Anabolic Steroids & Liver [GI]

[Michael Scally MD]

Stolz A, Navarro V, Hayashi PH, et al. Severe and protracted cholestasis in 44 young men taking bodybuilding supplements: assessment of genetic, clinical and chemical risk factors. Alimentary Pharmacology & Therapeutics 2019. https://doi.org/10.1111/apt.15211

Summary Background Bodybuilding supplements can cause a profound cholestatic syndrome.

Aim To describe the drug-Induced liver injury network's experience with liver injury due to bodybuilding supplements.

Methods Liver injury pattern, severity and outcomes, potential genetic associations, and exposure to anabolic steroids by product analysis were analysed in prospectively enrolled subjects with bodybuilding supplement-induced liver injury with causality scores of probable or higher.

Results Forty-four males (mean age 33 years) developed liver injury with a median latency of 73 days. Forty-one per cent presented with hepatocellular pattern of liver injury as defined by the R > 5 ([Fold elevation of ALT] ÷ [Fold elevation of Alk Phos] (mean, range = 6.4, 0.5-31.4, n = 42) despite all presenting with clinical features of cholestatic liver injury (100% with jaundice and 84% with pruritus).

Liver biopsy (59% of subjects) demonstrated a mild hepatitis and profound cholestasis in most without bile duct injury, loss or fibrosis. Seventy-one per cent were hospitalised, and none died or required liver transplantation.

In some, chemical analysis revealed anabolic steroid controlled substances not listed on the label.

No enrichment of genetic variants associated with cholestatic syndromes was found, although mutations in ABCB11 (present in up to 20%) were significantly different than in ethnically matched controls.

Conclusions Patients with bodybuilding supplements liver injury uniformly presented with cholestatic injury, which slowly resolved. The ingested products often contained anabolic steroids not identified on the label, and no enrichment in genetic variants was found, indicating a need for additional studies.

 

[Michael Scally MD]

Hui CL, Lee ZJ. Hepatic disorders associated with exogenous sex steroids: MR imaging findings. Abdominal radiology (New York) 2019. Hepatic disorders associated with exogenous sex steroids: MR imaging findings

OBJECTIVE: To describe the MRI findings of the effects of exogenous sex steroids on the liver.

FINDINGS: Estrogens, progesterone and synthetic testosterone are exogenous sex steroids that may result in a variety of liver diseases, including tumour formation and vascular disorders. These hormones are mainly administered in the form of the oral contraceptive pill (OCP) and anabolic steroids. Both are implicated in hepatic adenoma formation.

The HNF-1alpha-mutated and inflammatory adenoma subgroups are more commonly seen in association with the OCP whereas there is an increased incidence of the beta-catenin positive subtype with anabolic steroid use. Furthermore, anabolic steroids are associated with hepatocellular carcinoma resulting from malignant transformation of beta-catenin positive adenomas.

The oral contraceptive pill may also induce vascular disorders within the liver, some of which are related to the prothrombotic effect of the hormones, such as hepatic and portal vein thrombosis. Other hepatic vascular abnormalities resulting from exogenous sex steroids include veno-occlusive disease and peliosis hepatis.

 

[Munky]

Is clenbuterol harsh on the liver, just running test e , armosin and clen for 3to 4weeks , got some basic blood work onliver, renal panel and hemoglobin, I have been on Vyvanse aka Adderall for a few years has a real kick with clen, my phychatrist was wondering why I was getting rapid fast loss lol also checking thyroid and B12 levels, should I just tell him I'm on test, been blasting and Cruisin 5years I'm 48 and in excellent condition

 

[Dr JIM]

I'm 48 and in excellent condition

For starters it’s apparent your psychiatrist believes otherwise.

 

[Dr JIM]

For starters it’s apparent your psychiatrist believes otherwise.

And rest assured after years of Adderral
you won’t feel so healthy if it’s discontinued.

And although it’s prescribed, much like opiates were in the past, this amphetamine class of drugs IS abused by most Adults, bc they use it for a KICK, rather than as a therapeutic pursuit of WELLNESS.

