Selective androgen receptor modulators (SARMs) are synthetic androgen receptor ligands designed to have anabolic effects in muscle and bone while minimizing unwanted androgenic effects in areas like the prostate and cardiovascular system [1]. This tissue selectivity makes SARMs an attractive option for treating conditions such as osteoporosis and muscle wasting while avoiding the systemic side effects associated with traditional androgen therapies. However, no SARM has received US Food and Drug Administration approval to date. Studies show SARMs are associated with acute hepatotoxicity [2], and recent case reports indicate long-term testosterone suppression along with nephrotoxicity and cardiotoxicity [3,4]. Abuse of SARMs has become increasingly prevalent due to targeting of both athletes and youth through social media platforms. While reports of SARM abuse and toxicity have been rising, no study has examined adverse events (AEs) and laboratory data using self-reported social media posts.

Initially, 5249 unique posts were extracted, of which 1372 were excluded due to irrelevance or the inability to categorize the stage of SARM use. Of the remaining 3877 posts, 1694 were pre-SARM use, 1412 were mid-SARM use, and 771 were post-SARM use. RAD140 was the most mentioned SARM, with 1389 posts. The mean reported age was 27 (range 13-63, SD 7.9) years. In 418 posts reporting gender, 20 (4.8%) posters identified as female. Significant changes in aspartate aminotransferase, alanine aminotransferase, creatinine kinase, high-density lipoprotein, low-density lipoprotein, total testosterone, and sex hormone–binding globulin were observed before, during, and after SARM use (Table 1 and Multimedia Appendix 1). Of 2183 SARM users, 382 (17.5%) reported using tamoxifen or enclomiphene, and 170 (7.8%) reported using N-acetylcysteine or other hepatoprotective supplements (milk thistle or tauroursodeoxycholic acid) during or after SARM use.

Recent years have seen an alarming increase in targeted marketing of SARMs on social media, where they are portrayed as safe and effective [5]. Despite being illegal to sell for human consumption, SARMs are available for purchase through numerous online platforms, including commercial websites and chemical suppliers [6]. This analysis revealed that prior, current, and prospective SARM users frequently discuss their experiences, sources, dosing regimens, perceived benefits, laboratory results, and AEs on social media. Distributors also frequent these platforms to offer advice while marketing their products.

Our analysis revealed serious AEs of SARMs, with hepatotoxicity as a prominent concern. Comparing mean aspartate aminotransferase and alanine aminotransferase values across different stages of SARM use showed significant increases, indicative of drug-induced liver injury. Users attempted to self-manage hepatic complications through N-acetylcysteine, milk thistle, and tauroursodeoxycholic acid supplementation and hormonal imbalances with tamoxifen and enclomiphene. Our findings corroborate previous literature that has reported consistent patterns of hepatic changes attributable to SARM use [7].

This analysis has important limitations. The demographics of the sample predominantly comprised young men, limiting generalizability across gender and age. While self-reported laboratory values offer valuable preliminary insights, interindividual variability and small sample sizes in the reported data present an inherent challenge. To increase the robustness of the findings, future work should integrate traditional clinical data and include sensitivity analysis or weighted modeling. Moreover, since efforts were made to capture a wide net of hepatotoxic-specific data, the extraction methodology may underrepresent other AEs. Nonetheless, our findings highlight the need for increased awareness and regulation to address a growing public health crisis posed by SARM abuse. Until then, physicians should recognize that patients are increasingly seeking medical advice through social media and that AEs are likely underreported in the literature.