Vasireddi Nikhil, Hahamyan Henrik A, Gould Heath P, Gregory Andrew J M, Gausden Elizabeth B, Dodson Christopher C, Voos James E, Calcei Jacob G
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio, USA.
Am J Sports Med. 2025 Mar;53(4):999-1009. doi: 10.1177/03635465241252435. Epub 2025 Jan 5.
Selective androgen receptor modulators (SARMs) are small-molecule compounds that exert agonist and antagonist effects on androgen receptors in a tissue-specific fashion. Because of their performance-enhancing implications, SARMs are increasingly abused by athletes. To date, SARMs have no Food and Drug Administration approved use, and recent case reports associate the use of SARMs with deleterious effects such as drug-induced liver injury, myocarditis, and tendon rupture.
(1) To provide a comprehensive synthesis of the literature pertaining to SARMs from a sports medicine perspective and (2) to provide a better understanding of the clinical effects, treatment protocols, prevalence, and potential contamination associated with athlete-consumed SARMs.
Systematic review; Level of evidence, 4.
A systematic review of the English-language literature from PubMed, Cochrane, and Embase databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles relevant to SARM clinical outcomes, elimination profiles, contamination, safety profiles, prevalence, and doping control were included.
A total of 72 articles from 2003 to 2022 were identified for inclusion. The prevalence of SARM use among athletes is estimated to be 1% to 3%. SARM preclinical and clinical studies reported significant increases in lean body mass and side effects-including bone remodeling, testosterone suppression, and kidney, liver, and prostate enlargement. Thirteen case reports described 15 cases of SARM abuse. All described patients were men, with a median age of 32 years (range, 19-52 years), more than half were identified as athletes (8/15), and all ingested SARMs orally for a mean course of 8 weeks. Five patients described in the case reports explicitly denied "illicit drug use," implying patients may believe their use to be legal. Athletes most commonly purchased SARMs online, and most of these compounds have been shown to be contaminated with other substances, contributing to adverse effects. Athletes reported consuming SARMs at much higher doses than clinically studied, which may increase the risk of the reported side effects, such as liver injury, impaired insulin sensitivity, cardiovascular events, and tendon damage.
The results of this systematic review serve to educate sports medicine clinicians and researchers on how to better identify, diagnose, and treat athlete SARM abuse. SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body-including prostate enlargement and serum testosterone suppression. Identifying and treating SARM abuse requires taking a thorough substance and supplement use history with open communication, providing literature-supported patient education, negotiating SARM discontinuation, and performing multidisciplinary treatment of adverse events. Athlete SARM abuse is increasingly widespread and unsafe, and public health oversight bodies should advocate for regulation of these gray-market compounds.
选择性雄激素受体调节剂（SARMs）是一类小分子化合物，可对雄激素受体产生组织特异性的激动和拮抗作用。由于其具有增强运动表现的作用，SARMs越来越多地被运动员滥用。迄今为止，SARMs尚未获得美国食品药品监督管理局的批准使用，最近的病例报告将SARMs的使用与药物性肝损伤、心肌炎和肌腱断裂等有害影响联系起来。
（1）从运动医学角度对与SARMs相关的文献进行全面综述，（2）更好地了解与运动员使用的SARMs相关的临床效果、治疗方案、流行情况和潜在污染。
系统评价；证据级别，4级。
根据PRISMA（系统评价和Meta分析的首选报告项目）指南，对来自PubMed、Cochrane和Embase数据库的英文文献进行系统评价。纳入与SARM临床结果、消除情况、污染、安全性、流行情况和兴奋剂检测相关的文章。
共纳入2003年至2022年的72篇文章。据估计，运动员中使用SARMs的比例为1%至3%。SARM的临床前和临床研究报告称，瘦体重显著增加，同时伴有副作用，包括骨重塑、睾酮抑制以及肾脏、肝脏和前列腺肿大。13篇病例报告描述了15例SARM滥用案例。所有描述的患者均为男性，中位年龄为32岁（范围19 - 52岁），超过一半被确定为运动员（8/15），且均口服SARMs，平均疗程为8周。病例报告中描述的5名患者明确否认“使用违禁药物”，这意味着患者可能认为自己的使用是合法的。运动员最常通过网络购买SARMs，且大多数此类化合物已被证明被其他物质污染，从而导致不良反应。运动员报告使用的SARMs剂量远高于临床研究剂量，这可能会增加所报告的副作用风险，如肝损伤、胰岛素敏感性受损、心血管事件和肌腱损伤。
本系统评价的结果有助于教育运动医学临床医生和研究人员如何更好地识别、诊断和治疗运动员的SARM滥用。使用SARMs会导致肌肉量增加、肝毒性、心脏毒性、肌腱损伤以及全身的雄激素相关副作用，包括前列腺肿大和血清睾酮抑制。识别和治疗SARM滥用需要详细询问物质和补充剂使用史并进行开放沟通，提供有文献支持的患者教育，协商停用SARM，并对不良事件进行多学科治疗。运动员的SARM滥用日益普遍且不安全，公共卫生监督机构应倡导对这些灰色市场化合物进行监管。