 

[Old]

Is clenbuterol harsh on the liver, just running test e , armosin and clen for 3to 4weeks , got some basic blood work onliver, renal panel and hemoglobin, I have been on Vyvanse aka Adderall for a few years has a real kick with clen, my phychatrist was wondering why I was getting rapid fast loss lol also checking thyroid and B12 levels, should I just tell him I'm on test, been blasting and Cruisin 5years I'm 48 and in excellent condition

OK if you are taking ADHD meds you have focus/attention issues. So think this through. Why not tell him you are exercising more? He may be concerned that the Vyvanse is causing weight loss so he might wish to reduce your dosage. So your intent to loose weight might be a good disclosure.

BTW Vyvanse is not ''aka" Adderall, they are two different medications.

If you live in a country where AAS are restricted, do you want this on your medical records? Electronic records are NOT secure and are often stolen for identity theft (or even blackmail). Any judge can issue a warrant for medical records - at least in USA (so the privacy act and paperwork means nothing to LE).

Even if it is legal where you live, how is your psychiatrist going to respond? Is he going to be afraid to prescribe you anything because of concern for drug interactions or feeling that you are actually an addict and cannot be trusted with medication? And perhaps he would be right that you do need therapy for dysmorphia and/or addiction.

At times in life one might find themselves in a life-threatening situation where it could be advisable to disclose what one has been doing. But is rapid fat loss because you are trying to have rapid fat loss a serious medical issue to disclose illicit drug use? In the end it isn't a bad thing for your doc to check your thyroid and B12 levels ... in fact with AAS it is good to have all sorts of blood tests run periodically.

 

[Munky]

Okie I'm going to just stay quiet, I'm just heading to see him , I am actually going to go with the lowest dose of test like maybe one shot of test e 1ml of 250mg every 10days I was thinking of getting on trt if I stop now I'm toast I lay block and brick and huge stone all day I can't just stop now , I'm in Canada there pretty good the doctors up here if anything I need to see a endocrineoligist will see what he says, he won't straight cut me off of Vyvanse, up here they have safe injection sites for junkies, weed is legal, big methamphetamine and femtanyl epidemic, they it more like a medical problem than a criminal problem for the basic user , steroids are legal to posess but can't traffic, thanks for the strategy I feel better

 

[Munky]

OK if you are taking ADHD meds you have focus/attention issues. So think this through. Why not tell him you are exercising more? He may be concerned that the Vyvanse is causing weight loss so he might wish to reduce your dosage. So your intent to loose weight might be a good disclosure.

BTW Vyvanse is not ''aka" Adderall, they are two different medications.

If you live in a country where AAS are restricted, do you want this on your medical records? Electronic records are NOT secure and are often stolen for identity theft (or even blackmail). Any judge can issue a warrant for medical records - at least in USA (so the privacy act and paperwork means nothing to LE).

Even if it is legal where you live, how is your psychiatrist going to respond? Is he going to be afraid to prescribe you anything because of concern for drug interactions or feeling that you are actually an addict and cannot be trusted with medication? And perhaps he would be right that you do need therapy for dysmorphia and/or addiction.

At times in life one might find themselves in a life-threatening situation where it could be advisable to disclose what one has been doing. But is rapid fat loss because you are trying to have rapid fat loss a serious medical issue to disclose illicit drug use? In the end it isn't a bad thing for your doc to check your thyroid and B12 levels ... in fact with AAS it is good to have all sorts of blood tests run periodically.

Ya not sure his stand on steroids, I'm in Canada it's not a big antisteroid country , I think lots of the law enforcement are on it , lots of guys on it in my town, actually I could have refused the blood work but I'm not that tripped out , it's nice to have you guys to talk with because most people don't understand anabolic steroids and are misinformed

 

[Munky]

And rest assured after years of Adderral
you won’t feel so healthy if it’s discontinued.thank you

And although it’s prescribed, much like opiates were in the past, this amphetamine class of drugs IS abused by most Adults, bc they use it for a KICK, rather than as a therapeutic pursuit of WELLNESS.

