting hepatic concentration. A transdermal SARM (or even SARM injections) could be a future direction for clinical use if oral routes pose issues.
• Detection and Anti-Doping Advances: On the flip side of development, anti-doping science is also moving forward. Researchers are continuously identifying metabolites of newer SARMs to improve detection windowsen.wikipedia.org. There is also interest in developing biological signatures of SARM use – for instance, certain patterns in biomarkers that could indicate use even if the compound itself has cleared. As more SARMs circulate (including any that become approved drugs), doping control will adapt accordingly. This is an ongoing cat-and-mouse game: as new SARMs are created, doping labs must develop tests for them, often using intelligence from seized black-market products or chemical catalogs.
• Regulatory Future: If a SARM does get approved (say enobosarm for breast cancer or cachexia), that could change the landscape. Doctors would then have a legal option to prescribe a SARM for certain patients. Off-label use might expand (for example, prescribing enobosarm off-label to an elderly patient with sarcopenia, if it’s approved for cancer cachexia). With legal pharmaceutical manufacturing, one would hope product purity issues vanish for that particular SARM. However, having an approved SARM might also increase off-label demand among athletes or bodybuilders (similar to how prescription testosterone and other anabolic drugs are sometimes diverted). Regulations like the potential SARMs Control Act in the US might schedule SARMs, which would severely restrict even research use and increase penalties for illicit distribution. We could see a bifurcation where medical SARMs (if approved) are tightly controlled and monitored, while black-market SARMs (including analogs not approved) continue in the shadows. Alternatively, success of one SARM might pave the way for more investment into pharmaceutical SARMs for other conditions, leading to a class of approved, safer androgen agonists available by prescription in 5-10 years.
• Long-Term Studies: There is recognition that to fully harness SARMs, more data on long-term safety is needed. We might see the initiation of longer (1-2 year) Phase III trials in certain populations if early results justify it. For example, a new trial for sarcopenia might run a year-long SARM treatment vs placebo to see effects on falls, frailty outcomes, etc. Similarly, for osteoporosis, a longer trial might measure actual fracture rates. These will be necessary to convince regulators of a favorable benefit/risk ratio. The cost and past trial failures make companies cautious, but if one indication (like breast cancer) gives a foothold, others may follow.

In essence, the future of SARMs holds two parallel stories: one of legitimate medical development – refining these compounds to treat serious diseases and improve patients’ lives – and one of continued underground use and enhancement, which raises challenges for safety and fairness in sports. How these play out will depend on scientific outcomes and regulatory decisions in the coming years.

It’s clear that SARMs have not yet reached their full potential or final chapter. They remain a work in progress, with much promise but also many lessons learned and to be learned. The hope from a medical perspective is that SARMs or their successors may eventually “revolutionize the treatment of many debilitating diseases” with minimal side effectspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov, much as SERMs did for estrogen-related conditions. Until then, researchers, doctors, regulators, and users will be navigating both the opportunities and the risks that SARMs present.

Market Availability, Sourcing, and Purity Concerns

A significant issue with SARMs is the way they are sold and the quality of products on the market. Unlike pharmaceutical-grade medications, SARMs sold online or in shops often come with no guarantee of purity or accuracy. This section discusses how SARMs are obtained and the associated concerns:

