남성 건강의 미래: SARMs 열풍에서 회복적 비뇨기과의 다음 20년까지

마지막 업데이트: 8월 17, 2026

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비뇨의학과 성의학 분야는 역사상 가장 흥미로운 변화 중 하나를 겪고 있습니다. 수십 년 동안 남성 건강 문제 치료는 주로 증상을 관리하는 것, 즉 호르몬을 보충하거나 발기 부전(ED)에 대해 단기 작용 약물을 처방하는 것을 의미했습니다. 그러나 의학은 이제 이러한 임시방편에서 벗어나 신체의 자연 기능을 실제로 복구하고 회복시키는 훨씬 더 야심찬 방향으로 나아가고 있습니다.

이러한 변화는 워싱턴 D.C.에서 열린 미국 비뇨기과학회(AUA) 2026 연례 학술대회 기간 중 개최된 제31회 북미 성의학학회(SMSNA) 연례 학술 프로그램의 핵심 주제였습니다. 모히트 케라(Mohit Khera) 교수를 따라다니며 이러한 발표들을 직접 경험한 것은 우리 분야의 미래를 엿볼 수 있는 놀라운 기회였습니다. 한 가지 분명한 사실은, 오늘날 남성들이 SARM과 같은 널리 퍼져 있지만 규제되지 않은 물질에 대해 내리는 선택이 향후 20년 동안 우리가 사용하게 될 첨단 회복 치료법과 직접적으로 연결되어 있다는 점이었습니다.

제1부: SARMs 딜레마 — 거대한 약속, 숨겨진 비용

AUA 2026에서 가장 큰 화제가 된 것 중 하나는 선택적 안드로겐 수용체 조절제(SARMs)의 폭발적인 인기였다. 이 화합물들은 잘 알려지지 않은 실험실 연구 단계에서 벗어나, 이제 누구나 처방전 없이 온라인으로 구매할 수 있는 물질로 자리 잡았다. 체형을 개선하고자 하는 피트니스 애호가들과 중년 남성들은 종종 SARMs를 일종의 현대판 ‘성배’로 여깁니다. SARMs는 전통적인 단백 동화 스테로이드와 같은 근육 증강 및 지방 연소 효과를 약속하면서도, 전립선 비대, 심한 여드름, 탈모와 같은 성가신 부작용은 없다고 알려져 있기 때문입니다.

One point to be clear about from the start: no SARM is an approved medicine. They are investigational compounds, sold online as research chemicals or supplements, outside any regulatory system. Independent analyses of products bought online have repeatedly found contents that do not match the label — a different compound, a different dose, or an undeclared anabolic steroid. Whatever the science says about SARMs as a class therefore says very little about what is actually in a bottle bought on the internet. They are also prohibited in sport: SARMs sit on the World Anti-Doping Agency’s prohibited list, and athletes have been sanctioned after taking supplements that turned out to contain them without saying so on the label.

The idea behind SARMs is something called tissue selectivity. Regular testosterone switches on androgen receptors all over the body, which is why it causes side effects everywhere. SARMs are designed to be smarter — targeting the receptors in muscle and bone while staying mostly quiet in sensitive areas like the prostate and skin.

The muscle effect itself is real and measurable: trials have consistently found gains in lean muscle mass. What is far less consistent is whether that extra muscle translates into anything a man can actually feel or do. Smaller studies reported improvements in practical measures such as walking speed in older adults, but larger development programmes have failed to show a reliable functional benefit, and extra lean mass on a body composition scan is not the same thing as being stronger, fitter, or healthier. That gap between a number on a scan and a change in someone’s life is exactly the kind of distinction that gets lost when a compound is marketed rather than prescribed.

잡음: 공짜 점심은 없다

Despite those muscle gains, the expert presentations drove home an uncomfortable truth: SARMs come with a real price tag for your health. Because they’re so easy to buy online without any medical supervision, most users have no idea about the systemic problems these substances can cause. The conference highlighted several key concerns:

• 일상적으로 나타나는 부작용: 많은 사용자들이 지속적인 두통이나 구강 건조증과 같은 성가신 증상을 호소하고 있습니다.
• Heart health risks: One of the most consistent findings is that SARMs lower HDL cholesterol — the kind that protects your blood vessels. Over time, this could increase the risk of cardiovascular problems.
• Liver stress: At higher doses, SARMs can put strain on the liver, showing up as abnormal liver test results. Cases of serious drug-induced liver injury have been reported in people using SARMs bought online.
• 체내 호르몬 기능 억제: 이것이 가장 큰 문제입니다. SARM은 테스토스테론보다 부작용이 적은 대안으로 홍보되고 있지만, 실제로는 체내에서 자연적으로 생성되는 테스토스테론 분비를 억제합니다. 복용량이 많을수록, 복용 기간이 길어질수록 체내 호르몬 시스템의 기능이 점점 더 억제됩니다.

