Selective Androgen Receptor Modulators in Women: What Do We Know, and What Is Still Missing.

Androgens and androgen receptor (AR) signaling influence many aspects of female physiology, including reproduction, musculoskeletal health, metabolism, and neurological regulation, yet are less studied than in males. Selective androgen receptor modulators (SARMs) were developed to provide tissue-selective anabolic effects with reduced androgenic side effects, but their effects in women are not well defined. This narrative review summarizes preclinical and clinical evidence on SARM use in female rodents and women, focusing on AR biology, tissue selectivity, therapeutic potential, and safety. A literature search of PubMed, Scopus, and Google Scholar identified relevant experimental and clinical studies addressing sex-specific AR signaling and SARM effects in females. Preclinical data indicate that SARMs can enhance sexual motivation and improve muscle and bone outcomes in ovariectomized models, with compound-dependent effects on reproductive tissues. Clinical studies in postmenopausal women demonstrate increases in lean body mass with generally limited androgenic effects, although functional benefits are inconsistent and alterations in lipid profiles and liver enzymes have been reported. Evidence also supports antitumor activity of AR-targeted SARMs in selected breast cancer subtypes. Overall, while SARMs show therapeutic potential in women, long-term safety and efficacy remain insufficiently characterized, warranting further sex-specific clinical investigation.