Peptides, anabolic steroids and SARMs are three different drug classes that often get grouped together as muscle builders. Steroids have the strongest evidence: in a Human RCT (n=43), above-normal testosterone doses increased muscle size and strength in healthy men (Bhasin 1996). SARMs show lean-mass gains in smaller Human RCTs, but none is FDA approved. “Peptides” range from approved drugs such as tesamorelin to unapproved gym peptides like BPC-157, whose evidence is almost all animal (Vasireddi 2025). All the muscle-related options in this guide are prohibited in sport (WADA 2026).
| Item | Status |
|---|---|
| US FDA status | Steroids: testosterone is an approved prescription drug and a Schedule III controlled substance. SARMs: none approved; FDA calls them unapproved drugs, not dietary supplements. Peptides: some approved (tesamorelin = Egrifta, HIV-associated abdominal fat); BPC-157, TB-500, CJC-1295 and ipamorelin are not |
| Compounding (503A/503B) | Ipamorelin (503B), GHRP-2/6 (503B) and ibutamoren (503A and 503B) remain in FDA Category 2; BPC-157, TB-500 and CJC-1295 were withdrawn from Category 2 and sit in no category. The PCAC met on 2026-07-23 to review BPC-157 and TB-500 for 503A listing (FDA meeting page); FDA has not published an official vote outcome, and any recommendation remains advisory with no FDA rule yet |
| Next regulatory step | FDA notice-and-comment rulemaking on the PCAC-reviewed peptides: none announced as of 2026-09-30 |
| WADA 2026 | All prohibited at all times: steroids S1.1, SARMs S1.2, GH-releasing peptides S2.2.4, TB-500 S2.3, BPC-157 S0 (WADA list) |
| Strongest evidence | Steroids: Human RCT (n=43) for muscle and strength. SARMs: Human RCT (n=120) for lean mass. Gym peptides: Human RCT for GH release only (CJC-1295); BPC-157 mostly Animal |
| Human trials | SARMs: phase 3 enobosarm trial NCT01355484 (n=321, completed; no approval followed); phase 2 NCT06282458 (n=168, completed, no results posted). BPC-157: no controlled human trial |
| Last checked | 2026-09-30 |
Key points:
- Raising growth hormone (GH) is not the same as gaining strength: in a meta-analysis of randomized trials in which 303 healthy young people received GH, it added 2.1 kg of lean mass, but strength did not appear to improve (Liu 2008).
- In a Danish cohort study, steroid users died at 2.81 times the rate of matched controls over a mean 11 years (Observational, n=1,189) (Windfeld-Mathiasen 2024).
- A 2024 review counted 20 published adverse-event reports for SARMs since 2020, most of them drug-induced liver injury (Leciejewska 2024).
- In the UK, anabolic steroids are Class C drugs; possessing limited amounts for personal use is not an offence, but supply is (MHRA).
How do peptides, steroids and SARMs differ?
The short version: steroids and SARMs both act on the androgen receptor, the same switch testosterone flips. The peptides people compare them with mostly work another way, by nudging the body’s own growth hormone or, for BPC-157, through pathways studied mainly in animals.
| Class | How it works | Strongest human evidence |
|---|---|---|
| Anabolic steroids | Testosterone and synthetic relatives; bind the androgen receptor in all tissues | Human RCT (n=43): muscle size and strength up (Bhasin 1996) |
| SARMs | Non-steroidal drugs built to act on the androgen receptor mainly in muscle and bone | Human RCT (n=120): lean mass and function up (Dalton 2011) |
| GH-releasing peptides | Signal the pituitary to release more GH | Approved label (tesamorelin); Human RCT for GH rise (CJC-1295) |
| Healing peptides | BPC-157, TB-500; mechanisms from lab and animal work | 1 uncontrolled human study (Vasireddi 2025) |
What are anabolic steroids?
Anabolic-androgenic steroids (AAS) are testosterone and lab-made molecules modeled on it. Testosterone itself is an approved prescription drug for men whose bodies make too little of it, and it is a Schedule III controlled substance in the US (FDA label). An Endocrine Society statement notes that most people using performance-enhancing drugs are not competitive athletes but recreational weightlifters (Pope 2014).
What are SARMs?
Selective androgen receptor modulators (SARMs) such as enobosarm (ostarine), LGD-4033 (ligandrol) and RAD140 were designed to give muscle and bone effects of testosterone with fewer effects elsewhere (USADA). None has been approved. Products sold as SARMs are often labeled as supplements, which FDA says they are not (FDA).