마지막 요점은 다음과 같이 작용합니다. SARM을 복용하면 뇌는 과도한 안드로겐 활동을 감지하고, 이에 대응하여 신체에 자체 테스토스테론 생성을 중단하라고 지시합니다. 뇌에서 고환으로 전달되는 신호가 점차 약해지면서 자연적인 호르몬 수치가 떨어집니다. 우려스러운 점은, 이러한 억제 효과가 실제로 해당 물질을 복용했던 기간보다 훨씬 더 오래 지속될 수 있다는 것입니다. 또한, 아직 적절한 인체 연구가 이루어지지 않았기 때문에 생식 능력에 미치는 장기적인 영향은 대부분 알려지지 않은 상태입니다.

If you are already using one of these compounds, the useful thing is not to hide it. Tell your doctor what you have been taking and for how long — the assessment is straightforward, involving hormone levels, a lipid profile, liver tests and, where fertility matters, a semen analysis. Suppression often recovers after stopping, but it can take months, and it is worth knowing where you stand rather than guessing. What does not help is treating a suppressed hormone system with more unregulated compounds bought from the same source, which is how a temporary problem becomes an entrenched one. If low testosterone turns out to be genuine and persistent, that is a treatable condition in its own right — managed with properly monitored 테스토스테론 치료, or, where a man still wants children, with medicines that raise his own production instead. Yellowing of the eyes or skin, dark urine, severe abdominal pain, chest pain or breathlessness need medical attention straight away.

SARMs가 실제로 도움이 될 수 있는 곳: 암 치료에서의 특화된 역할

흥미롭게도, SARM의 진정한 가치는 일반 대중이 아니라 매우 특정한 의학적 상황에서 드러날 수 있습니다. 전립선암 생존자를 대상으로 연구 중인 특수한 SARM이 그 좋은 예입니다.

Prostate cancer is normally fueled by male hormones, which means survivors who struggle with muscle wasting and erectile dysfunction usually cannot safely take standard testosterone therapy. In a carefully controlled trial involving men who were well past their prostate surgery with stable, undetectable cancer markers, researchers tested whether this targeted SARM could help. The results revealed both promise and limits: the drug safely built muscle and reduced body fat without reactivating the cancer — a genuinely encouraging safety result, though in a small, selected group followed for a limited time, which is not the same as long-term safety being established. It did not improve sexual function, a reminder that erectile problems after prostate surgery have deep, complex causes that one drug alone cannot fix. The researchers concluded that much more data is needed before this could be used in everyday practice. Nothing in that trial applies to a compound bought online: it used a specific agent, at a controlled dose, in a monitored population with undetectable PSA.

파트 II: DHEA 및 기타 일반 의약품은 어떨까요?

세션 중에, 일반적인 보충제와 대안 호르몬들이 비뇨의학과 의사의 진료 도구함에서 실제 어떤 위치를 차지하는지에 대한 논의가 이루어졌습니다. 몇 가지 명확한 결론이 도출되었습니다:

• DHEA: This widely available supplement can slightly nudge up testosterone levels in some studies, but over the long term it does not produce any reliable improvement in physical performance or strength. Asked whether adding DHEA to testosterone therapy helps, the panel was honest: there is no solid evidence that it does. It is not a neutral substance either. DHEA is a hormone precursor that the body converts to both testosterone and oestrogen, the actual content of supplements varies widely between products, it is best avoided by men with hormone-sensitive cancer, and it is prohibited in competitive sport. If you are taking it, say so at your appointment — it can change how your hormone results should be read.
• 5-alpha-reductase inhibitors (finasteride and dutasteride, used for prostate enlargement and for hair loss): these are worth understanding properly rather than in passing. They work by blocking the conversion of testosterone to DHT, so serum testosterone actually rises a little while DHT falls sharply — they are not a way to raise testosterone in any useful sense. A minority of men experience reduced libido, erectile difficulty or ejaculatory changes, and those symptoms are worth reporting rather than quietly tolerating. Two further points matter: these drugs roughly halve the PSA reading, so the doctor interpreting your prostate cancer screening must know you are taking one, and — as with any prescribed medicine — you should not stop it on your own. Raise it with the doctor who prescribed it.

