Anabolic Steroids & Liver [GI]

[Michael Scally MD]

Boks MN, Tiebosch AT, van der Waaij LA. A jaundiced bodybuilder Cholestatic hepatitis as side effect of injectable anabolic-androgenic steroids. J Sports Sci. http://www.tandfonline.com/doi/full/10.1080/02640414.2016.1265659

The use of anabolic steroids is prevalent in recreational athletes. This case report describes a young amateur bodybuilder who was referred to our outpatient clinic with jaundice and loss of appetite due to cholestatic hepatitis. Additional tests including a liver biopsy made it likely that the hepatitis was caused by the injectable anabolic steroid trenbolone enanthate. Cholestatic hepatitis may not be limited to the use of oral anabolic-androgenic steroids, as is widely assumed. Therefore, and because of other side effects, the recreational use of all forms of anabolic steroids should be discouraged.

 

[Michael Scally MD]

[OA] Romano A, Grassia M, Esposito G, et al. An unusual case of left hepatectomy for Focal Nodular Hyperplasia (FNH) linked to the use of Anabolic Androgenic Steroids (AASs). Int J Surg Case Rep 2016;30:169-71. http://www.casereports.com/article/S2210-2612(16)30471-0/fulltext

Highlights
· This is an unusual case of left hepatectomy for FNH.
· Focal Nodular Hyperplasia(FNH), is the second most common benign tumor of the liver.
· In our case the young patient was taking several herbal products and dietary supplements including anabolic androgenic steroids (AASs).
· We have reported a rare case of left hepatectomy for FNH. We suppose that the increasing of the lesion, in two years in which the patient made use of anabolic steroids. Hormonal conditioning of these lesions is known, under use of oral anabolic steroids being proved the increase in volume of FNH. This could be the explanation for increasing of nodule.

INTRODUCTION: Focal Nodular Hyperplasia (FNH) is the second most common benign tumor of the liver. Clinically FNH is asymptomatic and discovered incidentally. The pathogenesis is unclear; FNH is usually asymptomatic. When the tumor is large, it may be painful. Surgery is recommended only in the case of complications such as compression of adjacent organs, lesion progression with tumor size >5cm and presence of symptoms.

PRESENTATION OF CASE: A 30 years old man, was evaluated during a routine visit, for diffuse abdominal pain and weight loss; Abdominal ultrasound showed no evidence of biliary obstruction but the US shows a hypoechoic, well defined focal lesion in the left liver. For a more accurate diagnosis a Magnetic Resonance detected a focal area about 14x9 cm in diameter, hypointense. Liver biopsy was not done.

We could not diagnose it definitively as FNH from the results of imaging studies; so for the size of symptomatic lesion, the undefined diagnosis of FNH ,and due to the great increase in the size of the mass located in the left lobe, during such a short period , the surgery was been recommended.

DISCUSSION: FNH is the second most common hepatic lesion, but clinically relevant cases of FNH are rare with a reported prevalence in US studies of 0,03%. In our case the young patient was taking dietary supplements including anabolic androgenic steroids (AASs), carnitine and l-arginine.

CONCLUSION: The particularity of our case is the increasing of the lesion in two years in which the patient made use of anabolic steroids. under use of . This could be the explanation for increasing of nodule.

 

[JRA]

Orals=bad for liver. Injectables=bad for heart. Ok, we all get this. Now, is the risk worth the reward? We all gamble with our lives every day, at home, in cars or bikes, even walking on a busy street. Furthermore, obesity kills 300,000 US citizens every year. Smoking? Alcohol? Recreational drug use? The list goes on and on. If AAS if part of you life style, be smart, read threads like here to be educated, but more importantly, to be aware of the risks. It is up to you if the rewards are worth it. My grandfather smoked cig's for 65 years and died naturally at 94. Go figure.

 

[JRA]

^ In addition, regarding ricks of using steroids, any real numbers of how many people have actually died from steroid use and cause? Just read an article that absolutely links 9 deaths from cancer due to breast implants, yet 290,000 women under went breast augmentation implant surgery- FDA Links Breast Implants With Rare Form of Cancer Why aren't implants illegal? I know the obvious reason, but what a double standard.

