Does steroids really damage the liver?

Does steroids really damage the liver?

Pharmacological doping has become firmly established even in amateur athletes. What is the scale of this phenomenon? Different authors give different data, it is estimated that up to 50% of people exercising amateurishly used doping in their “career”. This seems to be quite a large percentage, given the number of myths and stories circulating about steroids. Today we will take under the microscope those most harmful to “doping”, i.e. those which are furthest from the real truth.

Myth 1: The liver dies and rots from steroids.

We will start rather shockingly, but… none of the commonly used steroids (except for injectable Winstrol and Methanabol) in laboratory tests showed direct, destructive effects on the liver. We are not talking here about cases where Winstrol, Anapolon, Metanabol (D-bol), Turinabol (it is less toxic than methanabol, but it is still a methylated agent) and e.g. injectable testosterone (which has been shown to be safe in certain doses even with continuous use) have been continuously used for months. Generally speaking, assuming you don’t abuse oral SAAs for months, and especially don’t use several at once, your liver will be fine. You can find maharajas of medicine on the internet, who preach theories about the harmfulness of SAA, based on, for example … a single case of overdose of two hepatotoxic preparations. Such data make no sense whatsoever. A group that would reliably confirm the hepatotoxicity of a given agent would have to include a sufficiently large (probably several hundred people and more) and sufficiently diverse group of people in terms of age and gender!

And this should be taken into account:

• genotype, predisposition to certain diseases, including liver, kidney, heart, diabetes, cancer, hypertension, etc.

• age (elderly and young people react very differently to toxic agents),

• health status (a completely different approach should be taken for a person with kidney or liver damage), co-morbidities,

• use of other drugs, including those harmful to the liver (e.g. NSAIDs, paracetamol, sulfonamides, cyclosporine, estrogens, etc.),

• lifestyle,

• the diet used,

• drinking alcohol,

• drug use …

For example: Alcohol is unquestionably a poison, destroying the body of an athlete. However, paradoxically, short-term small doses of alcohol according to research by e.g. Ichiro Wakabayashi [1] … increase HDL, lower triglyceride levels. Only the mentioned “small dose” is in the quoted study < 22 g of ethanol per day, i.e. the equivalent of one beer. In Poland, no one stops at such a negligible supply of alcohol. And the situation is completely different with the use of larger doses of alcohol. Besides, on the one hand ethanol lowers the risk of cardiovascular diseases, on the other hand it increases the risk of cancers, such as breast cancer, in women. It has been found that moderate ethanol consumption reduces the risk of hypertension, heart attack, stroke, sudden cardiac death and gallstones. However, even moderate alcohol consumption increases the risk of breast cancer, bone fractures, polyps and colorectal cancer. For example, in a study by Mostofsky E. et al [2], the dose of ethanol that did not increase blood pressure was up to 20 g per day (for women); however, already at the threshold of 20-34 g of ethanol per day, hypertension was found [2].

The same is true of anabolic-androgenic steroids – moderate to medium doses of injectable preparations are not associated with significant risk to the liver.

“Well, but there are, after all, animal studies in which SAAs have been shown to be extremely toxic.

Unfortunately, this is not true. Scientists, as usual, are super cautious and only write that, for example, boldenone or stanazolol can be harmful even in low doses. And that changes in ALT activity may indicate a certain hepatotoxic effect. The mentioned study by Dornelles GL et al. was published in 2017. [3].

I particularly stress the word ‘may’. – it does not mean that the drugs in question are toxic to the liver or other organs.

Rats were administered:

• boldenone undecylenate (BU),

• stanozolol (ST) – winstrol.

Intramuscular doses were applied in 3 protocols:

• P1; 5 mg per kg body weight once a week for 4 weeks,

• P2; 2.5 mg per kg body weight once weekly for 8 weeks,

• P3; 1.25 mg per kg body weight once a week for 12 weeks.

Transferring these figures to a model 100kg athlete it would be:

• 500 mg boldenone or stanazolol once a week in P1 variant (for 4 weeks),

• 250 mg boldenone or stanazolol once a week in the P2 variant (for 8 weeks),

• 125 mg boldenone or stanazolol once a week in P3 variant (for 12 weeks).

This is a very high dose for winstrol and negligible for boldenone. A control group of animals was given olive oil.

Paradoxically, only boldenone at a dose of 5 mg per kg body weight once a week (on day 30) and 2.5 mg per kg body weight once a week on day 60 changed ALT activity. So the researchers concluded that boldenone may be hepatotoxic. High doses of boldenone can alter cholesterol levels by inhibiting steroid biosynthesis. What is the issue here? It’s not known, because it’s … winstrol is “the bad guy” – it shows significantly more lipidogram and liver toxicity compared to boldenone.

In other human studies, even the most liver-damaging SAAs (such as anapolone) were used for years! Yes, years! Even in short-term experiments e.g. [4], not only was a cosmic dose used, but anapolone was given to those undergoing continuous ambulatory peritoneal dialysis. 6 months, 24 patients, one was given 2 x 50 mg oxymetholone daily plus rHuEPO (the famous doping agent, erythropoietin) – the group was 11 people. The other group (13 people) were given rHuEPO and a placebo. The most shocking fact is that EPO doping was considered a placebo. After 6 months in the anapolone group hematocrit increased by 38.1 ± 1.0% and haemoglobin by 32.8 ± 0.9%; 12.9 ± 0.3 g/dl and 11.0 ± 0.3 g/dl respectively. Body weight increased from 63.82 ± 2.71 kg to 67.02 ± 3.26 kg. An increase in liver enzymes was noted.

And that’s it, the researchers suggest monitoring liver function when using oxymetholone.

In another 2013 study by Ouppatham Supasyndh et al. [5] 100 mg of anapolone per day was administered for 24 weeks to severely ill people requiring haemodialysis (blood purification). The patients weighed an average of 55.7±8.3 kg. This treatment resulted in negligible liver burden: in the oxymetholone group ALAT/ALT (alanine aminotransferase ) increased on average by 55.5 units (IU), aspAT/AST (aspartate aminotransferase) increased on average by 31.7 units (IU).

It should be added that normally people weighing about 100 kg rarely exceed a dose of 150 mg of anapolone per day, while here as much as 100 mg was administered to people weighing 55 kg! In addition, with a cycle on oxymetholone it is rarely given for more than 6-8 weeks, while here the cycle lasted several times longer!

Summary: will anabolic-androgenic steroids damage my liver? They are a risk, but there is no certain data that they lead to serious diseases – as long as you do not overdose on oral SAAs for months. Of course, their use is morally reprehensible and can affect the functioning of the entire system. How much of an impact will it be? No one knows. Too many factors influence the end result. However, there are many years of research which prove that SAAs are not as dangerous as it is commonly believed.