Unregulated gains: a case of RAD-140–induced liver injury

Selective androgen receptor modulators (SARMs) are nonsteroidal compounds marketed as performance-enhancing supplements due to their anabolic effects on muscle and bone. Although promoted as safe, SARMs have been increasingly associated with hepatotoxicity. We report a case of severe cholestatic drug-induced liver injury in a previously healthy young man after use of a supplement containing RAD-140 and Andarin (S4). Despite drug cessation and corticosteroid therapy, he developed progressive hyperbilirubinemia requiring plasmapheresis, with a course complicated by pancreatitis and acute kidney injury requiring intensive care. This case represents the most severe manifestation of RAD-140-associated liver injury reported to date.