SARMs & Liver Health: Hepatotoxicity Risk, Case Studies & Safety Data

RAD-140 Case (Perananthan 2024)

• Patient: Previously healthy male
• Duration: 2 months RAD-140 use
• Peak bilirubin: 708 µmol/L (35x normal)
• Pattern: Cholestatic hepatitis with bile plugs
• Recovery: Full normalization within 5 months

Ligandrol/Ostarine Cases (Koller 2021)

• Patients: Two young men
• Duration: 2-9 weeks SARM use
• Critical finding: Symptoms appeared after stopping SARM and starting PCT
• Peak bilirubin: 401 µmol/L
• Histology: Cholestatic hepatitis with bile duct loss

Implication: PCT drugs may contribute to or trigger liver injury.

All documented cases show cholestatic pattern (bile stasis), NOT hepatocellular destruction:

• Canalicular bile plugs
• Minimal hepatocyte necrosis
• Profound hyperbilirubinemia (100-700+ µmol/L)
• Mild ALT elevation (100-200 U/L range)
• Normal or mildly elevated alkaline phosphatase
• INR mildly elevated but NO fulminant liver failure

Recovery

• 100% documented cases recovered
• Timeline: 3-12 months
• No deaths or liver transplants required

Most Likely: Idiosyncratic Immune-Mediated

1. BSEP Dysregulation: SARMs may disrupt Bile Salt Export Pump (ABCB11), causing bile acid accumulation
2. Genetic susceptibility: ABCB11 mutations and alpha-1-antitrypsin variants may increase risk
3. Metabolite toxicity: SARM metabolites may directly injure hepatocytes via CYP450 pathways

Why it's rare: Idiosyncratic mechanism means individual susceptibility, not dose-dependent toxicity.

Warning Signs (Stop Immediately)

• Jaundice (yellowing of skin/eyes)
• Dark urine
• Right upper quadrant pain
• Severe itching (pruritus)
• Unexplained fatigue

If Symptoms Develop

• Discontinue ALL hepatotoxic substances
• Seek medical evaluation (LFTs, bilirubin)
• Supportive care: hydration, ursodiol for itching
• Avoid alcohol, acetaminophen, herbal supplements
• Weekly liver function monitoring until normalized

Prevention

• Baseline liver function tests before cycle
• Avoid hepatotoxic combinations
• Limit cycle duration
• Consider liver support (NAC, milk thistle)