• Gray Market and “Research Chemical” Vendors: Because SARMs are not approved for human use, they are typically sold through unregulated channels. Many companies operate via websites advertising SARMs as “for laboratory research only.” They often avoid health claims in fine print, while their marketing images or product names (“Muscle Stack,” etc.) clearly target bodybuilders. These vendors import bulk powders (often from chemical manufacturers in China) and then suspend the SARM in solutions or press them into capsules. The lack of oversight means the dose stated on the label may not be accurate, or even the compound itself might not be what it says. A pivotal study in JAMA 2017 highlighted this problem: out of 44 products marketed as SARMs online, only 52% actually contained a SARM as a major ingredientpubmed.ncbi.nlm.nih.gov. Astonishingly, about 39% contained other unapproved drugs instead, such as MK-677 (a GH secretagogue), GW501516 (Cardarine), or SR9009pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. Some had no active compound at allpubmed.ncbi.nlm.nih.gov. And in 59% of products, the amount of SARM found did not match the label (either significantly lower or higher)pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. These findings mean that a person buying “Ostarine 25 mg capsules” might in reality be consuming 10 mg of Ostarine + some prohormone steroid, or perhaps 40 mg of Ostarine when they think it’s 25, or even a completely different substance. This is a glaring purity problem.
• Contamination and Adulteration: Some SARM products have been found spiked with traditional anabolic steroids or prohormones, likely to enhance the effect or because they’re cheaper to source. Others contained toxic impurities or research chemicals not listed. This poses serious risks: for example, if a product touted as a non-liver-toxic SARM actually contains methylstenbolone (a liver-toxic steroid), the user unwittingly faces high liver strain. There have also been cases where supplement companies included SARMs in products without listing them, leading to positive drug tests. The USADA high-risk supplement list includes over 100 products suspected to contain SARMs or similar agentsusada.org. A consumer taking such a supplement for muscle gain might have no idea they’re ingesting a potent drug. The lack of labeling honesty is thus a huge problem.
• Quality Control Issues: Even if a product does contain the correct SARM, the manufacturing quality can be poor. Some users have reported precipitates or crystals forming in liquid SARM solutions (indicating improper formulation or concentration issues). Others have received bottles with leakage or pills that vary in color and weight. Without GMP (Good Manufacturing Practice) standards, there’s no consistency. Additionally, the stability of these compounds might be in question – we don’t have robust data on how long a SARM suspended in glycerol or alcohol remains potent at room temperature. It’s possible that some products degrade and lose potency or produce breakdown products over time.
• Sourcing and Legality of Purchase: Legally, buying SARMs is often done via the internet. Payment is usually via credit card or cryptocurrency, and the product ships in unassuming packages. Customs seizures can occur (especially in countries like Australia or Canada with stricter import surveillanceabc.net.aufirstwordpharma.com). In the US, while many packages still get through, there have been instances of larger shipments being intercepted and even controlled deliveries leading to busts of major suppliers. Generally, individual users purchasing small amounts face low risk of legal action (unless in a country where possession is illegal), but they do risk losing the product and their money if seized. In countries where SARMs are controlled (like Australia), ordering them online could theoretically lead to legal consequences if tracked.
• Consumer Awareness: There is a gap in awareness among some fitness enthusiasts. Surveys and anecdotal evidence show many users think because SARMs are (or were) easily bought online, they must be “safe” or “legit” like normal supplements. In reality, as we’ve seen, you’re often rolling the dice with what you’re consuming. This has led to health authorities and organizations trying to raise awareness. For instance, the US Department of Defense’s Operation Supplement Safety (OPSS) program explicitly warns military personnel that SARMs in supplements are dangerous and will cause positive drug testsopss.org. The Royal Pharmaceutical Society in the UK has also highlighted the dangers of black-market SARMs and pushed for more consumer education and law enforcementrpharms.com.
• Economic and Ethical Concerns: The booming SARM market (which has been estimated in the tens of millions of dollars globally) operates in a legal gray zone. Reputable supplement retailers mostly stay away from SARMs now due to enforcement, but a network of sketchier operations has taken their place. This is reminiscent of the prohormone era of the early 2000s. Ethically, it’s problematic – these companies are profiting off selling drugs without medical oversight, and often to young customers (including teenagers) who might suffer harm. Some companies have been shut down, but others pop up. The allure of quick profit and high demand makes it an ongoing cycle. It’s a challenge for regulators: they must allocate resources to track down and stop these operations, which sometimes rebrand or move locations to evade detection.
• User Strategies and Risk Mitigation: Some savvy users have responded to purity concerns by sending their products for independent lab testing (a few forums had members who would run mass spectrometry on vials to confirm content). There are also a few “trusted” suppliers that the community believes have more accurate products (sometimes because those suppliers published third-party lab reports). However, trust can be misplaced, and lab reports can be forged. Realistically, without FDA regulation, no brand can be fully trusted – even if one batch tests fine, the next might not. Users who insist on using SARMs are often advised by harm-reduction advocates to (a) get blood tests done to see if what they took lines up with expected effects (like suppressed LH/testosterone, which if not present might mean the product was bunk), (b) stick to the most well-known compounds (like Ostarine or LGD, which are easier to source correctly, versus obscure SARMs which may be completely fake), and (c) avoid premade “stacks” or blends since those have even more room for mislabeling.
• Detection in Supplements: Another angle of purity is inadvertent contamination of normal supplements. The FDA and other agencies have found SARMs in products marketed as fat-burners or pre-workouts. For example, a pre-workout could be laced with Ostarine to give users an extra “pump” and muscle fullness, making them think the product is super effective, while hiding the actual cause. This is illegal adulteration, but it has happened. Athletes have been caught because of these spiked supplements. It’s another reason sports authorities urge athletes to only use certified safe supplements – the presence of SARMs in random products is a real risk.