What are “peptides” in this comparison?
Peptides are short chains of amino acids, and the word covers everything from insulin to research compounds. In muscle and recovery discussions it usually means growth-hormone secretagogues (CJC-1295, ipamorelin, tesamorelin) and healing peptides (BPC-157, TB-500). Of these, only tesamorelin is approved, as Egrifta for excess abdominal fat in people with HIV and lipodystrophy (FDA approval letter). The GH secretagogues are compared in detail in ipamorelin vs sermorelin vs tesamorelin, and the healing pair in BPC-157 vs TB-500.
How they work differently
- Steroids: act directly on androgen receptors throughout the body, including muscle, heart, liver, skin and the brain; the testosterone label lists heart, liver and psychiatric harms seen with misuse (FDA label).
- SARMs: act on the same receptor with more tissue selectivity, but not full selectivity: LGD-4033 still lowered natural testosterone in a Human RCT (n=76) (Basaria 2013).
- GH-releasing peptides: do not touch the androgen receptor. A single CJC-1295 dose raised GH 2- to 10-fold for six days or more and IGF-1 (the growth factor GH drives) 1.5- to 3-fold in a Human RCT in healthy adults (Teichman 2006). More on that peptide: CJC-1295 with vs without DAC.
- Healing peptides: BPC-157’s proposed effects on tendon, muscle, ligament and bone come from 35 animal studies against 1 human study in a systematic review (Vasireddi 2025).
What does the evidence show for muscle?
Each class has at least one encouraging result. The difference is how strong the study is, who was in it and what was measured. The table grades the best evidence for each claim.
| Claim | Best evidence | Level |
|---|---|---|
| Steroids build muscle and strength | Fat-free mass +6.1 kg with training in 10 weeks (Bhasin 1996) | Human RCT (n=43) |
| SARMs build lean mass | LGD-4033 raised lean mass dose-dependently in 21 days (Basaria 2013) | Human RCT (n=76) |
| SARMs improve function in older adults | Enobosarm raised lean mass and physical function in 12 weeks (Dalton 2011) | Human RCT (n=120) |
| Raising GH builds strength | GH raised lean mass 2.1 kg; strength unchanged (Liu 2008) | Meta-analysis (n=303) |
| GH secretagogue raises fat-free mass | Oral ibutamoren (MK-677): +1.1 kg vs −0.5 kg placebo at 12 months (Nass 2008) | Human RCT (n=65, age 60–81) |
| Tesamorelin cuts belly fat | Visceral fat −15.2% vs +5.0% placebo (Falutz 2007) | Human RCT (n=412); Approved label |
| BPC-157 aids injury recovery | 14 of 16 patients reported knee-pain relief, no control group (Lee 2021) | Human (case series, n=16) |
The steroid data are the most direct: the Bhasin trial measured muscle size and strength, not just body composition, and testosterone alone increased arm muscle size even without training (Human RCT, n=43). SARMs are the most promising alternative on paper, with two placebo-controlled trials showing lean-mass gains (Human RCT, n=120), yet a completed phase 3 enobosarm trial in lung-cancer muscle wasting (n=321) did not lead to an approval (NCT01355484). For peptides, the evidence shows they raise GH and IGF-1 in people, but the GH meta-analysis found that extra GH adds lean mass without adding strength or exercise capacity (meta-analysis, n=303). BPC-157’s tissue-healing results are real findings in rats, not yet tested in a controlled human trial; see peptides for injury ranked by evidence.
Which has more evidence for what: steroids have the most evidence for muscle size and strength; SARMs have more controlled human evidence for lean mass than any gym peptide; tesamorelin has approval-level evidence for visceral fat in HIV lipodystrophy; BPC-157 has the most animal research on tendon and soft-tissue repair. None of this is a reason to use any of them. A clinician is the person to decide what fits an individual’s health.
Can they be combined?
Stacking peptides with steroids or SARMs is common in bodybuilding forums. No controlled human study has tested these combinations, so their combined effects and risks are unknown.
Safety and side effects compared
Steroids
The testosterone label lists serious reactions reported with anabolic steroid misuse: cardiac arrest, heart attack, cardiomyopathy, heart failure, stroke, liver toxicity, serious psychiatric effects, testicular atrophy and infertility (Approved label). Stopping high doses can cause withdrawal lasting weeks or months, including depression and low natural testosterone. In 140 male weightlifters, long-term steroid users had lower heart pumping function (ejection fraction 52% vs 63%) and more coronary plaque than non-users (Observational, n=140). The Danish cohort study found 2.81 times higher mortality in users, with both natural and unnatural deaths raised (Observational, n=1,189).
