THE SARM-DEMIC: SOCIAL MEDIA ALGORITHMS, E-COMMERCE LOOPHOLES, AND THE NORMALIZATION OF EXPERIMENTAL PHARMACOLOGY IN RECREATIONAL USERS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6351Keywords:
Selective Androgen Receptor Modulators, Drug-Induced Liver Injury, Muscle Dysmorphia, Experimental Pharmacology, Social Media Algorithms, E-CommerceAbstract
The epidemiology of performance- and image-enhancing drug (PIED) use has shifted toward non-athlete recreational users who primarily seek cosmetic physical changes. This review evaluates the unregulated distribution of Selective Androgen Receptor Modulators (SARMs). We analyze this trend at the intersection of experimental pharmacology, social media algorithms, and e-commerce loopholes. We comprehensively synthesized the literature to contrast the clinical intent of investigational SARMs with the toxicological reality of digital markets. Phase II trials demonstrated that tissue-selective compounds like enobosarm increase lean body mass at controlled micro-doses ranging from 0.1 to 3 mg daily. However, the online market promotes supraphysiological dosing regimens exceeding 20 mg daily. Chemical analyses reveal widespread mislabeling and cross-contamination with unapproved experimental compounds, including PPAR-δ agonists and growth hormone secretagogues. Recreational dosing bypasses tissue selectivity. Case reports document severe lipid dysregulation, hypogonadotropic hypogonadism requiring unmonitored post-cycle therapy, and idiosyncratic drug-induced liver injury (DILI). Histologically, these hepatic injuries predominantly show bland centrilobular canalicular cholestasis, though instances of significant hepatocellular injury have also been documented. SARM misuse is exacerbated by social media, where young adults enter algorithmic echo chambers that amplify muscle dysmorphia and minimize pharmacological risks. Addressing SARM misuse requires an update to traditional anti-doping frameworks, with public health strategies focusing on e-commerce regulation, algorithmic transparency, and targeted diagnostic training for clinicians.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Basaria, S., Coviello, A. D., Travison, T. G., Storer, T. W., Farwell, W. R., Jette, A. M., Eder, R., Tennstedt, S., Ulloor, J., Zhang, A., Choong, K., Lakshman, K. M., Mazer, N. A., Miciek, R., Krasnoff, J., Elmi, A., Knapp, P. E., Brooks, B., Appleman, E., ... Bhasin, S. (2010). Adverse events associated with testosterone administration. New England Journal of Medicine, 363(2), 109-122. https://doi.org/10.1056/NEJMoa1000485
Bhasin, S., & Jasuja, R. (2009). Selective androgen receptor modulators as function promoting therapies. Current Opinion in Clinical Nutrition & Metabolic Care, 12(3), 232-240. https://doi.org/10.1097/MCO.0b013e32832a3d79
Bonnecaze, A. K., O'Connor, T., & Burns, C. A. (2021). Harm reduction in male patients actively using anabolic androgenic steroids (AAS) and performance-enhancing drugs (PEDs): a review. Journal of General Internal Medicine, 36(7), 2055-2064. https://doi.org/10.1007/s11606-021-06751-3
Brennan, B. P., Kanayama, G., & Pope, H. G., Jr. (2013). Performance-enhancing drugs on the web: A growing public-health issue. The American Journal on Addictions, 22(2), 158–161. https://doi.org/10.1111/j.1521-0391.2013.00311.x
Chong, S., Woolnough, C. A., Koyyalamudi, S. R., & Perera, N. J. (2024). Reversible gynecomastia and hypogonadism due to usage of commercial performance-enhancing supplement use. JCEM Case Reports, 2(8), luae148. https://doi.org/10.1210/jcemcr/luae148
Cinelli, M., Morales, G. D. F., Galeazzi, A., Quattrociocchi, W., & Starnini, M. (2021). The echo chamber effect on social media. Proceedings of the National Academy of Sciences, 118(9), e2023301118. https://doi.org/10.1073/pnas.2023301118