 

[Munky]

Everything went smoothly, my b12was to high from supplementing , all the blood work is normal, he even prescribed add on 10mg Vyvanse for my longer 12 to 14hour work days, thanks again Dr.jim and Old , I'm very blessed and grateful for your input, I'm a lot more responsible about my steroid use , that blood work scared me not knowing what the results would be , all is well thanks mesorx

 

[Dr JIM]

I final word of advice, in well over 20 years of practice I’m unaware of a single patient who REQUIRED amphetamines for wellness, to the contrary the chronic use of ANY schedule II drug is a one way street to trouble.

The point; You’ll be much better off wo THAT JUNK, but like most, after a year of use dependency and/or outright addiction are guaranteed.

IMO your “doctor” should be chastened
for prescribing that crap.

 

[Munky]

That is the goal Doctor, to be off all mind or mood altering substances, it has pros and cons, I was on concerta before as well, these medications can be used for mental health issues, along with prayer/meditation , clean diet/exercise and nutrition it has a place for people who actually need them, I believe a higher power can work through medicine, it is part of my spiritual journey, but I agree the goal is totally abstinence from all stimulants for me, I'm glad in Canada we get free Medicare I'm a proponent of getting blood work done by a professional doctor, as far as steroids go I believe testosterone in the proper dose is beneficial for me at my age , I'm lucky I have a great lab up here and clean products, if used correctly they can make a person live longer and healthier, as far as other anabolic steroids that depends on the purpose, I like deca for my bones and maybe might use anavar later , anything done in moderation and supervision of a trained trainer and consultant be optimal, but this only my opinion and opinions are like assholes everybody has one , thanks buddy I'm very humbled by your input.

 

[Munky]

I final word of advice, in well over 20 years of practice I’m unaware of a single patient who REQUIRED amphetamines for wellness, to the contrary the chronic use of ANY schedule II drug is a one way street to trouble.

The point; You’ll be much better off wo THAT JUNK, but like most, after a year of use dependency and/or outright addiction are guaranteed.

IMO your “doctor” should be chastened
for prescribing that crap.

Tyrosine is a great alternative, for mood, and b vitamins, dendrobium as well, caffeine in the right dose, if you have any other natural substances that can help me let me know doctor.

 

[Michael Scally MD]

Hepatic Actions of Androgens in The Regulation of Metabolism

PURPOSE OF REVIEW: The purpose of this review is to summarize recent findings on hepatic actions of androgens in the regulation of protein, lipid and glucose metabolism. The rationale for liver-targeted testosterone use will be provided.

RECENT FINDINGS: Liver-targeted testosterone administration, via the oral route, induces protein anabolic effect by reducing the rate of protein oxidation to a similar extent to that of systemic testosterone administration. Recent evidence indicates that testosterone exerts whole-body anabolic effect through inhibition of nitrogen loss via the hepatic urea cycle. Several hepatic effects of androgens, particularly on glucose metabolism, are direct and take place before any changes in body composition occur.

This includes an increase in insulin secretion and sensitivity, and reduction in hepatic glucose output by testosterone. Furthermore, lack of testosterone in the liver exacerbates diet-induced impairment in glucose metabolism. In the liver, androgens induce the full spectrum of metabolic changes through interaction with growth hormone or aromatization to estradiol.

SUMMARY: Liver-targeted testosterone therapy may open up a new approach to achieve whole-body anabolism without systemic side-effects. Aromatizable androgens may be superior to nonaromatizable androgens in inducing a complex spectrum of direct, estrogen-mediated and other hormone-mediated effects of androgens.