SMSNA 세션에서 얻은 핵심 메시지는 분명했습니다. SARM과 일반의약품이 근육 대 지방 비율을 변화시킬 수는 있지만, 부작용과 예측 불가능한 호르몬 억제, 성기능에 대한 실질적인 이점이 부족하다는 점을 고려할 때, 이러한 치료법들은 아직 일상적인 사용에 적합하지 않습니다.

3부: 발기부전 치료의 다음 20년

The highlight of the scientific sessions was a fascinating, forward-looking lecture by Dr. Johanna L. Hannan titled “ED Targets Most Likely to Translate Into Clinical Practice in the Next 20 Years.” Her talk completely reframed how we think about treating erectile dysfunction. If you want the present-day picture rather than the future one, I have written separately about erectile dysfunction as a symptom rather than a disease.

우리가 어디로 가고 있는지 이해하려면, 얼마나 멀리 왔는지 살펴보는 것이 도움이 됩니다:

• 1970년대: 치료법은 순전히 기계적인 방식이었는데, 진공 장치와 초기형 경질 음경 임플란트가 사용되었다.
• 1980년대: 음경 주사 요법의 등장으로 국소 투여 방식이 도입되었다.
• 1990s: The real revolution — oral pills like sildenafil changed everything.
• 2000년대: 경구용 치료제가 더 많이 등장했고, 초기 줄기세포 연구가 시작되었다.
• 2010s: The focus moved to minimally invasive physical therapies such as shockwave therapy and platelet-rich plasma (PRP) injections.
• 2040년을 향한 길: 이제 초점은 전적으로 유전자 치료와 진정한 재생 의학으로 옮겨가고 있다. 즉, 단순히 증상을 치료하는 것이 아니라 근본적인 조직 손상을 바로잡는 데 중점을 두고 있다.

This matters because current pills like sildenafil and tadalafil work by temporarily boosting blood flow — but they need intact nerves and healthy blood vessels to do their job. For men with serious tissue damage from pelvic surgery, advanced diabetes, or natural aging, these pills often simply stop working. That’s the gap the next generation of treatments is designed to fill. Today there are hundreds of clinical trials around the world focused on erectile dysfunction, and a meaningful share of the most cutting-edge ones are devoted to regenerative approaches like stem cells, PRP, and shockwave therapy.

A word of caution about that 2010s group, though, because it is where the marketing is loudest. Low-intensity shockwave therapy has a growing but still mixed evidence base and is offered to selected men. Platelet-rich plasma injections for ED are a different matter: they are sold commercially in a great many clinics, including here in Thailand, on the strength of very limited evidence, and the professional societies do not currently endorse them outside a research setting. Stem cell injections for ED are in the same position. It is worth holding on to the distinction — an active area of research is not the same as a proven treatment, and the fact that something can be purchased says nothing at all about whether it works.

제4부: 신체 복구 - 신경 자극, 유전자 치료 및 나노 기술

Dr. Hannan’s lecture spotlighted three specific scientific pathways that could revolutionize practice by directly healing damaged nerves and blood vessels. All three are research findings rather than treatments you can ask for: none is approved or available in routine practice anywhere, including in Thailand.

1. 신경 자극기

남성이 전립선암 수술을 받을 때, 발기에 중요한 역할을 하는 전립선 바로 옆에 위치한 신경이 손상되거나 늘어나거나 멍들 수 있습니다. 이는 신경 손상으로 인한 발기 부전을 야기할 수 있습니다.

Researchers have developed an implantable device that acts almost like a pacemaker for these nerves. A soft, flexible electrode is placed gently over the erection nerves during the healing period after surgery, connected to a small generator that can be recharged wirelessly. By delivering gentle electrical stimulation, the device helps protect the nerves from dying off, encourages them to regrow, and supports the healing process. In an early clinical trial following patients for a full year after robotic prostate surgery, the device proved safe — with no device-related infections and no significant pain — and men maintained erectile function during recovery. An early trial of this kind is designed mainly to answer whether a device is safe; whether it genuinely works better than recovery without it is the question the larger US-based study now underway is meant to settle.

2. 촉각과 감각의 과학

또 다른 흥미로운 연구 분야는 신체적 접촉이 세포 수준에서 어떻게 성적 신호로 전환되는지를 이해하는 것입니다. 『네이처(Nature)』와 『사이언스(Science)』와 같은 저명 학술지에 실린 최근 연구들은 성기 피부에 존재하며 성적 반응을 유도하는 미세한 특수 센서들의 구조를 규명했습니다. 이러한 센서들이 제대로 작동하지 않을 경우, 신체적 자극에 대한 발기 반응이 현저히 감소합니다.

