A few months back, a guy in one of my online coaching groups DM'd me after I posted a progress photo comparison. He wasn't asking about my programming or my macros. He wanted to know what I thought about "just doing one cycle" to break through a plateau he'd been stuck at for a year. He'd been watching guys online talk about gear like it was a vitamin, and SARMs marketed everywhere as the "safe, natural-ish" alternative. He wasn't looking for a lecture. He just wanted the truth.
Here's the thing — I've been coaching for 15 years, and I've had versions of this conversation more times than I can count. I'm not here to shame anybody for asking. Plateaus are frustrating, and the fitness industry is loud with bro science that makes performance-enhancing drugs sound like a shortcut with no real downside. But "no bro science" is the whole point of how I coach, which means when a client asks me this, I owe him the actual research, not my gut feeling and not internet mythology.
So that's what this post is. No dosing talk, no "how it's done" — that's not the point here, and it's not my lane. What I can do is walk you through what peer-reviewed research has actually found about what anabolic-androgenic steroids (AAS) and SARMs do to your body. If you're going to make a decision about your health, make it with real information, not gym-locker-room folklore.
Cardiovascular Risks
Your heart takes this seriously even when you don't feel it yet. One of the most cited studies here comes from Baggish and colleagues, published in Circulation in 2017, comparing long-term AAS users to non-using weightlifters with similar training backgrounds. The findings were sobering: AAS users showed reduced left ventricular function — meaning the heart's main pumping chamber didn't squeeze blood out as efficiently — along with a higher coronary plaque burden, the kind of artery buildup that's a known driver of heart attacks. The study was specifically designed to isolate steroid use as the variable, and the differences showed up even in otherwise fit, athletic men.
That matters because cardiovascular damage is often silent. You don't feel your ejection fraction dropping or plaque quietly building in your arteries. You feel fine, you're lifting heavier, your physique is changing — and underneath that, your cardiovascular system may be absorbing stress it wasn't built to handle. This is the risk category I'd call most serious, because it's the one most likely to show up years later as something life-threatening rather than something you notice mid-workout.
Liver and Hepatotoxicity Risks
Next up is your liver, and this is where both steroids and SARMs show up in the research — which surprises a lot of guys who've been told SARMs are the "safer" option. A 2017 review by Solimini and colleagues in the European Review for Medical and Pharmacological Sciences compiled evidence on AAS-induced hepatotoxicity, documenting liver damage ranging from elevated liver enzymes to more serious conditions like cholestasis (impaired bile flow) and, in some reported cases, liver tumors — particularly with oral compounds, which are processed directly through the liver.
Here's where it gets relevant for the "SARMs are safer" crowd: they're not off the hook. Case reports in the Ochsner Journal (Leung et al., 2022) and the Journal of Medical Case Reports (Likhitsup et al., 2023) both documented drug-induced liver injury in otherwise healthy young men who'd used RAD-140 (sold under names like Testolone). These weren't guys with pre-existing liver issues — they developed jaundice and significant liver enzyme elevation after using a product marketed as a research chemical or supplement. The FDA's own 2025 consumer update on SARMs echoes this, warning that these compounds are unapproved and have been linked to liver injury, among other serious health risks, in teens and young adults using them for bodybuilding.
Hormonal and Fertility Risks
This is the one guys ask me about most, probably because it hits close to home for anyone thinking about having kids someday. When you introduce exogenous testosterone or other androgens into your body, your own hormonal production system — the hypothalamic-pituitary-gonadal axis — senses plenty of hormone already circulating and shuts down its own signal to produce more. Rahnema and colleagues laid this out in a 2014 paper in Fertility and Sterility, describing AAS-induced hypogonadism: suppressed natural testosterone production, shrinking testicles, and significantly reduced sperm production, sometimes dropping to zero.
The part that catches guys off guard is that this doesn't always reverse quickly, or fully, once you stop. Recovery of natural hormone production and fertility can take months, and for some men takes much longer or doesn't fully return to baseline. If building a family is part of your future, this is a risk worth sitting with, not glossing over.
Mental Health and Mood Risks
This part of the conversation tends to get dismissed as "roid rage" jokes, but there's real controlled research behind it. Pope, Kouri, and Hudson ran a randomized, double-blind, placebo-controlled trial, published in 2000 in the Archives of General Psychiatry, giving normal men supraphysiologic (above-normal) doses of testosterone versus a placebo. A meaningful subset of men experienced significant increases in manic-type symptoms — irritability, aggression, mood instability — directly tied to the hormone dose, not to any pre-existing psychological profile. Some men showed almost no mood change at all, which tells us the effect isn't universal, but it is real and measurable in controlled conditions, not just anecdote. That's the key difference from "bro science" — this wasn't guys saying their buddy got angrier on gear; it was a trial specifically designed to measure mood and aggression as the outcome.
The Takeaway
I'm not writing this to scare anyone or to moralize. You're an adult, and it's your body and your decision. But decisions are only as good as the information behind them, and so much of what circulates in gyms and comment sections about steroids and SARMs is confident-sounding nonsense with zero research behind it. What I've laid out here isn't my opinion — it's what's actually been published and peer-reviewed: documented cardiovascular strain, liver injury (steroids and SARMs both), suppressed hormone production and fertility impact, and measurable mood and aggression effects in a controlled trial.
If you're chasing a plateau-breaking physique change, I'd rather help you get there through training, nutrition, and recovery that we can actually dial in and sustain — no asterisks, no "we'll see how your bloodwork looks in six months." That's the conversation I had with the guy who messaged me, and it's the one I'll keep having, because you deserve real answers, not bro science.
References
- Baggish, A. L., Weiner, R. B., Kanayama, G., Hudson, J. I., Lu, M. T., Hoffmann, U., & Pope, H. G. (2017). Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation, 135(21), 1991–2002.
- Solimini, R., Rotolo, M. C., Mastrobattista, L., Mortali, C., Minutillo, A., Pichini, S., Pacifici, R., & Palmi, I. (2017). Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. European Review for Medical and Pharmacological Sciences, 21(1 Suppl), 7–16.
- Rahnema, C. D., Lipshultz, L. I., Crosnoe, L. E., Kovac, J. R., & Kim, E. D. (2014). Anabolic steroid-induced hypogonadism: Diagnosis and treatment. Fertility and Sterility, 101(5), 1271–1279.
- Pope, H. G., Kouri, E. M., & Hudson, J. I. (2000). Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: A randomized controlled trial. Archives of General Psychiatry, 57(2), 133–140.
- Likhitsup, A., et al. (2023). Idiosyncratic drug-induced liver injury related to use of novel selective androgen receptor modulator RAD140 (Testalone): A case report. Journal of Medical Case Reports, 17, 69.
- Leung, J., et al. (2022). RAD-140 drug-induced liver injury. Ochsner Journal, 22(4), 361–364.
- U.S. Food and Drug Administration. (2025). FDA warns of use of selective androgen receptor modulators (SARMs) among teens, young adults. FDA Consumer Updates.
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