The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men

Anna L. Goldman; Harrison G. Pope, Jr.; Shalender Bhasin


J Clin Endocrinol Metab. 2019;104(4):1069-1074. 

In This Article

Internet Sales of AASs and Nonsteroidal Sarms

Even though no oral SARM has yet been approved by the Food and Drug Administration for any indication, these compounds are being sold on the Internet. In a systematic investigation of products marketed as SARMs through the Internet, we found that only 52% contained genuine SARMs, and many were inaccurately labeled.[37] Some products marketed as SARMs contained other drugs, whereas other products contained amounts that differed from that listed on the label. Other studies of various dietary supplements have found that many contain surreptitious AAS or AAS precursor molecules. These findings suggest that greater regulatory oversight is needed for dietary supplements sold on the Internet.

The ease of purchasing AASs without a prescription through the Internet represents a growing source of concern. The Internet has enabled small unlicensed laboratories in and outside the United States to synthesize and package these compounds, disseminate information about their products, and to sell them to potential users around the globe. These suppliers easily operate outside the usual network of licensed pharmacies, and they can create and remove Web sites as often as needed to stay ahead of law enforcement and regulators. A recent study identified eight leading Internet sites accessed by the search term "buy steroids".[38] Among these sites, seven offered injectable testosterone, other commonly used forms of AASs, and non-AAS hormone therapies; six offered recommendations for stacking and cycling regimens, and accepted common forms of payment such as credit cards. No site required a prescription for purchase of any substance, and all sites were supplied by unregulated international pharmacies providing shipment to home addresses with disclaimers that consumers are liable to local laws. Although many countries have their own laws to regulate the dispensing, sales, and distribution of AASs, illegal distribution of these compounds into the United States via unregulated, international pharmacies continues. Enforcement efforts to shutdown Internet sales of narcotics and other illicit substances have proven challenging as new vendors and Internet sites quickly replace the sites that are shut down. Harmonization of global efforts to combat underground AAS sales and distribution is needed.