Dalton, J. T., Barnette, K. G., Bohl, C. E., Hancock, M. L., Rodriguez, D., Dodson, S. T., Morton, R. A., & Steiner, M. S. (2011). The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: Results of a double-blind, placebo-controlled phase II trial. Journal of Cachexia, Sarcopenia and Muscle, 2(3), 153–161. https://doi.org/10.1007/s13539-011-0034-6
Danan, G., & Teschke, R. (2015). RUCAM in drug and herb induced liver injury: The update. International Journal of Molecular Sciences, 17(1), 14-35. https://doi.org/10.3390/ijms17010014
European Association for the Study of the Liver. (2019). EASL Clinical Practice Guidelines: Drug-induced liver injury. Journal of Hepatology, 70(6), 1222-1261. https://doi.org/10.1016/j.jhep.2019.02.014
Fearon, K., Strasser, F., Anker, S. D., Bosaeus, I., Bruera, E., Fainsinger, R., Jatoi, A., Loprinzi, C., MacDonald, N., Mantovani, G., Davis, M., Muscaritoli, M., Ottery, F., Radbruch, L., Ravasco, P., Walsh, D., Wilcock, A., Kaasa, S., & Baracos, V. (2011). Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology, 12(5), 489-495. https://doi.org/10.1016/S1470-2045(10)70218-7
Gadaj, A., Ventura, E., Ripoche, A., & Mooney, M. H. (2019). Monitoring of selective androgen receptor modulators in bovine muscle tissue by ultra-high performance liquid chromatography-tandem mass spectrometry. Food Chemistry: X, 4, 100056. https://doi.org/10.1016/j.fochx.2019.100056
Gao, W., Bohl, C. E., & Dalton, J. T. (2005). Chemistry and structural biology of androgen receptor. Chemical Reviews, 105(9), 3352-3370. https://doi.org/10.1021/cr020456u
Gaudiano, M. C., Aureli, F., Manna, L., Borioni, A., Maccelli, A., Raimondo, M., De Giorgi, D., & Bartolomei, M. (2024). Illegal products containing selective androgen receptor modulators purchased online from Italy: Health risks for consumers. Sexual Medicine, 12(2), qfae018. https://doi.org/10.1093/sexmed/qfae018
Habeb, B., Valdes, O., Khair, S., & Thomson, E. S. (2025). Silent threats to the liver: Acute hepatotoxicity attributed to selective androgen receptor modulators (SARMs). Cureus, 17(6), e85500. https://doi.org/10.7759/cureus.85500
Kaufman, M. J., Hudson, J. I., Kanayama, G., Muse, S., Schnabel, J., Sokoll, R., & Pope, H. G., Jr. (2024). A study of long-term supraphysiologic-dose anabolic-androgenic steroid use on cognitive function in middle-aged men. The American Journal of Drug and Alcohol Abuse, 50(5), 670-681. https://doi.org/10.1080/00952990.2024.2403582
Labban, H., Kwait, B., Paracha, A., Islam, M., & Kim, D. O. (2024). LGD-4033 and a case of drug-induced liver injury: Exploring the clinical implications of off-label selective androgen receptor modulator use in healthy adults. Cureus, 16(9), e69601. https://doi.org/10.7759/cureus.69601
Leciejewska, N., Jędrejko, K., Gómez-Renaud, V. M., Manríquez-Núñez, J., Muszyńska, B., & Pokrywka, A. (2024). Selective androgen receptor modulator use and related adverse events including drug-induced liver injury: Analysis of suspected cases. European Journal of Clinical Pharmacology, 80(2), 185–202. https://doi.org/10.1007/s00228-023-03592-3
Machek, S. B., Cardaci, T. D., Wilburn, D. T., & Willoughby, D. S. (2020). Considerations, possible contraindications, and potential mechanisms for deleterious effect in recreational and athletic use of selective androgen receptor modulators (SARMs) in lieu of anabolic androgenic steroids: A narrative review. Steroids, 164, 108753. https://doi.org/10.1016/j.steroids.2020.108753
Nagata, J. M., Hur, J. O., Murakami, K., Ganson, K. T., He, J., Murray, S. B., & Lavender, J. M. (2023). Muscle dysmorphia in adolescents and young adults. The Lancet Child & Adolescent Health, 7(7), 504–515. https://doi.org/10.1016/S2352-4642(25)00283-4
Narayanan, R., Mohler, M. L., Bohl, C. E., Miller, D. D., & Dalton, J. T. (2008). Selective androgen receptor modulators in preclinical and clinical development. Nuclear Receptor Signaling, 6(1), e010. https://doi.org/10.1621/nrs.06010
