Its well known that anabolic steroids have nephrotoxicity, meaning their potential to cause damage to the kidneys. However most don’t understand how serious this is. All androgens themselves are nephrotoxic, and whilst Equipoise (boldenone), Trenbolone, and Winstrol are very much so, even Testosterone is nephrotoxic when taken in Supratherapeutic doses. The common belief is that only certain androgen derivatives pose a risk to kidney health, and ive even seen some people say that high protein consumption is more nephrotoxic relative to anabolics. 

 

Searching through the topic on pubmed, there are 35 case studies on kidney injury, damage, or failure amongst anabolic steroid users, with many of the case studies following more than one person. For example the study titled ‘Development of focal segmental glomerulosclerosis after anabolic steroid abuse’ follows 10 bodybuilders. Individuals suffered from glomerular sclerosis (scarring of the glomeruli, the filtering units in the kidneys) in these individuals. When kidneys are overstressed, they undergo hypertrophy (enlargement) to cope with the increased filtration demands. This hypertrophy can lead to detachment of podocytes (cells in the glomeruli) from other kidney structures, eventually resulting in scarring. 

Interestingly, the researchers noticed  that while six out of ten participants had moderate hypertension, they did not exhibit significant arteriosclerosis (hardening of the arteries) in their kidneys, which led them to believe that while high blood pressure contributes to kidney damage, the primary culprit in this case was likely the direct toxicity of androgens on the kidneys.

Now although case reports rank at the bottom of the scientific hierarchy of evidence, this study involves extensive research by interested nephrologists, and there is also mechanistic data behind this. 

There are various animal studies including one where while male rodents show improved kidney health after castration, particularly in response to damage, that link androgens and a decline in kidney kidney health, as well as animal studies on nephrotoxicity from boldenone and nandrolone. The systematic review titled ‘The potential effects of anabolic-androgenic steroids and growth hormone as commonly used sport supplements on the kidney: a systematic review’ elucidate the complications involved.

Another complicating factor is kidney damage is often irreversible, especially from long term anabolic-androgenic steroid use. However it is worth mentioning that the case study on ten bodybuilders did see improvements in glomerular filtration rate (GFR) and creatinine levels after ceasing androgen usage.

The issue is its very hard for many bodybuilders and steroid users to quit forever and many often go back to using after some time because of the confidence boosting effects etc. It’s clear that Anabolic Steroids effect on the kidneys may be a silent killer and if you are using you should carefully consider the potential long-term consequences.

So how exactly does this happen?

As mentioned before, when kidneys are overstressed, they undergo hypertrophy (enlargement) to cope with the increased filtration demands. This hypertrophy can lead to detachment of podocytes (cells in the glomeruli) from other kidney structures, eventually resulting in scarring. This stressing comes from both an increase in metabolic waste (like nitrogen by products) which the kidneys have to deal with and filter out, due to an increase in body weight and muscle mass. In addition to the glomeular damage which can eventually lead to glomerulosclerosis (scarring of the kidneys structures), increases in blood pressure and fluid retention will also stress the liver whilst it is already overworked dealing with an increase in waste products, furthering increases the risk of glomerulosclerosis.

This is not to mention that steroids also promote oxidative stress and inflammation, which damage kidney cells directly. Some steroids do this far more than others.

Another thing to consider is some ethnicities are more at risk of Kidney damage then others.

Ok, so how can we reduce the harm on our kidneys?

Firstly, rapid increases in body weight and fluid are particularly harmful for your kidneys. If your weight is going to increase from anabolic steroids (and food intake obviously) or other PEDs, and your kidney biomarkers are suffering, ensure less drastic increases in bodyweight. This can simply be done by tapering up or down doses over a longer period of time then what you were doing before. There are a handful of over the counter supplements you can take to deal with water retention (dandelion root, black & green tea, asparagus, and caffeine), as well as managing your Estrogen which can contribute to fluid retention.

Secondly over the counter supplements that directly support kidney health.

