SARMs: A Physician’s Perspective

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We’re currently facing an interesting dichotomy in our society. While our country as a whole continues to decline in overall fitness and health, the ever-increasing mindshare of Instagram, Tinder, Bumble, and other image based social media services continues to place more and more emphasis on physical appearance for young people.

Decisions about someone’s worth are now almost instantaneous in what has become a ‘swipe left, swipe right’ culture. Our phones readily serve up constant streams of images consisting of elite athletes and ‘influencers’ with what appear to be perfect bodies posed in ideal lighting. The needle for what is ‘normal’ has been distinctly shifted and many argue that the pressure to look one’s absolute best has never been greater.

As a result, many young men have felt pressured to take performance enhancing substances. No longer just the domain of elite athletes, anabolic steroids and selective androgen receptor modulators (SARMs) have trickled their way down into mainstream society. In particular SARMs have becomes popular as they are 1) easily accessible online, 2) administered orally (aka no shots necessary), and 3) are marketed with implication that they are ‘safer’ than traditional anabolic steroids.

After seeing multiple patients in the past few weeks suffering from the side effects of these experimental compounds, I feel obligated to address the issue of SARMs head on.

 

So what are they?

Selective androgen receptor modulators (SARMs) are chemical compounds that were originally developed to exploit the benefits seen with traditional anabolic steroids with fewer side effects. For example, while testosterone can increase sex drive, lean muscle mass, and overall energy, it can also accelerate male pattern baldness and (in the high doses often seen in the fitness community) increase blood pressure and cholesterol levels. Also, ANY dose of testosterone will reduce 98% of men's sperm counts to ZERO. This kind of testicular damage is sometimes temporary, but can often be permanent. (There are ways to preserve fertility while on testosterone, but that’s beyond our scope today.)

SARMs are supposed to avoid these pitfalls by only binding to the body’s androgen receptor selectively. Ideally, this means SARMs should possess all of the benefits of anabolics with none of the drawbacks. Unfortunately, this is far from reality.

It needs to be stated that there are NO SARMs currently approved for human use in either the United States or Europe. While some compounds (like Enobosarm aka ostarine) have been investigated for the treatment of muscle wasting in clinical trials, none of them have made it to market and MOST of the available compounds online have never even been studied in humans. The compounds that are available are sold with questionable legality under the auspices of being ‘for research only’ despite misleading marketing and consumer-friendly packaging.

 

What are the risks?

SARMs manipulate the body’s natural hormonal axis and frequently behave in unpredictable ways. While some men have claimed increased gains in the gym and improvements in body composition, others have developed debilitating and life-altering complications. These include many of the complications traditionally seen with anabolics that they are hypothetically supposed to avoid including stroke, high blood pressure, heart attack, and infertility.

I’ve personally taken care of several patients that have suffered these complications and many of my colleagues have done the same. This begs the question: is that six pack really worth your health or not being able to start your family?

SARMs are uniquely dangerous in that their dose-response relationship is poorly understood. While traditional anabolic steroids have been around for decades, making it easier to predict their side effect profiles, SARMs are relatively new. I’ve met men with major hormonal imbalances after only taking SARMs for a relatively short period of time.

 

Parting Thoughts

If you’re reading this and you’re considering taking (or have taken) SARMs or other performance enhancing drugs, I understand. What guy doesn’t want bigger arms or better performance on the field? Who doesn’t want a better physique? Especially when almost every single professional bodybuilder and male social media ‘influencer’ is on them?

But the truth is that, despite what your trainer or someone on the internet might tell you (present company notwithstanding), SARMs are powerful but poorly understood compounds with potentially lifelong health consequences.  

Don’t believe the hype or false promises of safety. If you ever have questions about performance enhancing drugs, fertility, or your overall health, please reach out to your physician. We’re here to help, not to judge.  

-Alex