In summary, the current market for SARMs is a buyer-beware environment. Most products are not what they seem, regulatory agencies have found widespread mislabeling and adulterationpubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov, and the only way to have a guaranteed pure SARM is in a clinical trial setting or by synthesizing it yourself (not feasible for consumers). This Wild West scenario significantly amplifies the health risks discussed earlier – not only are users exposed to SARM side effects, but also to unknown chemicals or incorrect dosages. Until or unless pharmaceutical-grade SARMs become accessible by prescription, anyone obtaining SARMs on the black market should recognize they are playing roulette with their health.

Efforts to clean up the market (through enforcement and legislation) are underway, but as long as demand exists, supply likely will too. The best advice from health experts is to avoid these products entirely outside of research settingsusada.orgbiospace.com. For those who choose to proceed, at the very least they should get educated on the risks, ensure thorough blood work monitoring, and perhaps reconsider if the potential gains are worth the uncertainties.

Ethical and Policy Considerations

The rise of SARMs raises several ethical and policy issues that extend beyond individual health. These include fairness in sports, the ethics of enhancement, regulatory policy, and how society should respond to these kinds of substances.

• Fairness in Sports: From an ethical standpoint, the use of SARMs (or any performance-enhancing drug) in competitive sports is considered cheating, as it provides an artificial advantage and undermines the principle of a level playing field. WADA’s ban on SARMs since 2008 reflects a consensus that they are indeed performance-enhancing and thus have no place in legitimate competitionusada.orgen.wikipedia.org. An ethical athlete is expected to compete based on natural talent and hard work, not pharmacological enhancement. The emergence of SARMs posed a challenge initially – they were new, harder to detect, and some athletes took advantage of that. This can erode trust in sport, as spectators and fellow competitors might feel doubt (“Was that record due to training or SARMs?”). Ethically, athletes using SARMs are violating not only rules but the integrity of sport. On the flip side, one might argue the pressure to win and the perception that “everyone is doing something” pushes athletes toward such substances. Hence, sporting bodies have a responsibility to vigorously enforce anti-doping rules and improve testing to uphold fairness. Cases of athletes caught with SARMs have been public and often high-profile (e.g., Olympians, UFC fighters), serving as cautionary tales. Yet, some ethicists debate whether the war on doping is winnable or if resources could be better used – an old debate revived by each new drug class like SARMs. The current stance remains zero tolerance in sport for SARMs, justified by both health concerns and fairness.
• The Ethics of Human Enhancement: Beyond organized sports, SARMs bring up the broader question: is it ethical for healthy individuals to use drugs to enhance their physical abilities or appearance? This touches on the same issues as anabolic steroids. Some libertarian viewpoints suggest individuals should have autonomy to enhance themselves as they wish, provided they are informed of risks. Others worry about societal pressure: if SARMs (or other enhancers) became safe and widespread, people might feel coerced to use them just to keep up (in jobs requiring fitness, in the dating market for looks, etc.). Right now, SARMs are illegal for distribution, which paternalistically protects people from their potential harm. If one day a SARM were proven very safe and became legal, society would face questions similar to those around cosmetic surgery or cognitive enhancers – is it okay to “biohack” ourselves for non-medical reasons? There is also the matter of long-term societal effects: if use becomes common, will there be a public health cost down the line (e.g., heart disease burden)? Ethically, encouraging muscle drug use could be seen as promoting a form of cheating in life, not just sport. On the other hand, some argue that moderate, regulated use for personal goals is not inherently unethical if risk is low – akin to drinking caffeine to be more alert. SARMs blur lines because they are for physique/performance, not exactly for immediate pleasure or treating illness.