 

[Rupling]

Orals=bad for liver. Injectables=bad for heart. Ok, we all get this. Now, is the risk worth the reward? We all gamble with our lives every day, at home, in cars or bikes, even walking on a busy street. Furthermore, obesity kills 300,000 US citizens every year. Smoking? Alcohol? Recreational drug use? The list goes on and on. If AAS if part of you life style, be smart, read threads like here to be educated, but more importantly, to be aware of the risks. It is up to you if the rewards are worth it. My grandfather smoked cig's for 65 years and died naturally at 94. Go figure.

You summed up both sides of this argument the best

 

[Juced]

avoid orals, dont go crazy on inject doses ( i rec stay under 1g total) use AI on cycle and do PCT after if not in HRT, eat healthy and stay active and you are still WAY more likely to live longer than the average joe shmo IMO

 

[Michael Scally MD]

[OA] Solimini R, Rotolo MC, Mastrobattista L, et al. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmacol Sci 2017;21(1 Suppl):7-16. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping

Anabolic Androgenic Steroids (AAS) abuse and misuse is nowadays a harmful habit involving both professional or recreational athletes, as well as general population. AAS are also frequently present in over-the-counter dietary supplements without being declared in the list of ingredients, leaving consumers unaware of the risks of adverse effects. Indeed, health risks of AAS consumption in pharmaceutical preparations or dietary complements seem still underestimated and under-reported. The variety of complications due to AAS misuse involves cardiovascular, central nervous, musculoskeletal and genitourinary systems of both males and females; psychiatric and behavioral effects, damages to metabolic system, skin and mainly liver. For instance, relevant concern has been raised by the AAS hepatotoxicity including adenoma, hepatocellular carcinoma, cholestasis, and peliosis hepatis. The present review reports the information available on the hepatotoxic effects of AAS use in professional and amateur athletes.

 

[JRA]

Well, if one is going to do damage to one's body (internal organs), at least ASS's make you look great.. I just read a study (I am sorry I am trying to find it again) where pct's are proven not to help as most bodybuilders believe.

 

[TheSpectre]

Dr. Scally, can you please tell us your medical conclusions on sulfasalazine for the liver?

Thanks.

 

[Poolmantx]

I thought this topic would be of interest. I will go through Meso to find posts relevant to this thread and copy/paste. If anyone knows of a post that should be included, let me know. In the meantime, for a first post.

El Sherrif Y, Potts JR, Howard MR, et al. Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations? Liver Int. Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations? - El Sherrif - 2013 - Liver International - Wiley Online Library

BACKGROUND: Though possession of androgenic anabolic steroids (AAS) is illegal, non-prescription use of AAS persists.

METHODS: We describe two Caucasian males (aged 25 and 45 years) with cholestatic hepatitis following ingestion of the dietary supplement Mass-Drol ('Celtic Dragon') containing the AAS 2alpha-17alpha-dimethyl-etiocholan-3-one,17beta-ol.

RESULTS: Despite substantial hyperbilirubinaemia peak gamma-glutamyl transferase (GGT) remained normal. Besides 'bland' intralobular cholestasis, liver biopsy in both found deficiency of canalicular expression of ectoenzymes as seen in ATP8B1 disease. In the older patient, bile salt export pump marking (encoded by ABCB11) was focally diminished. We hypothesized that AAS had either induced inhibition of normal ATP8B1/ABCB11 expression or triggered initial episodes of benign recurrent intrahepatic cholestasis (BRIC) type 1/or 2. On sequencing, ATP8B1 was normal in both patients although the younger was heterozygous for the c.2093G>A mutation in ABCB11, a polymorphism previously encountered in drug-induced liver injury.

CONCLUSION: AAS marketed as dietary supplements continue to cause hepatotoxicity in the UK; underlying mechanisms may include unmasking of genetic cholestatic syndromes.

So is there something you can take to prevent liver/ kidney damage from, test, hgh, HCG, tren ?

 

[Poolmantx]

So is there something you can take to prevent liver/ kidney damage from, test, hgh, HCG, tren .
Thank you,
Pool

 

[Docd187123]

So is there something you can take to prevent liver/ kidney damage from, test, hgh, HCG, tren ?

Water...

Limit the dose and duration of anythimg hepatotoxic and give your liver ample time off from them as well

 

[Dr JIM]

Water...

Limit the dose and duration of anythimg hepatotoxic and give your liver ample time off from them as well

Agreed and since the hepato-toxic effects of AAS usually don't begin until roughly 4-6 weeks, very few folk are going to sustain any more "damage" than what would be expected from drinking ETOH providing they CYCLE AAS.

