Are SARMs Liver Toxic? Which SARMs Harm the Liver (2026 Evidence)

Short answer: yes, SARMs can be liver toxic. Liver injury is the most common serious harm reported with SARMs: a systematic review of SARM use in healthy adults found 15 case reports of drug-induced liver injury, and raised ALT in about 7% of people exposed in clinical trials (Vignali 2023). Cases have been reported with ostarine, LGD-4033, RAD-140 and SR9009, usually cholestatic (bile-flow) injury with jaundice after weeks to months of use; most people recovered after stopping, some needed intensive care, and one teenager needed a liver transplant (Shams Bin Shaheen 2026). No supplement has been shown to prevent it.

This page covers how SARM liver injury shows up, what is known compound by compound (including MK-677, cardarine and SR9009, which are often stacked with SARMs), and what bloodwork can catch.

SARMs And Liver Enzymes

The old version of this page said healthy men only get harmless, temporary enzyme rises from SARMs. The evidence is more serious than that:

• In trials, enzyme rises were common: ALT rose in 5 of 24 people on 3 mg of ostarine over 86 days (Dalton 2011), and AST and ALT rose in 59% and 45% of patients on RAD-140, with serious (grade 3/4) rises in 23% (LoRusso 2022).
• In real-world use, doses are often far higher than in trials, and case reports describe jaundice, very high bilirubin and, rarely, kidney injury from bile (Arayangkool 2023).
• Most cases recovered after stopping, often over 1–6 months.

So yes, most people won’t develop liver injury, but some healthy young men have, and nobody can predict who. Tracking liver enzymes is the only early warning.

ALT and AST – Detecting Liver Toxicity

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes released into the blood when liver cells are damaged. SARM liver injury is often cholestatic, meaning bile flow is affected, so bilirubin and ALP (alkaline phosphatase) are just as important; in some cases ALT was only mildly raised while bilirubin was many times normal (Flores 2020). A useful liver panel before and during a cycle: ALT, AST, ALP, GGT and bilirubin.

The old claim that ALT and AST should always be in a 4:5 ratio was not correct and has been removed. Alcohol also raises liver enzymes; see SARMs and alcohol.

Types And Causes of Liver Toxicity

Drugs harm the liver in two broad ways:

Dose-dependent toxicity (High Dosage)

Some drugs damage the liver more as the dose goes up. In SARM trials, liver-enzyme rises did increase with dose: ALT rose with dose in a 14-day ostarine study of up to 30 mg a day (EMERALD protocol). Most users take several times the trial doses, which may raise the risk.

Idiosyncratic Toxicity (Genetic Deformation)

Idiosyncratic injury is unpredictable and not simply dose-related. Doctors have described SARM liver injury in this way (Ladna 2023, Govil 2025). The “1 in 100,000” figure in the old version had no source and has been removed; how often SARM liver injury happens is unknown.

Drug Allergy

Immune-mediated (allergic-type) reactions are one suggested mechanism for idiosyncratic injury (Govil 2025). The old claim that hard training inflames the liver and that you should limit gym time while on SARMs had no evidence and has been removed.

SARMs and liver toxicity

Warning signs from the case reports: jaundice (yellow skin or eyes), itching, nausea, loss of appetite, fatigue and weight loss (Flores 2020, Khan 2022). Stop and see a doctor if they appear. Compound by compound:

Ostarine

Ostarine is often called mild, but it is one of the SARMs with the most liver data. In the 86-day trial in 120 older adults, ALT rose as a side effect in 7 people on ostarine (5 of 24 on 3 mg) and none on placebo; one person on 3 mg left the study because of it, though it was not classed as serious (Dalton 2011). In a 14-day Phase 1 study, ALT rose with dose and was the most common side effect (EMERALD protocol). Case reports describe cholestatic liver injury in young men using ostarine products, with bilirubin over 30 mg/dL in one and albumin dialysis needed in another (Bedi 2021, Mertens 2024). Users often take ten times the trial dose. More: ostarine fact sheet.

Ligandrol – LGD 4033

In the 21-day trial at 0.1–1 mg a day, LGD-4033 caused no clinically significant change in liver enzymes (Basaria 2013). That trial was short and low-dose, and real-world cases tell a different story: cholestatic hepatitis confirmed on biopsy, bilirubin reaching 30 times normal, and a 24-year-old who took ligandrol for 9 weeks and needed about 4 months to recover (Barbara 2020, Flores 2020). The old advice that 5 mg a day avoids problems has no basis: no dose above 2 mg has been studied. More: LGD-4033 dosage.