SARMs
FDA lists heart attack or stroke, psychosis, liver injury and acute liver failure, infertility, miscarriage and testicular shrinkage among the problems reported with SARM products, and notes hospitalizations for liver injury (FDA). The same page describes a product that tested positive for an undeclared anabolic steroid, so what is on the label is not always what is in the bottle. Even in a controlled trial, LGD-4033 suppressed testosterone and HDL (“good”) cholesterol, which returned to normal after stopping (Human RCT, n=76). USADA adds that long-term effects are unknown (USADA).
Peptides
FDA keeps several GH-releasing compounds in Category 2 for safety reasons: GHRP-2 and GHRP-6 over immune reactions, ipamorelin over peptide impurities and adverse events, and ibutamoren over possible congestive heart failure (FDA Category 2 page). In the GH meta-analysis, swelling and fatigue were more common with GH (meta-analysis, n=303), and ibutamoren raised appetite and caused transient swelling (Human RCT, n=65). For BPC-157, clinical safety data remain limited (Vasireddi 2025). Peptides are not automatically safer than SARMs; they are less studied. More in are peptides safe?
Legal status in the US and UK
- US, steroids: testosterone is a Schedule III controlled substance available only on prescription (FDA label).
- US, SARMs: unapproved drugs that are illegally marketed as supplements; FDA has sent warning letters and pursued criminal cases against distributors (FDA).
- US, peptides: tesamorelin is approved; BPC-157, TB-500 and CJC-1295 are unapproved and have no compounding category after leaving Category 2, while ipamorelin, GHRP-2/6 and ibutamoren remain in Category 2 (FDA). The July 2026 advisory committee vote on BPC-157 and TB-500 is non-binding and no rule has followed (FDA PCAC).
- UK, steroids: Class C under the Misuse of Drugs Act 1971; possession of limited amounts for personal use is not illegal, while supply is an offence (MHRA).
WADA status for athletes
For tested athletes the three classes are equal: all are prohibited in and out of competition. Steroids fall under S1.1 and SARMs under S1.2 “other anabolic agents”; GH-releasing peptides such as CJC-1295, sermorelin, tesamorelin and ipamorelin fall under S2.2.4, growth hormone releasing factors; TB-500 under S2.3; and BPC-157 under S0, non-approved substances (WADA 2026 list; USADA). The 2026 list also clarified that esters of prohibited anabolic agents, such as testosterone cypionate, are prohibited (USADA 2026 advisory).
What users report
These are unverified self-reports, usually from people who bought unregulated products, and they are not evidence. People who post about steroids commonly describe the fastest and largest strength and size changes of the three, alongside acne, mood swings, hair loss and worry about blood pressure and blood work. A recurring topic is the low mood and low libido after stopping. SARM users often describe noticeable but smaller gains, frequently mention lethargy or suppressed natural testosterone, and argue about whether products contain what the label says; posts about liver enzymes and yellowing skin appear regularly. People who post about GH-releasing peptides tend to report better sleep, water retention, hunger and tingling hands rather than dramatic muscle gain, and many say they noticed little. BPC-157 posts focus on joint and tendon pain, with some crediting it for faster recovery and others reporting no effect. Across all three, cost, product quality and fear of fakes are constant complaints, and a long-running argument is whether peptides are truly “safer” or simply less studied.
Frequently asked questions
Are peptides steroids?
No. Peptides are short amino-acid chains, while steroids are ring-shaped molecules built on the testosterone structure. They also work differently: steroids bind the androgen receptor, whereas GH-releasing peptides such as CJC-1295 raise the body’s own growth hormone, which rose 2- to 10-fold after one dose in a Human RCT (Teichman 2006).
Are peptides safer than SARMs?
That has not been shown. SARMs have a documented record of liver injury, with 20 published adverse-event reports since 2020 (Leciejewska 2024). Most gym peptides simply have too little human data to judge, and FDA still lists ipamorelin, GHRP-2/6 and ibutamoren as compounding safety risks. Less reported harm is not the same as proven safety.
Are SARMs legal in the US?
