Metabolic and hormonal dysfunction in asymptomatic patient using selective androgen receptor modulators: a case report

Background Selective androgen receptor modulators (SARMs) are becoming increasingly common amongst athletes and the general population, but their side effect profile in human subjects at recreational doses is understudied. Case presentation A 27-year-old asymptomatic male weightlifter presented for an annual physical exam and was coincidentally found to have an abnormal lipid panel, which the patient believed to be due to recreational SARMs (LGD-4033 and S-23) usage. Further work-up revealed elevated liver enzymes suggestive of hepatocellular injury and suppression of the pituitary–gonadal axis. Lipids, hepatic function, and hormones returned to baseline after cessation of SARMs. Conclusions This is the first case report on how SARMs may impact LDL, cause hepatocellular rather than cholestatic liver injury, and alter health markers despite complete lack of symptoms. It is also the first case report on the potential negative effects of the SARM S-23.