RAD 140 – Testolone

RAD-140 has the clearest liver signal of the common SARMs. In its only trial, AST rose in 59% and ALT in 45% of patients, bilirubin in 27%, and serious enzyme rises occurred in 23% (LoRusso 2022). Case reports in users describe cholestatic injury after weeks to months, including a 49-year-old man with jaundice after a 4-week course plus intermittent use, whose bilirubin reached 291 µmol/L (Flores 2020), and a 2026 case needing steroids, plasmapheresis and intensive care (case report 2026). The old conclusion that RAD-140 is safe for 99% of people had no basis. More: RAD-140 fact sheet.

Andarine

Andarine’s liver effects have not been studied, and “zero reports” mostly reflects that no one has looked. At least one published RAD-140 liver-injury case involved a product that also contained andarine (case report 2026). More: Andarine review.

YK11

YK11’s liver effects have not been studied in people or animals that we could find. The old claim that its “methylated groups” make it liver toxic was speculation; the honest answer is that it is unknown. Its main animal safety finding so far is brain inflammation in rats (Dahleh 2023). More: YK11 review.

S23

No study has looked at S-23 and the liver. The old reasoning that it should be “weaker on the liver than YK11” had no evidence. Get bloodwork before and after if you use it. More: S23 review.

MK 677

MK-677 (ibutamoren) is not a SARM, but it is not “not toxic to the liver at all” as the old version said. In trials, a few participants had reversible ALT/AST rises and two women stopped for levels over three times normal (FDA briefing, 2024), and a 2025 case report described liver inflammation after 2 months of use that resolved after stopping (Cobani 2025). It also raised blood sugar in trials. More: MK-677 side effects.

Cardarine

In 2-week human trials, cardarine actually lowered liver fat by 20% (Risérus 2008). In mice with chemically induced liver injury, it did not protect the liver the way another PPAR-delta agonist did, and it raised a pro-scarring factor (Iwaisako 2012). A 43-year-old man using cardarine with ostarine had ALT up to 922 U/L, AST up to 2,558 U/L and severe muscle breakdown, recovering over about 6 weeks (Kintz 2021). Its main concern remains cancer in long-term animal studies. More: cardarine fact sheet.

Stenabolic – SR9009

The old version of this section said you don’t need to worry about SR9009 and the liver. That has changed. In lab and mouse studies, activating REV-ERB reduced markers of liver scarring (Thomes 2016), but SR9009 has never been tested in people, and recent case reports link it to liver injury in a 40-year-old man (Govil 2025) and to acute liver failure needing an emergency transplant in a 17-year-old (Shams Bin Shaheen 2026). The other study the old version cited was about atherosclerosis and did not measure liver enzymes. More: SR9009 dosage.

In short: RAD-140, ostarine, LGD-4033 and SR9009 all have published liver-injury cases; MK-677 and cardarine have occasional signals; andarine, YK11 and S23 are unknown rather than safe. Nothing on this list is “completely safe” for the liver.

SARMs liver support

“Liver support” supplements such as TUDCA and milk thistle are popular in SARM circles. None has been shown to prevent or treat SARM liver injury. The old version of this page recommended TUDCA at 500 mg a day and milk thistle on the basis of studies in other liver diseases and in mice; we have removed those recommendations because they could give false reassurance. Some people with SARM liver injury needed hospital treatment, including steroids and plasmapheresis, which no supplement replaces.

What actually helps: a liver panel before you start and during use, avoiding alcohol, not stacking several compounds with liver signals, and stopping at the first sign of jaundice or itching. The PCT and bloodwork planner lists the markers.

Conclusion

Are SARMs liver toxic? Some clearly can be: ostarine and RAD-140 raised liver enzymes in trials, and ostarine, LGD-4033, RAD-140 and SR9009 all have published cases of serious liver injury, mostly in young men taking doses far above anything tested. Most recovered after stopping, some needed intensive care, and one needed a transplant. No supplement prevents it. If you use these compounds, get a liver panel before and during use, avoid alcohol, and stop at the first warning sign. Compare compounds’ evidence in the SARMs database.