The best OTC supplements for kidney health include:

• Vitamin C (1000mg with each meal) – according to ‘Serum vitamin C levels and their correlation with chronic kidney disease in adults: a nationwide study’ – ‘Higher levels of serum vitamin C were associated with a reduced likelihood of CKD’
• There was also a study that directly investigated using Vitamin C to protect from Boldenone induced Nephrotoxicity – ‘Boldenone Undecylenate-Mediated Hepatorenal Impairment by Oxidative Damage and Dysregulation of Heat Shock Protein 90 and Androgen Receptors Expressions: Vitamin C Preventive Role’
• Interestingly, a study titled ‘The Modulatory Role of Vitamin C in Boldenone Undecylenate Induced Testicular Oxidative Damage and Androgen Receptor Dysregulation in Adult Male Rats’ noted that Vit-C can help prevent testicular oxidative stress in the following ways:
• Safeguarding spermatogenesis
• Maintaining the viability of sperm
• Preventing sperm agglutination
• Increasing testosterone in serum
• Increasing total sperm output and sperm concentration
• Improving sperm motility

• Coenzyme Q10 (CoQ10)
• Particularly protects the mitochondria in kidney cells, reduces oxidative damage, and improves overall kidney function.
• Megadoses of CoQ10 (over a gram per day) have shown some ability to reduce markers of oxidative stress in patients with chronic kidney disease – ‘Efficacy of coenzyme Q10 in patients with chronic kidney disease: protocol for a systematic review’. It may be beneficial to supplement with Coenzyme Q10 with a fat containing meal.
• ALSO CoQ10 levels in semen fluid are associated with antioxidant status and sperm quality, and CoQ10 supplementation improves semen quality and increases the likelihood of fertility in studies.

I’ve noticed that the Nephro-protective actions of many anti-oxidative supplements seems to have overlapping benefits on testicular function. However this may not carry over for Angiotensin-Converting Enzyme (ACE) Inhibitors & ARBs – Lisinopril, Ramipril (ACE inhibitors), Losartan, Telmisartan (ARBs).

Refrences:

Rosenberg AZ, Kopp JB. Focal Segmental Glomerulosclerosis. Clin J Am Soc Nephrol. 2017 Mar 7;12(3):502-517. doi: 10.2215/CJN.05960616. Epub 2017 Feb 27. Erratum in: Clin J Am Soc Nephrol. 2018 Dec 7;13(12):1889. doi: 10.2215/CJN.12071018. PMID: 28242845; PMCID: PMC5338705.

Davani-Davari D, Karimzadeh I, Khalili H. The potential effects of anabolic-androgenic steroids and growth hormone as commonly used sport supplements on the kidney: a systematic review. BMC Nephrol. 2019 May 31;20(1):198. doi: 10.1186/s12882-019-1384-0. PMID: 31151420; PMCID: PMC6545019.

Podkowińska A, Formanowicz D. Chronic Kidney Disease as Oxidative Stress- and Inflammatory-Mediated Cardiovascular Disease. Antioxidants (Basel). 2020 Aug 14;9(8):752. doi: 10.3390/antiox9080752. PMID: 32823917; PMCID: PMC7463588.

Almukhtar SE, Abbas AA, Muhealdeen DN, Hughson MD. Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuilders(†). Clin Kidney J. 2015 Aug;8(4):415-9. doi: 10.1093/ckj/sfv032. Epub 2015 May 26. PMID: 26251708; PMCID: PMC4515889.

Wang C, Zhao J, Zhou Q, Li J. Serum vitamin C levels and their correlation with chronic kidney disease in adults: a nationwide study. Ren Fail. 2024 Dec;46(1):2298079. doi: 10.1080/0886022X.2023.2298079. Epub 2024 Jan 8. PMID: 38186336; PMCID: PMC10776057.

Behairy A, Mohamed WAM, Ebraheim LLM, Soliman MM, Abd-Elhakim YM, El-Sharkawy NI, Saber TM, El Deib MM. Boldenone Undecylenate-Mediated Hepatorenal Impairment by Oxidative Damage and Dysregulation of Heat Shock Protein 90 and Androgen Receptors Expressions: Vitamin C Preventive Role. Front Pharmacol. 2021 Apr 27;12:651497. doi: 10.3389/fphar.2021.651497. PMID: 33986679; PMCID: PMC8111012.

Behairy A, El-Sharkawy NI, Saber TM, Soliman MM, Metwally MMM, Abd El-Rahman GI, Abd-Elhakim YM, El Deib MM. The Modulatory Role of Vitamin C in Boldenone Undecylenate Induced Testicular Oxidative Damage and Androgen Receptor Dysregulation in Adult Male Rats. Antioxidants (Basel). 2020 Oct 28;9(11):1053. doi: 10.3390/antiox9111053. PMID: 33126548; PMCID: PMC7694087.

Xu Y, Liu J, Han E, Wang Y, Gao J. Efficacy of coenzyme Q10 in patients with chronic kidney disease: protocol for a systematic review. BMJ Open. 2019 May 14;9(5):e029053. doi: 10.1136/bmjopen-2019-029053. PMID: 31092669; PMCID: PMC6530451.