SARMs vs. Steroids: What Are the Similarities and Differences?

Dr George TouliatosDisclaimer: The following article is for educational purposes only and does not promote the use of illegal substances. If you have any questions or concerns, Dr. Touliatos is currently available for consultation.


Scientists have formulated SARMs (selective androgen receptor modulators) as a potential treatment for cachexia. SARM manufacturers claim they mimic the effects of steroids for building muscle mass, yet with fewer side effects.

Discover how SARMs really compare to steroids, based on existing medical research, anecdotal evidence, and observations.

If SARMs are found to be safe, they will be used in medicine in the same way that anabolic steroids are: to help people with muscle wasting, anemia, osteoporosis, red blood cell count, and low bone mineral content.

How Do They Promote Anabolism?

SARMs and steroids both strongly bind to the androgen receptor to promote muscle building, strength, and fat loss in users.

However, new-generation SARMs, formulated in the late 1990s, are non-steroidal and thus not exogenous testosterone. Consequently, this has sparked debate among the bodybuilding community, with the claim of being able to take SARMs and remain natural.

A unique structural characteristic of SARMs is tissue selectivity. This is a mechanism that aims to stimulate anabolism in desirable cells while inhibiting unwanted effects in others, thus potentially eliminating or reducing the side effects associated with anabolic steroids. However, in practice, we have not found this to be accurate, with SARMs possessing comparable levels of toxicity to anabolic steroids.

Disclosure: We do not accept any form of advertising on Inside Bodybuilding. We monetize our practice via doctor consultations and carefully chosen supplement recommendations, which have given our patients excellent results.

What Are the Legal Restrictions?

The US and many other countries around the world classify anabolic steroids as Schedule 3-controlled substances, making them illegal. A doctor’s prescription for specific steroids, such as testosterone for hypogonadism, is the only exception to this rule.

The legality of SARMs is less clear. They are legal to purchase for research purposes; thus, if researchers are acquiring SARMs to administer liquid drops to rodents and observe the effects, this is within the confines of the law.

However, as SARMs have not been approved by the FDA for human use, they are technically illegal to purchase or sell for human consumption due to their recent formulation and long-term effects not yet being established.

Which is the More Anabolic Substance?

SARMs and anabolic steroids produce similar benefits for users, namely increased muscle mass, strength, and fat loss, albeit to varying degrees.

There is medical research to suggest users’ results on anabolic steroids are enhanced compared to SARMs, with the latter building a portion of the lean mass in comparison. Our anecdotal findings also support this viewpoint.

  • Researchers found that administering SARMs to humans increased their fat-free mass by 1–1.5 kg over 4–6 weeks (1).
  • In comparison, the testosterone enanthate group gained 5–7 kg in fat-free mass on dosages of 300 and 600 mg/week.

Furthermore, Dr. Thomas O’Connor has observed major adverse effects in numerous patients on SARMs, relating to their cholesterol and liver profiles. Yet he mentions such patients reporting “little to no change” in body composition.

What Are the Potential Risks of Steroids and SARMs?

steroids
We have almost a century’s worth of medical research concerning anabolic steroids’ effects since the creation of testosterone in 1935. Thus, steroids’ benefits, side effects, and safety are better understood in the short and long term.

In contrast, we have a limited amount of research available on SARMs, particularly concerning their effects on humans, due to their more recent discovery. Therefore, SARMs are classified as investigational drugs, unlike anabolic steroids.

The FDA has previously approved several anabolic steroids for use in medicine, including Anavar (oxandrolone), testosterone, and Deca Durabolin (nandrolone). Thus, the FDA once deemed them safe for treating chronic diseases under medical supervision in therapeutic doses. For instance, doctors have successfully prescribed Anavar to men, women, and children historically for cachexia, demonstrating its less toxic nature and tolerance under the care of physicians.

What Has Dr. O’Connor Observed?