Scientists have also identified specific touch-sensitive channels that appear to be linked to premature ejaculation — when there are too many of them concentrated in certain areas, ejaculation tends to happen faster. Understanding these channels opens the door to precise, localized treatments that could fine-tune sensation without numbing it, offering better control over both erections and ejaculation timing in the future. This work is at the stage of mapping biology in laboratory models, not of designing a product — a target being identified is the beginning of a long road, not the end of one.

3. 건강한 혈관 재건

마지막 기둥은 강력한 천연 신호 단백질인 SDF-1을 사용하여 혈관 자체를 복구하는 데 중점을 두며, 이 단백질은 신체 자체의 복구 세포를 동원하여 손상된 조직을 복구합니다. 신경 손상 관련 ED의 실험실 모델에서 이 단백질을 직접 주사하는 것은 그렇지 않으면 손실되었을 발기 기능을 보존하는 데 도움이 되었습니다.

But nobody wants repeated injections. So researchers have gone a step further, packaging the genetic instructions for this repair protein inside microscopic protective nanospheres — advanced nanotechnology that delivers the healing message directly into the cells. When injected, these nanoparticles stay localized exactly where they’re needed, with no unwanted spread to the rest of the body. In diabetic models — a notoriously difficult cause of ED — a single localized treatment produced a marked recovery of erectile function. This is one of the most exciting directions in the entire field. It is also, at this stage, animal work: the step from a laboratory model to a treatment given to patients is long, and many promising therapies do not survive it.

Part V: Preventative Urology — Extending Both Healthspan and Sexspan

The final takeaway from Dr. Hannan’s presentation connected sexual medicine to the bigger picture of healthy aging. The goal of future medicine isn’t simply to make us live longer — it’s to extend our healthspan, the years we spend healthy and free from chronic disease. And alongside it, what we might call our sexspan — the years we maintain a healthy, satisfying sexual life.

The Zombie Cell Problem

As we age, some of our cells enter a strange state: they stop dividing but refuse to die. Scientists call these senescent or zombie cells, and they accumulate over time, leaking out a mix of inflammatory chemicals into the surrounding tissue. This slow drip of inflammation is thought to contribute to many age-related diseases — heart disease, diabetes, dementia and others. In men’s health, the same process appears to damage the blood vessels and smooth muscle in the penis, and it is one proposed driver of both prostate enlargement and erectile dysfunction. This is an active and plausible research model rather than settled fact, and it should be read as a promising explanation rather than a proven mechanism you can act on today.

세포 노화에 맞서 싸우기

이러한 세포 퇴행을 막기 위해 비뇨기과 의사들은 다양한 전략을 모색하고 있습니다.

• Lifestyle first: Structured exercise combined with a healthy diet — think Mediterranean-style eating, rich in olive oil, nuts, and antioxidants — forms the foundation. These choices calm down systemic inflammation and keep blood vessels healthy and flexible. This is the only item on the list with strong evidence behind it today, and it is also the only one available to everybody right now.
• New longevity medications: An emerging class of drugs aims to either clear out these senescent cells entirely or quiet down the chemicals they release — protecting the delicate nerves and blood vessels that erections depend on. These remain experimental, and the anti-aging compounds sold direct to consumers on that premise are not the same thing as the agents being studied.
• Metabolic helpers: The growing use of modern weight and diabetes medications (like the well-known GLP-1 drugs) reflects a major shift toward proactive, preventative care — tackling the root metabolic causes of disease before they damage sexual health. These are prescribed by endocrinology and internal medicine rather than by this urology clinic, which does not provide them.

결론: 미래에 대한 명확한 비전

워싱턴 D.C.에서 열린 AUA 2026에 참석하면서 Khera 교수님을 참관했던 경험은 남성 건강 분야의 미래를 명확하게 보여주었습니다. 차세대 의사들과 환자들을 위한 메시지는 세 가지의 간단한 원칙으로 요약됩니다:

1. 단순히 대충 덮어두지 말고 근본적으로 치료하십시오. 증상을 일시적으로 가릴 뿐인 단기적인 해결책에서 벗어나, 발기부전과 조직 손상의 근본 원인을 실제로 치료하는 방법에 집중하십시오.
2. 치료제를 정밀하게 전달해야 합니다. 이러한 획기적인 성과를 안전하게 임상 현장에 적용하기 위해서는, 신체의 다른 부위에는 영향을 주지 않으면서 필요한 부위에서만 정확하게 작용하는 나노입자와 같은 스마트 전달 시스템이 필요합니다.
3. 조기에 예방하세요. 진정한 돌봄이란 첨단 수술과 선제적 예방을 결합하여, 세포 노화와 대사 건강과 같은 근본 원인을 해결함으로써 건강 수명과 성생활 수명을 모두 연장하는 것을 의미합니다.

