Endocrine Abstracts

Introduction: SARMs (Selective Androgen Receptor Modulators) are non-steroidal anabolics and should improve body strength, muscle building and aid in burning excess fat. There have been ongoing clinical trials regarding positive effects of SARMs in patients with cancer cachexia, hypogonadism, benign prostatic hyperplasia, breast cancer, Alzheimeŕs disease, osteoporosis etc. with conflicting results. Liver injury and cardiovascular disease are possible severe side-effects. For these reasons, SARMs have not been officially approved. Nevertheless, SARMs can be freely purchased on the market as supplements.

Case report: A 29-year-old male was examined due to gynecomastia, which has persisted since puberty. The patient wished to undergo surgical treatment. Medical history: negative. Occupation: croupier in a casino. No history of smoking, alcohol, or drugs. On physical examination: 179 cm, 89 kg, BMI 27.8 kg/m², muscular constitution, gynecomastia negative. Breast ultrasound described chronic signs of gynecomastia. Laboratory results: Cholesterol 2.78 (2.90-5.00 mmol/l), HDL cholesterol 0.46 (1.00-2.10 mmol/l), LDL cholesterol 2.12 (1.20-3.00 mmol/l), triglycerides 0.53 (0.45-1.70 mmol/l). Liver enzymes: Bilirubin total 9.4 (2.5-21.0 μmol/l), ALT 4.55 (0.17-0.83 μkat/l), AST 1.40 (0.17-0.85 μkat/l), GGT 0.24 (0.17-1.19 μkat/l). Hormonal profile: LH <0.1 (1.7–8.6 IU/l), FSH 0.1 (1.5–12.4 IU/l), testosterone (TST)> 100.00 (10-34 nmol/l), free TST (calculated using TST, SHBG, albumin) 3507.5 (168-735 pmol/l), Free Androgen Index (FAI) (TST/SHBG) 4347.83 (30-150%), dihydrotestosterone 7.96 (0.90-3.60 nmol/l), estradiol 0.579 (0.0948–0.223 nmol/l), androstendion 87.80 (2.16-10.90 nmol/l), progesterone 0.862 (0.00–0.474 nmol/l), and SHBG 2.3 (7.9-38.2 nmol/l). The patient admitted using SARMs for body-building purposes. Laboratory results after stopping SARMs: normalization of the liver enzymes. Hormonal profile: LH <0.1 IU/l, FSH <0.1 IU/l, TST 47.04 nmol/l, free TST 1613.7 pmol/l, FAI 855.27%, SHBG 5.5 nmol/l. The patient conceded using also TST i.m. weekly and discontinued his follow-ups.

Conclusion: SARMs should have more selective effects (more anabolic and less androgenic) with less side-effects when compared to testosterone. Clear evidence is lacking, and persons, especially the male population should be advised of the potential for harm.