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Study shows many performance-enhancing agents sold online contain unapproved drugs, substances

More than 90% of tested products sold and marketed on the internet as selective androgen receptor modulators contained unapproved substances and drugs, according to findings recently published in JAMA.

“Recent reports have described the increasing use of nonsteroidal selective androgen receptor modulators, which have not been approved by FDA, to enhance appearance and performance,” Ryan M. Van Wagoner, PhD, of the Sports Medicine, Research and Testing Laboratory, Salt Lake City, and colleagues wrote. “The composition and purity of such products is not known.”

Researchers conducted a limited, systematic investigation of 44 products marketed as selective androgen receptor modulators that they purchased over the internet. They used chemical analysis to determine the chemical identity and the amount of the compound in the product and compared those findings with the label information.

Van Wagoner and colleagues found that among the 44 products tested, only 23 had one or more selective androgen receptor modulators — Andarine, LGD-4033 or Ostarine. Seventeen products contained another unapproved drug, including the Rev-ErbA agonist SR9009, the peroxisome proliferator-activated receptor- agonist GW501516, and the growth hormone secretagogue ibutamoren. No active compound was found in four of the products tested and 11 of the products included substances not listed on the label. In 18 of the products tested, the label and the amount of active compound in the product matched, but in 26 of the products, the amount of the compounds listed on the label was substantially different than the amount found by analysis. In addition, 24 were labeled as “not for human consumption”, “for research use only,” or both and 20 were sold as dietary supplements.

“These findings suggest the need for greater regulatory oversight of products sold on the internet,” Van Wagoner and colleagues wrote.

In a related editorial, Richard J. Auchus, MD, PhD; of the division of metabolism, diabetes, and endocrinology at the University of Michigan and Kirk J. Brower, MD, of the department of psychiatry at the University of Michigan wrote that physician prescribing is also partially to blame for the “public health problem” surrounding androgen receptor modulators.

“Some physicians overdiagnose idiopathic hypogonadotropic hypogonadism, especially in older men, to legitimize their use of these products despite findings that improvements in fatigue or vitality are neither statistically nor clinically different from placebo,” they wrote. “Physicians should be encouraged to examine their prescribing practices, including avoiding use of testosterone outside FDA and professional society guidelines for men with low levels of testosterone who lack a medical indication.”

Auchus and Brower called on medical professionals to persuade government authorities to better police the “ready access of these potent drugs.” - by Janel Miller

Disclosures: Auchus reports receiving consulting fees from the U.S. Anti-Doping Agency, Major League Baseball, and the National Football League. Van Wagoner reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.