Agent | Alternative name(s) listed on supplement label | Proposed mechanism of activity | Potential adverse effects |
Anabolic steroids | Often described using chemical terms such as "androstra-3,5-diene-7,17-idone" | Agonists of endogenous androgens, including testosterone | Acne vulgaris, gynecomastia, neuropsychiatric symptoms (mood disorders, aggressive behavior)[1-3] With oral 17-alpha-alkylated androgens: LFT abnormalities, cholestatic jaundice, and peliosis hepatis[1-3] Hypogonadism (in males) can occur following discontinuation[2] |
Aromatase inhibitors | Testolactone, letrozole, anastrozole, exemestane | Inhibits aromatase (which converts androstenedione to estrone, and testosterone to estradiol) | Reduced bone mineral density, cardiovascular disease, diabetes, hypercholesterolemia, myalgias |
SARMs | Andarine (GTX-007, S-4 cpd), ostarinestarine, LGD-4033 | SARMs which bind better to androgen receptors in certain tissues (eg, muscle and bone) than to those in genital tissues[4,5] | Hallucinations, cholestasis, peliosis hepatis, hepatocellular injury |
SERMs (eg, tamoxifen, raloxifene, others) | Typically not declared/listed on supplement label | When used by males taking exogenous testosterone, they prevent gynecomastia that develops due to testosterone conversion to estradiol | Flushing, hypertension, depression, menstrual irregularities |
IGF-1 | Deer antler velvet, deer velvet (deer antler velvet supplements have been adulterated with pharmaceutical IGF-1 [mecasermin])[6] | Stimulates growth of many tissues | Irreversible enlargement of tissues, including joints, heart, and liver[6,7] |
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