Perananthan, V., & George, J. (2024). Severe liver injury following use of RAD-140, a selective androgen receptor modulator, for body building. Australian Prescriber, 47(1), 26–28. https://doi.org/10.18773/austprescr.2024.004
Pope, H. G., Jr., Wood, R. I., Rogol, A., Nyberg, F., Bowers, L., & Bhasin, S. (2014). Adverse health consequences of performance-enhancing drugs: An Endocrine Society scientific statement. Endocrine Reviews, 35(3), 341–375. https://doi.org/10.1210/er.2013-1058
Scarth, M., Havnes, I. A., Jørstad, M. L., McVeigh, J., Van de Ven, K., & Bjørnebekk, A. (2023). Investigating anabolic-androgenic steroid dependence and muscle dysmorphia with network analysis among male weightlifters. BMC Psychiatry, 23(1), 342. https://doi.org/10.1186/s12888-023-04781-1
Svensson, J., Lönn, L., Jansson, J. O., Murphy, G., Wyss, D., Krupa, D., ... & Bengtsson, B. A. (1998). Two-month treatment of obese subjects with the oral growth hormone (GH) secretagogue MK-677 increases GH secretion, fat-free mass, and energy expenditure. The Journal of Clinical Endocrinology & Metabolism, 83(2), 362-369. https://doi.org/10.1210/jcem.83.2.4539
Thevis, M., & Schänzer, W. (2018). Detection of SARMs in doping control analysis. Molecular and Cellular Endocrinology, 464, 34-45. https://doi.org/10.1016/j.mce.2017.01.040
U.S. Food and Drug Administration. (2023). FDA Warns of Use of Selective Androgen Receptor Modulators (SARMs) Among Teens, Young Adults. https://www.fda.gov/consumers/consumer-updates/fda-warns-use-selective-androgen-receptor-modulators-sarms-among-teens-young-adults
Van Wagoner, R. M., Eichner, A., Bhasin, S., Deuster, P. A., & Eichner, D. (2017). Chemical composition and labeling of substances marketed as selective androgen receptor modulators and sold via the internet. JAMA, 318(20), 2004–2010. https://doi.org/10.1001/jama.2017.17069
Vasilev, V., Boyadjiev, N., Hrischev, P., Gerginska, F., Delchev, S., Arabadzhiyska, D., Komrakova, M., Boeker, K. O., Schilling, A. F., & Georgieva, K. (2024). Ostarine blunts the effect of endurance training on submaximal endurance in rats. Naunyn-Schmiedeberg's Archives of Pharmacology, 397(9), 6523–6532. https://doi.org/10.1007/s00210-024-03030-w
Vasilev, V., Georgieva, K., Arabadzhiyska, D., Delchev, S., Gerginska, F., Komrakova, M., Boeker, K. O., Schilling, A. F., & Boaydjiev, N. (2025). Ligandrol lowers endurance and negatively affects lipid and hormonal profile of male rats. Naunyn-Schmiedeberg's Archives of Pharmacology, 398(9), 11975–11987. https://doi.org/10.1007/s00210-025-04028-8
Vignali, J. D., Pak, K. C., Beverley, H. R., DeLuca, J. P., Downs, J. W., Kress, A. T., Sadowski, B. W., & Selig, D. J. (2023). Systematic review of safety of selective androgen receptor modulators in healthy adults: Implications for recreational users. Journal of Xenobiotics, 13(2), 218-236. https://doi.org/10.3390/jox13020017
Weinblatt, D., & Roy, S. (2022). Drug-induced liver injury secondary to enobosarm: A selective androgen receptor modulator. Journal of Medical Cases, 13(5), 244–248. https://doi.org/10.14740/jmc3937
World Anti-Doping Agency. (2013). WADA issues alert on GW501516. https://www.wada-ama.org/en/news/wada-issues-alert-gw501516
World Anti-Doping Agency. (2024). The Prohibited List. https://www.wada-ama.org/en/prohibited-list
Yin, D., Gao, W., Kearbey, J. D., Xu, H., Chung, K., He, Y., Marhefka, C. A., Veverka, K. A., Miller, D. D., & Dalton, J. T. (2003). Pharmacodynamics of selective androgen receptor modulators. Journal of Pharmacology and Experimental Therapeutics, 304(3), 1334-1340. https://doi.org/10.1124/jpet.102.040840
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Stanisław Kucharczyk, Filip Sarek, Karol Jóźwik, Zuzanna Rak, Zuzanna Ignatowska, Alicja Maria Wielogórska, Aleksander Kamecki, Karolina Dzień
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
