Long-Term Effects Compared: Steroids, SARMs and Peptides

Why this comparison is lopsided

Anabolic-androgenic steroids (AAS), selective androgen receptor modulators (SARMs) and performance peptides often get grouped together as "enhancers", but the long-term record for each looks very different. For steroids, researchers have tracked more than a thousand users through national registries and scanned long-term users' hearts. SARMs have short drug-company trials plus a growing file of hospital case reports. For most research peptides, human data stop after a few months.

A short side-effect list can mean a compound is gentle, or it can mean nobody has looked. As of October 2026, no study has followed long-term peptide users the way Danish researchers have followed steroid users, and no trial has compared these classes head-to-head.

Each organ system has its own article in this section, linked below. For how the drugs differ in what they do to muscle, see our comparison of peptide and steroid mechanisms and results.

Anabolic steroids: decades of observational data

Randomized trials can't ethically give healthy people the doses that steroid users take, so most of what we know comes from observational studies. A 2014 Endocrine Society scientific statement reviewed that literature and linked performance-enhancing drug use to a higher risk of death and to disorders in nearly every organ system.

Two Danish registry studies give the clearest numbers. In a 2019 cohort of 545 men who tested positive for steroids during gym doping controls, mortality over about seven years was three times that of matched non-users (hazard ratio 3.0). A 2024 follow-up of 1,189 sanctioned men tracked for about 11 years found a hazard ratio of 2.81. Accidents explained part of the excess. Cancer and heart disease were the most common natural causes. The authors note that observational data can't prove the steroids caused those deaths, because other drug use and risk-taking may play a part.

A 2017 US imaging study compared 86 experienced weightlifters who reported at least two years of steroid use with 54 lifters who had never used them. Users had weaker pumping function (average ejection fraction 52% vs. 63%) and more coronary plaque, and plaque volume rose with total years of use. Diastolic function (how well the heart relaxes and fills) was impaired even in men who were off drugs. Our cardiovascular impact comparison covers these findings and the lipid changes behind them.

Hormonal recovery is also well documented. In a 2016 Danish case-control study, former users who had stopped about 2.5 years earlier still had lower testosterone than controls, and 27% were below the reference limit for healthy young men. Low libido and erectile dysfunction were more common in former users, and about a quarter reported depressive symptoms. The hormonal recovery comparison walks through recovery timelines, and the reproductive health article covers sperm production and fertility.

SARMs: short trials and a growing case-report file

SARMs were developed as drug candidates, so some have short, low-dose controlled trials. In a 2013 trial of LGD-4033, 76 healthy men took daily doses of up to 1.0 mg, or placebo, for 21 days. Lean mass went up, and so did dose-dependent suppression of total testosterone and HDL cholesterol. Both returned to baseline after stopping.

The trials can't show what happens at the doses people use outside a study. A 2023 analysis of suspected adverse-event cases describes one person with severe liver injury who reported taking 10 mg of LGD-4033 a day, ten times the highest trial dose, though the product was never tested. A review of SARM-related liver injury found a cholestatic pattern much like the injury seen with oral steroids: jaundice with only mild enzyme rises, usually improving once the SARM is stopped. FDA's consumer warning on SARMs lists liver injury among the reported problems. It also lists a higher risk of heart attack or stroke, along with psychosis. The liver and kidney comparison goes organ by organ.

Beyond a few months, the SARM record is case reports, which show that harm happens but not how often.

Peptides: the long-term record is mostly blank

"Peptides" covers compounds with little in common.

Growth hormone secretagogues

These compounds raise the body's own growth hormone (GH) and IGF-1 instead of acting on the androgen receptor, so they don't shut down testosterone production the way steroids do. Their long-term questions center on blood sugar and fluid retention, plus what years of higher IGF-1 might mean for cancer risk.

The longest controlled data come from MK-677 (ibutamoren), an oral ghrelin mimetic sold alongside peptides. In a two-year trial in 65 healthy adults aged 60-81, 25 mg daily raised GH and IGF-1 to young-adult levels and increased fat-free mass. Fasting glucose rose, and insulin sensitivity fell. A 24-week trial of the same dose in 123 older adults recovering from hip fracture was stopped early after more heart failure cases in the treated group (4 of 62 vs. 1 of 61 on placebo). Both trials enrolled older people, so they don't map neatly onto young lifters. Nobody has run a comparable multi-year study of injectable secretagogues such as ipamorelin or CJC-1295.

The IGF-1 question is the subject of our cancer risk analysis. So far it rests on GH and IGF-1 biology; no study has measured cancer rates in people using secretagogues.

Repair peptides

BPC-157 and TB-500 are used mostly for injuries. Nearly all BPC-157 data come from rodents, with only small uncontrolled human pilots. The human trials of thymosin beta-4 used the full protein, not the TB-500 fragment sold online. There is no basis yet for calling either one safe or unsafe over years.

Product quality

Research-use vials aren't made to drug standards. A preprint (not yet peer-reviewed) posted in April 2026 analyzed 6,441 independent test results across 14 peptides. Depending on the standard applied, 41.6% to 71.1% of samples failed basic quality criteria. Measurable endotoxin turned up in 15% of the 243 samples tested for it. No clinical trial captures that risk. Gray-market steroids and SARMs carry it too.

Side by side

Mood and behavior have their own page: the psychological effects comparison looks at depression after stopping steroids and the psychiatric reports linked to SARMs.

What users report vs. what studies measure

In forum discussions, lifters tend to rank steroids hardest on the body and peptides the mildest. The studies partly agree, but for a different reason: steroid harms have been measured in thousands of users, while harms from SARMs and peptides past the first year mostly haven't been measured at all.

User reports often describe SARM cycles as needing little recovery, yet the LGD-4033 trial showed testosterone suppression after three weeks at 1 mg, well below what users commonly describe taking. Many people also combine classes, and no study has looked at the long-term effects of those combinations.

As of October 2026, WADA's 2026 Prohibited List places steroids and SARMs under S1 (anabolic agents). BPC-157 is named under S0, and GH secretagogues fall under S2. Our legal landscape analysis covers how US law treats each class.

What we still don't know

• Whether years of on-and-off GH secretagogue use in healthy young adults changes glucose control or cancer risk.
• How much SARM liver injury depends on dose, given that case reports rarely confirm what the product contained.
• How much of the excess death rate in steroid users comes from the drugs and how much from other risks that tend to travel with them.
• Whether repair peptides have long-term effects in people. As of October 2026, no long-term human safety study of BPC-157 or TB-500 has been published.