Dr. Thomas O’Connor, part of our medical team, has treated thousands of men on anabolic steroids for almost two decades. In contrast, he has treated over 2,000 men on SARMs, accumulating data over a 10-year period. Based on Dr. O’Connor’s anecdotal evidence and extensive analysis of patients’ labs, he concludes that SARMs are “more dangerous” than anabolic steroids in the dosages commonly administered. The main SARM side effects he has observed include:

  1. Cardiovascular strain
  2. Testosterone suppression
  3. Liver stress

Dr. O’Connor likens the hepatotoxic effects of SARMs to the “equivalent of taking a large dose of Anavar, such as 50 mg/day.”

The FDA has also found evidence of liver and cardiovascular complications in SARM users in the short term. In 2017, the FDA labeled SARMs as “potentially dangerous” and successfully shut down numerous online websites that were labeling SARMs as dietary supplements for human use instead of research chemicals.

What Has Dr. Israetel Observed?

Dr. Mike Israetel states that, despite SARMs being “relatively safe, they are not risk-free.” Furthermore, Dr. Israetel warns that SARMs’ adverse effects are similar to anabolic steroids with potentially less reward.

However, some of our patients report taking SARMs, such as ostarine, without experiencing any notable side effects. Therefore, SARMs may present reduced toxicity compared to anabolic steroids, depending on the type of SARM, dosages, and how the individual responds to it based on their own body chemistry.

SARMs vs. Steroids: How Do the Adverse Effects Compare?

In theory, SARMs’ side effects should be milder than those of anabolic steroids due to the mechanics of tissue selectivity. However, in practice, we have observed SARMs’ side effects to be similar to anabolic steroids’.

Blood Pressure

One of the drawbacks of anabolic steroids is their negative effects on HDL, LDL, and blood pressure.
Different steroids will pose varying levels of cardiovascular risk. For example, oral steroids such as Dianabol or Anadrol can cause notable fluctuations in cholesterol, increasing the risk of hypertension. However, injectable steroids, such as testosterone or Deca Durabolin, have less toxic effects on blood lipids.

Based on patients’ lipid profiles, we have evidence of SARMs notably reducing HDL cholesterol levels and increasing the risk of arteriosclerosis.

We find SARMs’ negative effects on the heart to be similar in severity to steroid tablets, due to the same method of oral administration.

When SARMs and steroids are taken by mouth, they are broken down by the liver. This increases the hepatic lipase enzyme and lowers HDL cholesterol.

Dr. Rand McClain has observed that “mild” SARMs, including Ostarine, cause deleterious effects on HDL cholesterol. Dr. McClain says, “From a medical perspective, it is a no-brainer (to administer anabolic steroids over SARMs),” as they are more extensively researched and superior in terms of anabolism.

Liver Toxicity

As previously mentioned, liquid SARMs will be broken down by the liver, causing ALT and AST enzymes to rise, signifying inflammation and stress for the organ.

This is a similar effect to C-17 alpha-alkylated oral steroids, which have the potential to cause liver damage if abused.

Researchers have found that SARMs can damage the liver after two healthy men developed hepatocellular-cholestatic injuries. The first male used LGD-4033 for 9 weeks, and the second male used RAD 140 (testolone) for 4 weeks (2).

We find these outcomes to be concerning, due to the short nature of use and given the typical resilience of the liver, which displays self-healing properties (3). However, some SARM users’ ALT and AST enzymes do not rise to clinically high levels, and thus, there may be additional lifestyle factors that can exacerbate SARMs’ hepatotoxicity.

Testosterone Suppression

Anabolic steroids are forms of exogenous testosterone. Thus, when the body detects excessive levels of artificial testosterone, it shuts down natural production.

When a steroid cycle ceases, users may experience hypogonadal effects, such as the following:

  • Diminished libido
  • Sexual function
  • Low energy
  • Decreased well-being

The above side effects are typically temporary, lasting several weeks or months, depending on the steroids used. However, if an individual abuses anabolic steroids, these symptoms may be experienced long-term.