Birzniece V. Hepatic actions of androgens in the regulation of metabolism. Current opinion in endocrinology, diabetes, and obesity 2018;25:201-8. Hepatic actions of androgens in the regulation of metabolism : Current Opinion in Endocrinology, Diabetes and Obesity

 

[Michael Scally MD]

[OA] [ASIH] A Potent Liver Mediated Mechanism for Loss of Muscle Mass During Androgen Deprivation Therapy

CONTEXT: Androgen deprivation therapy (ADT) in prostate cancer results in muscular atrophy, due to loss of the anabolic actions of testosterone. Recently we discovered that testosterone acts on the hepatic urea cycle to reduce amino acid nitrogen elimination.

We hypothesize that ADT enhances protein oxidative losses by increasing hepatic urea production, resulting in muscle catabolism. We also investigated whether progressive resistance training (PRT) can offset ADT-induced changes in protein metabolism.

OBJECTIVE: To investigate the effect of ADT on whole body protein metabolism and hepatic urea production with and without a home-based PRT program.

DESIGN: A randomised controlled trial.

PATIENTS AND INTERVENTION: Twenty-four prostate cancer patients were studied before and after 6 weeks of ADT. Patients were randomised to usual care (UC) (n = 11) or PRT (n = 13) starting immediately after ADT.

MAIN OUTCOME MEASURES: Rate of hepatic urea production was measured by the urea turnover technique using 15N2-Urea. Whole-body leucine turnover was measured, and leucine rate of appearance (LRa), an index of protein breakdown and leucine oxidation (Lox), a measure of irreversible protein loss, was calculated.

RESULTS: ADT resulted in a significant mean increase in hepatic urea production (from 427.6+/-18.8 to 486.5+/-21.3; p<0.01) regardless of PRT. Net protein loss measured by Lox/LRa increased by 12.6+/-4.9% (p<0.05). PRT preserved lean body mass without affecting hepatic urea production.

CONCLUSION: As early as 6 weeks after initiation of ADT, testosterone suppression increases protein loss through elevated hepatic urea production. Short-term PRT had no effect on protein metabolism during profound testosterone deficiency.

Lam T, McLean M, Hayden A, et al. A potent liver mediated mechanism for loss of muscle mass during androgen deprivation therapy. Endocrine connections 2019. https://ec.bioscientifica.com/view/journals/ec/aop/ec-19-0179.xml

 

[Michael Scally MD]

[OA] [Spanish] Drug-Induced Liver Injury Secondary To Anabolic Steroid Use

Drug-induced liver injury (DILI) is a rare condition; However, it is responsible for 40-50% of acute liver failure1, 2. There are 3 patterns of damage: hepatocellular, cholestatic and mixed, with the cholestatic pattern representing 20-40% of cases3, 4. Their manifestations range from biochemical alterations in the absence of symptoms, up to acute liver failure and chronic liver damage. The diagnosis is exclusion, based on circumstantial evidence. In most cases, the patient's picture improves with the withdrawal of the medication responsible for the damage5.

We present the case of a 38-year-old man with a history of alcoholism of 15 years of evolution with 21.6 g / day of alcohol, with date of last ethyl consumption (1 l of fermented) one week before the start of the clinical picture, without get drunk. With intramuscular application of anabolic steroids based on testosterone 250 mg, nandrolone 100 mg and stanozolol 50 mg, one vial each week, for 31 days.

…

During his hospitalization, management was initiated with methylprednisolone 60 mg every 24 h with subsequent dose reduction with prednisone, S-adenosylmethionine (SAMe) 500 mg every 12 h and ursodeoxycholic acid 15 mg / kg / day divided into 3 doses, with adequate clinical evolution during 5 days of intrahospital stay. After discharge, his evolution was favorable, normalizing his liver function tests 4 months after the suspension of anabolic steroids.

…

The liver biopsy of our patient showed a canalicular pattern compatible with the clinical and biochemical characteristics that he presented, having an adequate evolution after the suspension of said anabolic steroids.

The use of SAMe, as it was in the case of our patient, had a favorable response in conjunction with ursodeoxycholic acid, where different meta-analyzes have determined the efficacy of SAMe in the reduction of pruritus and the serum bilirubin values associated with the cholestasis, compared with placebo8.