Those who do get into trouble are often running oral agents as part of a "blast n cruise" regimen and in spite of the risk rarely if ever obtain baseline and/or periodic LFTs..

The point, baseline AND periodic
LFTs are mandatory for those running ORAL anabolic steroids
on a regular basis. ("regular" meaning more than 4-6 weeks over a 12 week cycle)

And to that end, funds used to purchase "liver protectors" are much more wisely spent on testing that answers the question -- are AAS
hurting my liver?

Jim

 

[Dr JIM]

----- baseline AND periodic
LFTs are mandatory for those running ORAL anabolic steroids
on a regular basis

Jim

I suppose I should mention "mandatory" in this context applies to those whom are interested in minimizing the
inherent risk of cycling AAS.

And make no mistake about it, for unknown reasons, much like the alcoholic who develops cirrhosis (and very few do), for some AAS are indeed "hepatotoxic" and the most reliable means of making that determination is conducting (LFTs) Liver Function Tests, less one prefers a medical journal CPC "write up" as the interesting case of the month!

Jim

 

[Dr JIM]

Well, if one is going to do damage to one's body (internal organs), at least ASS's make you look great.. I just read a study (I am sorry I am trying to find it again) where pct's are proven not to help as most bodybuilders believe.

To date I'm unaware of any evidence based study that has evaluated the efficacy of PCT.

And I'm specifically referring to the use of either SERMS, HCG alone or in combination as POST CYCLE THERAPY for those running AAS!

(And not the efficacy of these agents as a substitute for TT in legitimate TRT patients)

So if you are aware on one I'd like to review it as would Doc Scally, I'm sure.

Many folk don't seem to understand the primary objective of PCT ---- and that is to maintain gains BETWEEN cycles.

But in the long term does PCT hasten a return of those feedback mechanisms that must be present to ensure natural homeostasis is the end result, probably not ---- but as a BRIDGE to HTPA recovery PCT IS THE BEST option, unless one prefers post-cycle TRT range testosterone levels, for months on end.

 

[Dr JIM]

I should also mention folk should not be misled into believing PCT is some HTPA/Gonadal "cure all" for years of AAS use or abuse.

The fact is many "cyclists" must either accept their "low T" values or TRT as the final remedy, it's the price many pay for a life of AAS especially when compounded by the hormonal changes of the aging male, as in andropause.

 

[Dr JIM]

Boks MN, Tiebosch AT, van der Waaij LA. A jaundiced bodybuilder Cholestatic hepatitis as side effect of injectable anabolic-androgenic steroids. J Sports Sci. http://www.tandfonline.com/doi/full/10.1080/02640414.2016.1265659


Additional tests including a liver biopsy made it likely that the hepatitis was caused by the injectable anabolic steroid trenbolone enanthate.

.

Consumption of a number of compounds may result in the development of cholestatic jaundice, (from OTC supplements to estrogen)

And for the authors to posit the cause in this case was the "injectable AAS Trenbolone Enanthate" is being presumptuous, to say the least.

Would this CPC even be published if a cause and effect relationship was stated to be any number of "oral anabolic agents" - NOPE

What measures were taken on behalf of the authors to ensure Tren was the ONLY substance being consumed, such that the etiology of this patients
"Jaundice" may be rightfully assigned to Tren ?

Here let me guess, this BB was provided a questioner which was used as a substitute for a much more informative assay - a urine drug screen .

The fact is for all intents and purposes, attributing causation to an injectable AAS, is what makes this "case" worthy of journal script!

Jim

 

[Rupling]

In terms of "liver abuse" being discussed on this thread, one must consider that you cannot just focus on abuse from AAS, tobacco, etc....even seemingly benign substances such as so-called "moderate" alcohol usage, fatty liver due to diet, over-use of prescription and OTC meds like Tylenol and the like can all contribute to a poisonous Witches' Brew on your liver. Other factors such as genetics also play a factor. There are so many variables--in the end, protection of one's health is not an exact science.

Like most areas of life, the best you can do is take precautions and enjoy your life in other areas MODERATELY....I think we all get caught up in what are and aren't "bad" drugs/substances, that we lose sight that even taking too much of supposedly safe OTC meds--or even food--can destroy your liver as much as doing 100mg of Orals ED for years on end, LOL

 

[Bigunitny]

Is Trenbolone liver toxic?

 

[Bigunitny]

So is there something you can take to prevent liver/ kidney damage from, test, hgh, HCG, tren .
Thank you,
Pool

Tren causes liver problems?