Anavar or Primobolan may cause a moderate drop in testosterone, while stronger compounds like Anadrol or trenbolone can cause clinical hypogonadism.

SARMs have a strong affinity for the androgen receptor, which can lower the amount of testosterone your body produces naturally (4). This results in a similar, transient effect on testosterone levels, like steroids.

The extent of testosterone suppression is not yet fully known with SARMs. However, we have seen 60–70% reductions in total testosterone via our SHBG tests. It is also common practice for bodybuilders to utilize post-cycle therapies following SARM cycles in an attempt to recover their natural testosterone production. Therefore, one can anticipate moderate interference with the HPTA (hypothalamic-pituitary-testicular axis) on SARMs.

We see the more potent SARMs exacerbating natural testosterone, such as LGD-4033 and RAD 140. However, milder SARMs, such as S4 and MK-2866, have a less negative effect.

Gynecomastia

Certain anabolic steroids can cause gynecomastia, which is essentially the expansion of breast tissue in men. This occurs due to the aromatase enzyme converting testosterone into estrogen. Other steroids can directly stimulate the estrogen receptors at a cellular level, such as Anadrol, which does not have the aromatase enzyme present.

SARMs do not aromatize. However, they can indirectly elevate estrogen levels, resulting in gynecomastia. This occurs due to SARMs competing with a user’s natural testosterone for binding to the androgen receptor. SARMs win this battle due to their significantly higher binding affinity. This results in natural testosterone levels being more readily available for binding to estrogen and DHT receptors.

Thus, gynecomastia remains possible on SARMs, in conjunction with water retention and hair loss. However, estrogenic side effects are often less prominent compared to aromatizing anabolic steroids.

Researchers can use a mild anti-aromatase inhibitor such as arimistane during SARM cycles to counteract the side effects of estrogen.

In contrast, we see bodybuilders typically utilize more potent AIs or SERMs during steroid cycles to counteract estrogenic effects.

Note: There are dry steroids that do not raise estrogen levels, creating a dry physique that decreases the risk of gynecomastia. Four examples of such compounds are:

  1. Anavar
  2. Superdrol
  3. Turinabol
  4. Winstrol

Anavar vs. SARMs: How Do Their Effects Differ?

Anavar has been the subject of continuous research for over 50 years. Thus, there is extensive clinical data detailing its effects. In contrast, the arrival of SARMs is more recent. Therefore, we do not entirely understand their effects.

Our patients on SARMs have experienced mixed results. Some users notice moderate muscle gains, while others fail to notice any significant benefits.

SARM users at our clinic have reported side effects equal to or worse than Anavar, relating to:

  • Suppressed testosterone levels
  • Elevated liver enzymes
  • Low HDL cholesterol levels

Dr. O’Connor believes a moderate dose of Anavar is not only less toxic than SARMs but also more efficacious, with increased anabolism and fat loss. However, further scientific research is required on selective androgen receptor modulators in order to reach this conclusion.

SARMs are legal for research and typically do not cause masculinization in women. Anavar is illegal to purchase in most countries, and in high doses, it poses the risk of virilization. Purchasing Anavar can be a more risky endeavor for women because underground lab products often do not contain Anavar but Dianabol, which causes masculinizing effects. However, acquiring genuine SARMs eliminates this risk.

Administration Methods: How Do They Compare?

Anabolic steroids are typically available in injectable or oral form. However, due to SARMs being classified as research chemicals, they are less commonly manufactured in tablet form but instead as a liquid.

There are no official dosing or administration guidelines for humans, as SARMs are currently only intended for research purposes.

Bodybuilders typically administer liquid SARMs orally, either by swallowing immediately or placing the liquid under the tongue (sublingually) and letting it sit for 10–15 seconds before swallowing. The latter method allows for greater absorption via contact with the mucous membrane.

testosterone steroid bottle
Orals can cause hepatic stress because the liver must break them down once they enter the bloodstream (5). Orals commonly elevate hepatic lipase, exacerbating blood pressure via the reduction of HDL cholesterol.

