I’ve always been intrigued by the world of anabolic steroids and their potential benefits. However, the potential side effects, especially regarding liver health, have always been a major concern for me. Many people largely consider oral steroids liver toxic, and simply by avoiding them you can maintain liver health whilst enhanced but is this really the case?

While many associate this risk primarily with oral steroids, the truth is that injectable steroids can also pose a threat to liver health. The key factors to consider are the androgenicity of the steroid and its rate of metabolism. Androgenicity refers to the strength of a steroid’s binding affinity to androgen receptors in the body. The higher the androgenic potential and the slower the metabolism, the greater the potential for liver damage.

Oral steroids are often modified to slow down their metabolism, making them more effective but also potentially more harmful. This modification, known as alpha 17 alkylation, allows the steroids to remain in the body longer, but it also increases the burden on the liver, leading to damage. However, even injectable steroids, especially those with long esters that remain in the system for extended periods, can cause similar damage if they are highly androgenic.

The damage caused by anabolic steroids is not always immediately apparent. While liver enzyme values may decline after stopping steroid use, the underlying DNA damage at the liver can persist for years, potentially leading to liver cancer even decades later. This delayed effect underscores the importance of understanding the long-term risks associated with steroid use.

One particularly concerning condition linked to anabolic steroid use is hepatocellular carcinoma (HCC), the most common form of liver cancer. Research has shown that androgen receptor density at the liver is correlated with the development of HCC. This finding is so significant that even individuals who haven’t used steroids but have HCC are looking for ways to reduce androgen receptor density in their livers.

It’s important to note that the risk of developing HCC is not limited to high doses of steroids. Studies have shown that similar doses of androgens can cause both liver tumors (adenomas) and HCC, and the median time to develop either condition is around five and a half years of consistent steroid use. This finding emphasizes that even moderate steroid use over an extended period can have serious consequences.

So, how can one protect their liver while using anabolic steroids? While completely eliminating the risk is impossible, there are steps that can be taken to mitigate the potential damage. Antioxidants, such as milk thistle, choline, TUDCA, coenzyme q10, have been shown to improve metrics in liver function tests and thus might attenuate liver damage from anabolic steroids or act as ancillaries.  Additionally, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and especially avoiding alcohol, is crucial for overall liver health.

It’s also important to remember that cycling off steroids, meaning taking breaks from their use, may not completely eliminate the risk of liver damage. While some cellular repair and apoptosis (programmed cell death) will occur during these breaks, the long-term effects of repeated steroid cycles are still not fully understood.

Ultimately, the decision to use anabolic steroids is a personal one that should be made with full awareness of the potential risks and benefits. If you’re considering using steroids or are currently using steroids, it’s essential to consult with a medical professional.