No SARM is FDA approved. FDA says products sold as SARMs are unapproved drugs, not dietary supplements, that they are illegally marketed, and that the agency has issued warning letters and pursued criminal action against distributors (FDA). They are also prohibited in sport under WADA class S1.2.
References
- Bhasin S, Storer TW, Berman N, et al. 1996. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med. PubMed 8637535
- Basaria S, Collins L, Dillon EL, et al. 2013. The safety, pharmacokinetics, and effects of LGD-4033, a novel nonsteroidal oral, selective androgen receptor modulator, in healthy young men. J Gerontol A. PubMed 22459616
- Dalton JT, Barnette KG, Bohl CE, et al. 2011. The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women. J Cachexia Sarcopenia Muscle. PubMed 22031847
- Liu H, Bravata DM, Olkin I, et al. 2008. Systematic review: the effects of growth hormone on athletic performance. Ann Intern Med. PubMed 18347346
- Nass R, Pezzoli SS, Oliveri MC, et al. 2008. Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults. Ann Intern Med. PubMed 18981485
- Teichman SL, Neale A, Lawrence B, et al. 2006. Prolonged stimulation of growth hormone and insulin-like growth factor I secretion by CJC-1295. J Clin Endocrinol Metab. PubMed 16352683
- Falutz J, Allas S, Blot K, et al. 2007. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. PubMed 18057338
- Vasireddi N, Hahamyan H, Salata MJ, et al. 2025. Emerging use of BPC-157 in orthopaedic sports medicine: a systematic review. HSS J. PubMed 40756949
- Lee E, Padgett B. 2021. Intra-articular injection of BPC 157 for multiple types of knee pain. Altern Ther Health Med. PubMed 34324435
- Baggish AL, Weiner RB, Kanayama G, et al. 2017. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation. PubMed 28533317
- Windfeld-Mathiasen J, Heerfordt IM, Dalhoff KP, Andersen JT, Horwitz H. 2024. Mortality among users of anabolic steroids. JAMA. PubMed 38483396
- Pope HG Jr, Wood RI, Rogol A, et al. 2014. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. PubMed 24423981
- Leciejewska N, Jędrejko K, Gómez-Renaud VM, et al. 2024. Selective androgen receptor modulator use and related adverse events including drug-induced liver injury. Eur J Clin Pharmacol. PubMed 38059982
- US FDA. Certain bodybuilding products put consumers at risk for heart attack, stroke, serious liver damage and more (content current as of 2025-12-02). fda.gov
- US FDA. Testosterone cypionate injection, USP CIII, prescribing information (revised August 2023). accessdata.fda.gov
- US FDA. 2010. Egrifta (tesamorelin for injection) NDA 022505 approval letter. accessdata.fda.gov
- US FDA. Certain bulk drug substances for use in compounding that may present significant safety risks (content current as of 2026-04-22). fda.gov
- US FDA. July 23–24, 2026: Meeting of the Pharmacy Compounding Advisory Committee. fda.gov
- World Anti-Doping Agency. 2026 Prohibited List (in force 2026-01-01). wada-ama.org
- USADA. Selective androgen receptor modulators (SARMs): prohibited class of anabolic agents. usada.org
- USADA. BPC-157: prohibited peptide. usada.org
- USADA. Athlete advisory: what’s new on the 2026 WADA Prohibited List. usada.org
- MHRA. 2021-05-28. PT jailed for sale of steroids and unlicensed medicines online. gov.uk
- ClinicalTrials.gov. NCT01355484: Phase III study of GTx-024 (enobosarm) on muscle wasting in non-small cell lung cancer. clinicaltrials.gov
- ClinicalTrials.gov. NCT06282458: Dose-finding study of enobosarm on body composition in patients taking a GLP-1. clinicaltrials.gov
Change log
2026-10-26: links to related entries added; no change to the facts.
2026-10-19: links to related entries added; no change to the facts.
2026-10-18: growth hormone meta-analysis described correctly: 303 healthy young people received GH, and strength did not appear to improve (Liu 2008); reviewed by the editorial team.
2026-10-14: WADA class for GH-releasing peptides given as S2.2.4 (growth hormone releasing factors), the sub-class the 2026 List names them in; reviewed by the editorial team.
2026-10-13: links corrected (a link inside a citation or on a generic word removed); no change to the facts.
2026-10-12: links to related entries added; no change to the facts.
2026-10-06: links to related entries were added on 2026-10-05; no change to the facts.
2026-09-30: first published after review by the editorial team.