• Regulatory and Policy Responses: Policymakers are grappling with how to handle SARMs. The question: Should SARMs be treated like anabolic steroids (controlled substances)? Proponents of strict control say yes – SARMs pose similar dangers of abuse and thus should be scheduled to allow criminal prosecution of traffickers and to dissuade use. In the US, this is the rationale behind the SARMs Control Actgrassley.senate.gov. Those against scheduling might argue that moving SARMs into the shadows could hinder legitimate research and that education and supplement regulation could suffice. However, given how quickly SARMs spread in the fitness community, many regulators see no option but to tighten laws. Indeed, countries like Australia effectively criminalized them and have taken aggressive actionabc.net.au. From a policy perspective, balancing innovation vs. misuse is tricky. Legitimate researchers want to develop SARMs into medicines for patients in need. If laws become too strict (e.g., placing SARMs in Schedule III alongside steroids), it could complicate research (requiring special DEA licenses for labs, etc.). Ideally, policy could carve out exceptions for research while clamping down on consumer sales. Another policy angle is supplement industry regulation: the fact SARMs were sold as supplements indicates gaps in enforcement of the Dietary Supplement Health and Education Act (DSHEA). Some advocate for modernizing supplement laws to prevent the next SARM-like substance from ever reaching shelves. For example, giving FDA more power to flag and ban novel synthetic drugs marketed as supplements swiftly. The ease with which SARMs were available implies policy failure in controlling dangerous supplements.
• Harm Reduction vs. Prohibition: Ethically, there’s debate on whether the approach to SARMs (and PEDs generally) should be outright prohibition or a harm-reduction model. Prohibition (the current approach) stigmatizes use and penalizes distribution, aiming to reduce prevalence. Harm reduction would accept that some will use anyway and focus on minimizing damage (through education, maybe providing medical supervision or testing services). For instance, providing anonymous testing of SARM products (like some places do for party drugs) could let users know what they actually have, possibly preventing poisoning from misidentified substances. But this clashes with legal frameworks since possession is illegal in many places. Ethically, if one’s priority is public health, harm reduction has merits – e.g., ensuring users don’t destroy their liver because they thought they had a pure SARM when it was something elsepubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. However, if the priority is preventing use entirely, then a tough stance is taken. Currently, most governments lean towards a tough stance, similar to how they treat steroids. Some might argue this pushes the trade further underground and impedes educating users, but politically, being seen as soft on doping drugs is rare.
• Medical Ethics and Prescription Use: If SARMs become approved medications, doctors might face ethical decisions. For example, say enobosarm gets approved for cancer cachexia – could a doctor ethically prescribe it off-label to a healthy gym-goer who wants to build muscle? That would violate the principle of prescribing only for medical necessity. We’ve seen abuses in hormone prescriptions (like “anti-aging” clinics liberally giving testosterone or HGH to people). SARMs could become the next frontier of “rejuvenation” or enhancement clinics if approved. Medical boards would likely caution or discipline physicians who prescribe SARMs off-label for enhancement. Ethically, a physician should do no harm – giving a healthy person a drug for gains carries risk with no medical benefit, so that’s dubious. Another scenario: if SARMs remain unapproved but more data suggests they could help, say, frail elderly individuals, some doctors might feel an ethical pull to recommend them despite illegality, in a kind of off-the-books harm reduction for someone who might otherwise waste away. But most will refrain due to legal risk.
• Equity and Accessibility: There’s also an ethical question of equity: if performance enhancers like SARMs become more prevalent (legally or illegally), those with more money or better access could have an advantage in various domains (not just sports, but physically demanding jobs, military fitness tests, etc.). This could pressure others to follow suit or be left behind. We see glimpses of this in highly competitive environments (like some soldiers reportedly using SARMs to improve PT scores). This raises fairness issues beyond formal sports – a sort of societal fairness in opportunities. Policymakers might consider this when deciding how to curb distribution.
• Preventing Youth Abuse: Ethically, protecting adolescents is paramount. Teenagers have been found using SARMs, drawn by the promise of quick muscle gains and perhaps thinking it’s safer than steroids. But teenage use is especially concerning, as their endocrine systems are still developing. There’s an ethical responsibility for communities (schools, athletic programs, parents) to educate young people on the dangers. Some high school athletes have been caught in doping tests with SARMs, indicating the need for better awareness. Policies requiring supplement education for high-schoolers, or bans on certain sales to minors, etc., could be considered. Ethically, the well-being of young individuals takes precedence over any argument for personal freedom in that context.