The journey from today’s unregulated SARMs craze to tomorrow’s precise, gene-based tissue repair represents an incredible leap forward. Guided by rigorous science, the next twenty years may fundamentally redefine men’s health. But it is worth ending where a doctor has to live rather than where a conference programme ends: the treatments that genuinely work today are the unglamorous ones — getting the metabolic risk factors under control, and using the established therapies properly. Nothing described in Parts III and IV is something you can be offered this year, and any clinic that tells you otherwise is selling something.

If you have questions about men’s health, testosterone, or 발기부전 and would like a comprehensive, up-to-date evaluation, Dr. Soarawee Weerasopone offers specialist consultations at 방콕 병원 본사. 사미즈 시라차 병원 예약은 비뇨기과로 전화하여 하실 수 있습니다. 088-022-1445.

Bangkok Hospital also runs a Telemedicine service for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation or treatment, please contact the hospital directly — Bangkok Hospital at bhquro@bdms.co.th, or Samitivej Sriracha on 088-022-1445.

자주 묻는 질문 (FAQ)

Are SARMs approved medicines?

No. SARMs are investigational compounds. None is approved as a medicine for building muscle or improving physique, and the products sold online are outside any regulatory system. Independent testing of such products has repeatedly found contents that do not match the label, including different compounds, different doses, and undeclared anabolic steroids. They are also on the World Anti-Doping Agency’s prohibited list. What the research literature says about a specific SARM at a controlled dose tells you very little about what is in a bottle bought on the internet.

Do SARMs actually build muscle?

Trials have consistently shown gains in lean muscle mass, so the effect on body composition is real. Whether that translates into being genuinely stronger or more capable is much less clear — smaller studies reported improvements in measures such as walking speed, but larger development programmes did not show a reliable functional benefit. Extra lean mass on a scan is not the same as a change you can feel, and it has to be weighed against hormone suppression, lower HDL cholesterol and liver risk.

Do SARMs affect testosterone and fertility?

Yes. Despite being marketed as a gentler alternative to testosterone, SARMs suppress the body’s own testosterone production, and the effect grows with dose and duration. The suppression can persist well beyond the period of use. The long-term effects on fertility are not well established, because the human studies have not been done — which is itself a reason for caution rather than reassurance. Anyone concerned about future fertility should have hormone levels and a semen analysis before assuming things are fine.

I have been taking SARMs. What should I do?

Tell your doctor what you have taken and for how long — the assessment is straightforward and involves hormone levels, a lipid profile, liver tests and, where relevant, a semen analysis. Suppression often recovers after stopping, but recovery can take months. Do not try to correct a suppressed hormone system with further unregulated compounds. Seek medical attention immediately for yellowing of the eyes or skin, dark urine, severe abdominal pain, chest pain or breathlessness.

Are the nerve-stimulation implant, gene therapy and nanoparticle treatments available now?

No. All of the restorative approaches described in this article are investigational. The nerve-stimulation implant is in clinical trials, and the SDF-1 gene and nanoparticle work is at the laboratory-model stage. None is approved or offered as routine treatment, in Thailand or elsewhere, and the step from a promising animal study to an approved therapy is long — many candidates do not complete it. This article describes where the field is heading, not what can be booked today.

What about PRP and stem cell injections for ED — they are advertised everywhere?

They are widely sold commercially, including in Thailand, but the evidence supporting them for erectile dysfunction is limited, and professional societies do not currently endorse either outside a research setting. Availability is not evidence. If you are considering one, it is fair to ask what the expected benefit is, what trial data supports it in men like you, and what happens if it does not work — and to have the underlying vascular and hormonal causes assessed properly first.

What actually works for erectile dysfunction today?

The established treatments remain oral PDE5 inhibitors such as sildenafil and tadalafil, intracavernosal injection therapy, vacuum devices, and penile prosthesis implantation where other options have failed. Low-intensity shockwave therapy is available for selected men and remains an active area of research. Alongside these, controlling the metabolic risk factors — weight, blood sugar, blood pressure, lipids, smoking, sleep and exercise — remains the intervention with the broadest evidence, and it is the one that also protects the nerves and blood vessels the future therapies aim to repair.

고지 사항: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Several of the therapies described in this article — including the nerve-stimulation implant, gene therapy and nanoparticle delivery — remain investigational and are not yet available as routine clinical treatments. SARMs are not approved medicines and are not recommended for physique or performance use. No medical advice, diagnosis or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment.