SARMs: What’s the Harm?

Whether you’re a competitive athlete, a fitness enthusiast or just looking for a more chiseled physique, you may be tempted to turn to supplements to give your body a muscle-building boost.

So, when you hear about SARMs (selective androgen receptor modulators), you may think you’ve found the magic bullet.

After all, you think, they’re not really steroids. So, they must be ... somehow ... better for you, right?

Not so fast, says family medicine physician Ayan Sanyal, MD. “SARMs are still in the investigational stages by the FDA (the U.S. Food and Drug Administration), so their safety profile and long-term effects haven’t been well studied. But from what we do know, SARMs have been associated with very major negative impacts across several vital organs in your body.”

What exactly are SARMs and what are the risks? Dr. Sanyal shares what we know so far.

What are SARMs?

SARM stands for selective androgen receptor modulators. It’s a category of compounds that affect the androgen receptors in your body.

Let’s break that down.

“Androgens like testosterone and dihydrotestosterone (DHT) are the sex hormones associated with things like muscle development, bone density, and sexual desire and function,” Dr. Sanyal explains.

Everyone has androgens in their bodies. But men and people assigned male at birth (AMAB) make more androgens than women and people assigned female at birth (AFAB).

In order to do their work, androgens need to bind to certain receptors throughout your body. But those receptors aren’t always fully activated. That’s normal.

SARMs bypass that system. Think of SARMs as a key that unlocks the androgen receptors in your muscles and bones. They open the doors and allow a rush of testosterone and DHT into those areas.

One effect of that is quicker muscle growth, without you having to put in the work of lifting weights. But there are other effects, too. Potentially dangerous ones. More on those in a bit.

Are SARMs legal?

SARMs aren’t technically illegal in the way that nonmedical drugs, like, say, cocaine, are illegal. But it is illegal for companies to market them as dietary supplements. And they can’t be prescribed by doctors.

SARMs also are banned by the U.S. Department of Defense, as well as sports organizations, including the NCAA and the World Anti-Doping Agency (WADA).

“More than 120 SARM products are on the WADA Prohibited List, which means these products show up as a positive on a drug screening test, even if you haven’t taken them for a while or don’t take them regularly,” Dr. Sanyal notes.

Why are SARMs prohibited in sports?

It’s two-pronged, really.

One reason is that SARMs can give you a competitive advantage by increasing muscle mass.

The other is because the known risks of SARMs are enough to cause concern.

How do you know if you’re buying SARMs?

Supplement manufacturers try to bypass the rules and regulations regarding selling SARMs in some sneaky ways.

One hint that you may be looking at a product that contains SARMs is on the label’s disclaimer. Because SARMs aren’t allowed to be sold as supplements, you’ll see language on their package to the effect of “For research purposes only.” Or “Not for human consumption.”

Or you can review the ingredients label. But know that SARMs go by a number of different names, making them hard to spot in a laundry list of ingredients.

The U.S. Anti-Doping Agency (USADA) says some of the most popular SARMs include:

• Ostarine (Enobosarm, MK2866, S22).
• Andarine (S4).
• LGD-4033 (Ligandrol).
• LGD-3033.
• TT-701.
• RAD140 (Testolone).
• S23.

See the full list of SARMs and other WADA-prohibited substances here.

But beware that no matter what the package claims, you’re likely not getting the full story.

“The supplement market is highly unregulated, and there’s very little quality control,” Dr. Sanyal warns. “Companies are trying to make a quick buck, and they know that some people will pay for SARMs. So, some of these products want you to think you’re getting SARMs, but they may actually be a very low percentage of those compounds.” (Good for your health. Bad for your wallet.)

On the other hand, the lack of regulation means your product could have very high — even toxic — levels of SARMs.

What’s the difference between steroids and SARMs?

SARMs work like anabolic steroids in that they can encourage quick muscle growth. But how they go about that work is a little different.

SARMs target the specific androgen receptors in your muscles and bones. Anabolic steroids unlock the androgen receptors across your whole body. Research from the National Institutes of Health says that anabolic steroids also create new androgen receptors.

The risks of misusing anabolic steroids have been well-studied and understood for years. They include issues like:

• Fluid retention.
• Sleep apnea.
• Enlarged prostate.
• Smaller testicles.
• High blood pressure.
• Blood clots.
• Stroke.
• Liver damage.
• Aggression.
• Depression.

What are the side effects and risks of SARMs?

Some people will tell you that because SARMs are choosy about which receptors they unlock, they don’t have negative side effects. Or that because they work differently from anabolic steroids, they aren’t a risk to your health.

But scientific research says otherwise.

“More research needs to be done to know more about SARM’s effects and their long-term effects, but the preliminary research has raised a number of concerns,” Dr. Sanyal shares.

The FDA warns that research to date has connected SARMs with risks and side effects like:

• Increased risk of heart attack or stroke.
• Psychosis and hallucinations.
• Sleep disturbances.
• Sexual dysfunction.
• Liver injury and acute liver failure.
• Infertility.
• Miscarriage.
• Testicular shrinkage.

“SARMs have yet to be subjected to the high-quality longitudinal studies that need to happen to fully understand their risks and any benefits,” he continues. “Future research will also be able to tell us more about how SARMs interact with other medications and supplements.”

Researchers are also studying the potential to use SARMs medically for people living with severe muscle loss, such as people with age-related muscle wasting, HIV or people who’ve lost muscle mass due to chemotherapy treatments.

Are SARMs worth the risks? 

When SARMs came along in the 1990s, they proliferated the market as a “safer” alternative to steroids.

That idea is going out of style. Because the more we learn, the less safe they appear.

In 2017, the FDA released a statement warning against SARMS, saying, in part, “SARMs, have not been approved by the FDA and are associated with serious safety concerns.”

The warning goes on to say that the FDA has and will continue to take legal action against companies selling products that contain SARMs.

“You're really rolling the dice by taking SARMs because we don’t know everything that they do to the body on the biochemical level,” Dr. Sanyal warns. “Eating a healthy diet with plenty of lean proteins and alternating cardio exercise with weight training is going to be the safer route to building muscle.”

And if you think a supplement is the way to go, talk with a healthcare professional about safe and effective options.