When comparing SARMs vs. steroids for methods of entry, SARMs may be more straightforward for some users, as they are predominantly oral drugs and do not require injections.

However, when swallowing liquid SARMs, they can have a strong or foul taste that lingers afterward.

How Do SARMs Interact With Women?

We find that most anabolic steroids are not suitable for women due to high incidents of virilization or masculinization.

Women utilizing anabolic steroids may experience:

  • Clitoral hypertrophy
  • Breast atrophy
  • A deeper voice
  • Irregular menstrual cycles
  • Hirsutism

There are exceptions to this rule, such as Anavar, which females can cycle in conservative dosages and commonly avoid masculine side effects with.

Despite the paucity of research on the virilizing effects of SARMs, our anecdotal findings indicate that women do not experience such effects because their tissue selectivity inhibits androgenicity. However, notable risks to the liver and heart still apply to women taking SARMs.

Are There Counterfeit Products?

counterfeit SARMs
The black market frequently counterfeits both anabolic steroids and SARMs, posing health risks to users.

Physicians prescribe specific anabolic steroids for medical purposes, which can later appear on the black market. Medical professionals formulate pharmaceutical-grade steroids in a laboratory, ensuring users receive the correct active ingredient and dose.

Due to a lack of FDA approval, doctors currently do not prescribe pharmaceutical-grade SARMs. Therefore, it may be equally challenging to find a reliable SARM source that meets the label’s specifications as it is to find pharmaceutical-grade steroids.

Reviews

Researchers have published these steroid and SARM anecdotes in our private Facebook group.

I like SARMs; they do the job but can be suppressive like most all PEDs. MK-2866 is probably the safest and least suppressive. RAD 140 is my favorite but can get pretty suppressive, and I’ve used every one of them. But the key to all PEDs is blood work.


SARMs are super easy to get a hold of. A lot fewer side effects, but there is a ceiling. It really depends on your ultimate goal. Long term, it’s going to be SARMs for me because I’m not competing. For me, having an option where I don’t have to stab myself with stuff is a huge plus.


Technically not a SARM, but I love MK 677, especially when bulking. Side effect of being hungry all the time. Find you sleep a lot better on it as well.


SARMs are weak steroids that still reduce or shut down your test in most cases. If you are going to use PEDs, stick with the old tried-and-true AAS.


I’ve tried SARMs. They work. If you use actual gear, YK-11 could be interesting to you. The ones for muscle gain are nowhere near the effectiveness of gear. However, the ones to increase endurance are a nice addition to a tren cycle.

SARMs vs. Steroids: Which Are More Favorable?

injectable steroids
Based on existing studies and our anecdotal data, there is evidence to suggest SARMs can cause toxicity similar to anabolic steroids.

SARMs also produce less anabolism compared to anabolic steroids. Therefore, the risk-to-reward ratio at this stage may be more optimal for anabolic steroids than SARMs. This is especially true when administering less toxic steroids such as testosterone, which US physicians prescribed to over 1,000,000 men in 2017 (6).

Co Authors :

  • A 7% mean increase in ALT levels was observed in patients receiving SARM treatment (7).
  • A 31-year-old male was diagnosed with cholestatic liver injury following 2 months of Anavar use (8).
  • The risk of hepatocellular carcinoma notably increases following 5 to 15 years of anabolic steroid use (9).
  • A Stockholm laboratory conducting male urine analysis found 4% of male samples to contain SARMs (10).
  • One study found that 72% of SARM users are aged between 18 and 29 (11).
  • A 24-year-old male's tests indicated total bilirubin levels of 38.5 mg/dL following 5 weeks of RAD 140 supplementation (12).
  • Research has shown that RAD 140 can increase AST levels in humans by as much as 59% (13).
  • A study found SARMs to reduce tumor weight by over 90% in breast cancer sufferers (14).