In conclusion, the advent of SARMs forces us to confront age-old questions in new form: How do we maintain fairness in competition? How do we regulate enhancement technologies? How to protect individuals (especially vulnerable ones) from harm while respecting autonomy? And how to foster scientific innovation without fueling abuse? The consensus in most circles is that doping with SARMs is unethical and selling them to unwitting consumers is deplorable – hence strong condemnations by sports bodies and regulatorsusada.orgbiospace.com. As for the average individual, using SARMs for vanity or strength raises personal ethical questions (cheating oneself of true natural achievement, or potentially harming oneself and burdening healthcare).

Policy is trending towards treating SARMs with the same seriousness as anabolic steroids: tight regulation, education campaigns, and punitive measures for illicit distribution. Ethically, this is aimed at the greater good – preventing a widespread public health issue and preserving integrity in sports and society. Time will tell if this approach reduces SARM use or if, like with steroids, a subculture of users will persist regardless, keeping the ethical debate alive.

In navigating these considerations, it’s clear that transparency, education, and fair-minded policy will be key. Athletes and the public should be made fully aware of what SARMs are and the risks they carry. Regulators and sporting leagues must continue to adapt to new developments. And researchers have an ethical imperative to report findings honestly, to ensure that if SARMs do have a safe medical role, it’s pursued responsibly, and if not, that information is disseminated to dissuade misuse.

Conclusion: SARMs represent a significant development in pharmacology, offering the tantalizing prospect of anabolic benefits without the full spectrum of steroid drawbacks. Scientifically, they have advanced our understanding of tissue-selective receptor modulation and hold promise for treating serious muscle-wasting diseases, osteoporosis, and perhaps other conditions. Clinically, results have been mixed but still encouraging in certain domains, warranting further research and carefully designed trials.

However, the story of SARMs is also a cautionary tale of unintended consequences: a drug class meant for healing found its way into gyms and online marketplaces long before approval, bringing forth familiar problems of doping, health risks, and regulatory gaps. The uncontrolled use of SARMs has led to adverse events and underscores the importance of proper testing and oversight.

From a public health perspective, the message from experts is clear – do not use these substances outside of clinical trials. They are investigational drugs with insufficient safety data and known risks (hormonal, hepatic, cardiovascular) that could have serious long-term implicationsusada.orgbiospace.com. For those seeking muscle growth or athletic enhancement, the safest path remains proven methods: training, nutrition, and if needed, medically-supervised therapies for deficiencies. The “quick fix” offered by SARMs is not worth the potential cost to one’s health and livelihood (especially considering legal and sporting consequences).

On the horizon, if scientists can address the current limitations, we may yet see SARMs or related molecules become valuable tools in medicine. Imagine a frail older adult regaining strength and independence thanks to a safe SARM therapy – that is the vision that launched SARM research and it’s a goal still worth pursuing. Achieving it will require continued rigorous studies to satisfy regulators of efficacy and safety. Until then, SARMs straddle a line between scientific hope and underground hype.

In concluding this comprehensive overview, one might say SARMs exemplify the double-edged sword of scientific innovation: the potential to greatly improve lives, and the potential to be misused with harmful outcomes. Harnessing the good while minimizing the bad is the task at hand for clinicians, scientists, and policymakers. As individuals, the wisest approach is caution – let the science mature and the regulatory processes do their work. In the meantime, maintaining natural health and fitness without experimental drugs is the prudent choice.

Sources: The information in this report was drawn from peer-reviewed medical literature, clinical trial data, and official statements from agencies like the FDA, WADA, and TGA to ensure accuracy and reliability. Key sources include a 2019 comprehensive review of SARMs in Sexual Medicine Reviewspmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov, a 2023 systematic safety review in Journal of Xenobioticsscholar.usuhs.eduscholar.usuhs.edu, the FDA and Health Canada public warningsusada.orgrecalls-rappels.canada.ca, WADA/USADA doping informationusada.orgen.wikipedia.org, and the JAMA analysis of product contentspubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov, among others as cited throughout. These provide a robust, evidence-based foundation for the statements made herein.