Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4062
Peer-review started: January 20, 2021
First decision: February 24, 2021
Revised: February 28, 2021
Accepted: March 25, 2021
Article in press: March 25, 2021
Published online: June 6, 2021
Processing time: 112 Days and 2 Hours
Muscle growth promoters are being developed for the treatment of disease-induced loss of muscle mass. Ligandrol and ostarine are selective androgen receptor modulators (SARMs) with a non-steroidal structure and a presumably more favorable side effect profile. In recent years, these substances with or without “post-cycle therapy” (PCT) are often misused by amateur athletes aiming to promote muscle growth. At the same time, reports on their toxic effects on organ systems are emerging.
We report two cases of liver injury in young men who used ligandrol and/or ostarine for a few weeks followed by the use of substances for PCT. Acute liver injury occurred in both cases after stopping SARMs while on PCT. The clinical picture was dominated by jaundice and fatigue. The biochemical pattern showed a mixed type of injury with normal alkaline phosphatase and high concentrations of bilirubin and serum bile acids. Histological evidence showed predominantly cholestatic injury with canalicular bile plugs, ductopenia, and mild hepatocellular damage without significant fibrosis. The patients recovered from the condition after 3 mo. The off target effects of SARMs were likely idiosyncratic, but our report highlights the yet unrecognized effects of other toxic substances used for PCT, supra-therapeutic doses, and the complete absence of monitoring for adverse effects.
Among muscle-building amateur athletes, SARMs (ligandrol or ostarine) and/or substances in PCT may cause cholestatic liver injury with prolonged recovery.
Core Tip: Ligandrol and ostarine are selective androgen receptor modulators with a presumably more favorable side effect profile. They are often misused by amateur body builders aiming to promote muscle growth. Reports on the toxic effects on organ systems are emerging. We report the liver injury in two young men who used ligandrol and/or ostarine in addition to other muscle-promoting substances known as post-cycle therapy. They showed jaundice and fatigue, a mixed type of injury, normal alkaline phosphatase, and high levels of bilirubin and bile acids. Histological evidence showed cholestatic injury, canalicular bile plugs, and ductopenia. The patients recovered after only 3 mo.