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Case Reports
. 2025 Jun 7;17(6):e85500.
doi: 10.7759/cureus.85500. eCollection 2025 Jun.

Silent Threats to the Liver: Acute Hepatotoxicity Attributed to Selective Androgen Receptor Modulators (SARMs)

Bola Habeb  1 , Otto Valdes  1 , Sandy Khair  2 , Erica S Thomson  1
Affiliations
Case Reports

Silent Threats to the Liver: Acute Hepatotoxicity Attributed to Selective Androgen Receptor Modulators (SARMs)

Bola Habeb et al. Cureus. .

Abstract

Selective androgen receptor modulators (SARMs) have garnered significant attention in recent years due to their potential to improve muscle mass and athletic performance with reduced androgenic side effects compared to traditional anabolic steroids. However, despite their growing popularity, there is increasing evidence linking SARMs to acute liver injury, raising concerns regarding their safety profile. SARMs can disrupt normal liver function through various pathways, including oxidative stress, alterations in lipid metabolism, and direct hepatocellular toxicity. This article explores the association between SARMs and acute liver injury, examining the mechanisms of hepatotoxicity, clinical manifestations, and potential therapeutic approaches. The findings underscore the need for further research and regulatory oversight in using SARMs, particularly in non-medical and performance-enhancing contexts.

Keywords: acute hepatotoxicity; acute liver injury; androgen receptors; drug-induced liver injury (dili); muscle growth supplements; non-medical use of sarms; painless jaundice; performance-enhancing drugs; sarms; sarms safety profile.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Right upper quadrant ultrasound with Doppler.
(A) Contracted gallbladder without evidence of cholelithiasis or biliary ductal dilatation. (B) Normal-caliber portal vein without evidence of portal vein thrombosis.
Figure 2
Figure 2. Coronal view of a contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis demonstrating no evidence of acute intra-abdominal pathology.
Figure 3
Figure 3. Magnetic resonance cholangiopancreatography (MRCP).
(A) Coronal T2-half-Fourier acquisition single-shot turbo spin-echo (HASTE) imaging shows a normal course and caliber of the common bile duct (CBD), without evidence of intrahepatic or extrahepatic biliary ductal dilatation. (B) T2-half-Fourier acquisition single-shot turbo spin-echo (HASTE) with fat saturation (fs), utilizing a slab and three-angle technique, demonstrated a normal course and caliber of the common bile duct (CBD) without evidence of intrahepatic or extrahepatic biliary ductal dilatation.
Figure 4
Figure 4. Aminotransferases and alkaline phosphatase trend.
Graph showing aminotransferases and ALP trend over 45 days. ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase
Figure 5
Figure 5. Total and direct bilirubin trend.
Notably, total bilirubin peaked at 27 mg/dL and trended down to 5.8 mg/dL at 45 days.
See this image and copyright information in PMC

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