Adulteration With Real Drugs, SARMs, and Steroids
The Cohen JAMA Analyses of 'Natural' Products Spiked With Anabolic Agents
Evidence grade 4 of 5, Strong. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- Illegal adulteration; FDA acts post-market
Reference only. Not medical advice.
What can go wrong
The hazards are real and serious: undeclared anabolic steroids carry liver, cardiovascular, lipid, and HPG-suppression risks; novel designer steroids and SARMs are unstudied in humans; hidden stimulants can cause cardiovascular events; hidden sildenafil/tadalafil can collapse blood pressure in men taking nitrates. Athletes can fail drug tests from adulterants they never knew they consumed, the inadvertent-doping pathway.
This is something to take to a clinician. The Atlas can tell you what is known about adulteration with real drugs, sarms, and steroids in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
A recurring, documented finding, much of it from Pieter Cohen and colleagues in JAMA and JAMA Internal Medicine, is that supplements marketed as natural muscle-building, weight-loss, or sexual-enhancement products are spiked with undeclared pharmaceutical agents: anabolic steroids and designer steroid analogs, SARMs (selective androgen receptor modulators), unapproved stimulants, and PDE5 inhibitors. When a 'natural' product produces a real anabolic or erectile effect, hidden drugs are a leading explanation. These adulterants carry genuine risks and can also cause athletes to fail drug tests.
Some 'natural' boosters work because they are not natural.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
How it works
Adulteration is deliberate: manufacturers add an active pharmaceutical (or an unapproved analog engineered to evade detection) so the 'natural' product delivers a perceptible effect that herbs alone cannot. Designer steroids and novel stimulants are often analogs of banned compounds, created specifically to sidestep both detection and the drug-approval process while remaining biologically active, and unstudied for safety.
The recall-and-return problem
Cohen's work documented that even after FDA recalls, adulterated supplements frequently remained available for purchase, sometimes still containing banned stimulants months later. Because DSHEA puts the FDA in a reactive posture, a spiked product can be sold, recalled, and reappear under a new label faster than enforcement can keep up. The consumer cannot tell a spiked 'natural' booster from an honest one by reading the label, which is the entire danger.
What people get wrong
Often saidA 'natural' product cannot contain real drugs
ActuallyDocumented repeatedly. Spiked anabolic agents, SARMs, stimulants, and PDE5 inhibitors are among the most common adulterants in muscle, weight-loss, and enhancement products.
Often saidIf it produced a strong effect, the herbs must work
ActuallyA strong effect from a 'natural' product is a red flag for hidden pharmaceuticals, not proof the botanicals are potent.
Who profits, and who pushes back
Pieter Cohen
We have repeatedly found pharmaceutical drugs, including ones never approved for human use, hidden in products sold as natural dietary supplements.
Set against the alternatives
This is the most concrete, evidence-backed harm in the natural-testosterone space (graded higher than most booster-efficacy claims precisely because the adulteration is repeatedly documented in peer-reviewed analyses). It is the strongest argument for batch-tested certification and for skepticism of any 'natural' product with a dramatic effect.
What we do not know
- What fraction of enhancement/muscle supplements are spiked at any given time?
- Can supply-chain and analytical surveillance outpace designer-analog evasion?
- Would mandatory pre-market product registration curb adulteration?
At a glance
- Lead investigator
- Pieter Cohen, Harvard Medical School
- Common spikes
- Anabolic/designer steroids, SARMs, stimulants, sildenafil/tadalafil
- Detection
- Often after FDA recall, sometimes years later
- Why it persists
- Post-market enforcement under DSHEA
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Adulteration With Real Drugs, SARMs, and Steroids. A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Cohen et al. (analysis of recalled supplements still containing banned drugs)2014
JAMA: a substantial fraction of supplements recalled for adulteration still contained banned ingredients when repurchased months later
Cohen et al. (BMPEA in supplements)2015
Documented an amphetamine-like stimulant (BMPEA) in mislabeled 'Acacia rigidula' supplements, an undeclared synthetic drug in a 'botanical'
Cohen et al. (DMBA and novel stimulants)2015
Identified undeclared experimental stimulants in sports and weight-loss supplements never tested in humans
Tucker et al. (SARMs in products)2018
JAMA: products sold as SARMs frequently had inaccurate labels, undeclared substances, or no detectable active compound