The long-term prognosis for DILI, in general, depends on the initial clinical and biochemical presentation of the patient9. The interest of this case lies in the approach to reach the diagnosis of the DILI, the adequate treatment and the good evolution of the patient despite the high levels of total bilirubin at the beginning.

Diaz-Garcia JD, Cordova-Gallardo J, Torres-Viloria A, Estrada-Hernandez R, Torre-Delgadillo A. Drug-induced liver injury secondary to anabolic steroid use. Revista de gastroenterologia de Mexico 2019. https://www.sciencedirect.com/science/article/pii/S0375090619300503

 

[Michael Scally MD]

[OA] Hepatocellular Carcinoma in Body Builders; An Emerging Rare but Serious Complication of Androgenic Anabolic Steroid Use

Illicit use of androgenic anabolic steroids (AAS) is a known problem amongst certain groups including body builders and other athletes. Use of these drugs is thought to be high in some areas of South Wales.

A number of adverse effects have been associated with use of AAS including the development of hepatic adenomas. There have been a handful of rare cases of the development of hepatocellular carcinoma following AAS use.

We report two such cases presenting to the same surgical centre in South Wales within six months. We do this with reference to data from Public Health Wales, including the Harm Reduction Wales Needle and Syringe provision report, which indicate a particularly high rate of use of AAS in the surrounding area.

We believe these cases are important from the public health point of view. They demonstrate a rare and not widely known about, but potentially fatal adverse effect of AAS, now becoming prevalent with the high use of these drugs. This is important for doctors to be aware of, but also could form the focus of a public health campaign targeted at AAS users.

Woodward C, Smith J, Acreman D, Kumar N. Hepatocellular carcinoma in body builders; an emerging rare but serious complication of androgenic anabolic steroid use. Annals of hepato-biliary-pancreatic surgery 2019;23:174-7. https://synapse.koreamed.org/DOIx.php?id=10.14701/ahbps.2019.23.2.174 (Hepatocellular carcinoma in body builders; an emerging rare but serious complication of androgenic anabolic steroid use)



Preoperative computed tomography images of the case 2. Axial image (A) and coronal image (B) showing multiple hypervascular lesions within the liver. Masses occupy the segment 2 and 3, with another pedunculated mass arising from the segment 3.



Intraoperative photographs of the case 2. (A) A left lateral sectionectomy was performed along with removal of the pedunculated mass arising from the segment 3. (B) A large pedunculated lesion can be seen clearly.

 

[Millard]

They demonstrate a rare and not widely known about, but potentially fatal adverse effect of AAS, now becoming prevalent with the high use of these drugs.

It is rare but prevalent.

 

[Dr JIM]

It is rare but prevalent.

HCc is a rare form of cancer and although rare HCC is relatively common form of CA in patients with HEPATITIC C

Prevalence is referring to the frequency of a disease in a specific group of patients known or in this case hypothesized to be at risk, those using AAS

The question then becomes are ASS a risk factor for HC carcinoma as is HEPATITIC C, obviously NOT, but might they pose A risk?

It’s REALLY impossible to know bc competitive BB use a variety of PEDs and other “supplements” none of which have been studied alone or in combination to determine their relative risk of acquiring HCC

Nonetheless since there is an relationship between chronic hepatic inflammation (cirrhosis) and HCC and some AAS have been associated with cholestasis that may result in cirrhosis,
IMO it seems plausible AAS pose a small yet unproven risk, especially in those who use ORALS on a chronic high dose basis.

Jim

 

[Millard]

HCc is a rare form of cancer and although rare HCC is relatively common form of CA in patients with HEPATITIC C

Prevalence is referring to the frequency of a disease in a specific group of patients known or in this case hypothesized to be at risk, those using AAS

Yeah, but as far as I can tell both are referring to AAS side effects:

"They demonstrate a rare and not widely known about, but potentially fatal adverse effect of AAS, now becoming prevalent with the high use of these drugs."

IOW, it is a rare side effect in users of AAS.

And it is a prevalent side effect in users of AAS.

They do say "high use" of AAS.