When Gains Go Wrong: A Case of Selective Androgen Receptor Modulator-Related Liver Injury

Selective androgen receptor modulators (SARMs) causing drug-induced liver injury is a rare, albeit inadequately described, potentially serious side effect for those in the fitness industry looking to maximize muscle growth, strength gain, and fat loss as quickly as possible. We present a case of a patient with drug-induced liver injury after starting Stenabolic, a newer SARM. We report a case of a 40-year-old male who presented with vague gastrointestinal symptoms. Before the presentation, he was relatively healthy but taking multiple over-the-counter supplements. Although he had been taking most of these supplements for a long time without notable side effects, he had recently started taking Stenabolic, a performance-enhancing drug under the SARM category. Laboratory and imaging studies confirmed hepatocellular injury. After ruling out infectious and autoimmune etiology, it was thought that the likely source was Stenabolic. The patient was treated with supportive care and was advised to discontinue Stenabolic. Upon discharge, he began to show clinical improvement. Although there is limited research about Stenabolic, other agents in the SARM class have been implicated in similar patterns of liver injury. Its structural and pharmacologic similarities to anabolic steroids raise concern for hepatotoxicity through an idiosyncratic immune-mediated mechanism. This case highlights the potential hepatotoxicity of performance-enhancing supplements like Stenabolic. With the growing popularity of SARMs and limited regulation, healthcare providers should maintain a high index of suspicion for supplement-induced liver injury. Further research is needed to clarify the safety and mechanisms of these agents. Until then, their use should be discouraged.