SARMs Side Effects: Medical Evidence & Health Risks in 2025

schedule10 min readcalendar_todayUpdated Nov 29, 2025

GUIDE

SARMs carry documented health risks including drug-induced liver injury (DILI), testosterone suppression, and cardiovascular effects. This guide reviews the clinical evidence from 9+ peer-reviewed case studies.

articleDrug-Induced Liver Injury (DILI)

The most serious documented side effect. 9+ peer-reviewed cases show cholestatic hepatitis:

Key Case: RAD-140 (Perananthan 2024)

Peak bilirubin: 708 µmol/L (35x normal)
Pattern: Cholestatic hepatitis with bile plugs
Recovery: Full normalization within 5 months

Mechanism

Bile Salt Export Pump (BSEP) dysregulation
Idiosyncratic immune-mediated response
Individual genetic susceptibility (ABCB11 mutations)

Critical finding: ALL documented cases recovered with drug cessation. No deaths or transplants required.

articleTestosterone Suppression

All SARMs suppress the HPG axis dose-dependently:

LGD-4033 Clinical Trial Data (Basaria 2013)

Dose	Total T	Free T	LH	SHBG
0.1 mg/day	Minimal	Minimal	Minimal	Minimal
0.3 mg/day	Moderate	Suppressed	Suppressed	Suppressed
1.0 mg/day	Significant	Significant	Significant	Dose-dependent

Recovery timeline: 4-16 weeks with proper PCT. Without PCT, recovery can take months.

articleCardiovascular Risk

HDL Cholesterol Suppression (Guo 2022)

Dose	HDL Change	% Decrease
1 mg/day	-5.2 mg/dL	-10%
5 mg/day	-13.4 mg/dL	-26%
15 mg/day	-18.3 mg/dL	-35%

Mechanism: Elevated hepatic lipase (HTGL) activity catabolizes HDL particles. APOA1 reduction up to 40 mg/dL at high doses.

Important caveat: Long-term cardiovascular outcome data is ABSENT. HDL reduction may not directly translate to atherosclerosis risk.

articleVision Side Effects (Andarine S-4)

Unique to Andarine (S-4):

Xanthopsia: Yellow-tinted vision
Nyctopia: Reduced night vision
Impaired adaptation: Slow adjustment between light/dark

Prevalence: ~3% of users. Dose-dependent (threshold ~50mg/day).

Reversibility: ALL cases fully reverse within 2-7 days of cessation. No permanent vision damage reported.

help_outlineFrequently Asked Questions

Most documented side effects (liver injury, testosterone suppression, vision changes) are reversible with drug cessation. Liver recovery takes 3-12 months, testosterone 4-16 weeks with PCT, vision 2-7 days. Long-term effects remain unknown.

RAD-140 and Ligandrol are most frequently implicated in liver injury cases. Andarine (S-4) uniquely causes vision disturbances. Cardarine (technically not a SARM) carries cancer risk based on animal studies.

menu_bookReferences & Sources

[1]RAD-140 Liver Injury Case(Australian Prescriber, 2024)
[2]SARM-Induced DILI Series(PMC/NIH, 2021)

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