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Steroids, Supplements and Liver Damage

Breathless mass-media distortion leads much of the public to think that merely using anabolic steroids results in huge mass and extraordinary athletic ability—a magic pill.

Testosterone is a primary anabolic hormone, and the huge size of many bodybuilders and athletes is a direct result of anabolic steroid usage combined with heavy training. That last aspect, exercise, seemingly obvious, is often overlooked. Breathless mass-media distortion leads much of the public to think that merely using anabolic steroids results in huge mass and extraordinary athletic ability—a magic pill.

The results vary. For example, I’ve seen countless bodybuilders duplicate the precise drug regimes favored by champion bodybuilders yet never approach championship muscularity. Clearly, genetics plays a role. The same holds true in sports: The notion that using a certain combination of drugs empowers you to set a home-run record or win the Tour de France, is specious at best. While drugs do play a role, you can’t discount genetic ability or the skill acquired through high-level training.

On the other hand, all things being equal, drugs do enable most people to reach a muscular size that simply doesn’t come naturally. While many drug-free bodybuilding competitors have impressive physiques, they pale in comparison to the average pro bodybuilder. You can surmise just how much drugs contribute to the pros’ physiques by observing them when they aren’t on a drug cycle. That’s when their bodies appear more mortal.

It’s also a misconception that bodybuilders and other athletes enjoy using anabolic drugs. Having known many of them, I can attest that that’s not the case at all. Most use drugs simply to even the playing field. Without drugs, even the most genetically gifted bodybuilder wouldn’t stand a fighting chance against a less gifted but more juiced competitor. The athletes are all too aware of the risks they’re taking with their health by using drug doses far in excess of what’s prescribed for therapeutic reasons. They feel the rewards are worth it.

In truth, despite the vast amounts of various drugs used by pro athletes, reports of serious health consequences are rare. Some suggest that they will emerge in the future. While that’s logical, most experts also agree that although athletes have been using anabolic steroids extensively for more than 40 years, there are no reports of extensive health damage among former users. Indeed, published reports suggest that nearly all side effects linked to steroid use reverse after the athletes no longer use drugs.

The consensus among athletes is that some anabolic steroids are considerably more dangerous than others. Injectable drugs, which bypass liver metabolism, are thought to be safer than oral drugs. All anabolic steroids, however, are manipulated versions of three steroid hormones: testosterone, nandrolone and dihydrotestosterone, a.k.a. DHT. All have their advantages and disadvantages. 

Testosterone, which is most commonly injected, can convert into estrogen through the actions of the enzyme aromatase found in body tissue, mainly fat and muscle. A man with excess estrogen is subject to various effects, such as a buildup of fat under the skin, water retention and gynecomastia, pejoratively known as “bitch tits.” To combat those effects, athletes resort to either estrogen-receptor blockers, such as Nolvadex, or aromatase-inhibiting drugs, such as Arimidex.

On the other hand, one advantage of testosterone injections is the absence of effect on high-density lipoprotein, a protective cholesterol carrier in the blood. Most other steroids, especially the oral versions, are notorious for acutely lowering HDL. Luckily, depressed  HDL returns to normal when the drugs are no longer used.

Nandrolone has a reputation as a “gentle” anabolic steroid most suitable for those concerned about avoiding androgenic-related side effects like male-pattern baldness and acne. True enough, nandrolone doesn’t convert into either estrogen or DHT, but it does operate a little like progesterone, another steroid hormone, which stimulates (wait for it) gynecomastia. A lot of bodybuilders don’t realize that. What’s more, nandrolone is probably the worst steroid to use if you’re looking at drug-tested events. Its residue can readily be detected in the body for more than a year.

The DHT-based anabolics are popular and are often considered highly anabolic because they don’t convert into estrogen. Even so, you’re looking at male-pattern baldness and acne—plus prostate problems. Some users opt for drugs that block 5-alpha reductase, the enzyme that converts testosterone into DHT. Propecia, for example, is used to blunt male-pattern baldness. If you want to know whether you might take a hit like that, look at your maternal grandfather. If he went bald, you’ve likely got the genes to continue that unfortunate family legacy.

After realizing that oral doses of testosterone rapidly degrade in the liver, scientists began manipulating the basic test structure in the late 1950s. The result was hundreds of possible commercial compounds—most of which never left the lab because of potential problems. Their molecular structures, however, were recorded in some chemistry texts, notably one written in the 1960s, and a few years ago several of these formulas were resurrected and sold over the counter as “pro-hormone” supplements. Flash forward to 2005, when the government banned the last generation of pro-hormones because they were potent and potentially toxic—explaining why the drug companies that developed them 40 years ago never released them.

Because oral doses of testosterone aren’t of much use, scientists tweaked its structure to prevent its premature destruction in the liver. The most common tweak involved C-17 alpha alkylation—clinicspeak for preventing the liver from rapidly degrading the drug. The flip side, however, was that the drugs tended to accumulate in the liver and cause hepatitis, a general term indicating a liver inflammation—precisely what occurs with large doses of oral anabolic steroids.

The liver is remarkably plastic. By that I don’t mean that we are all walking around with synthetic livers. I mean that the liver has remarkable regenerative powers. That was no accident, as the liver is the body’s primary detoxifying organ, performing thousands of functions constantly. You can remove three-quarters of the liver and survive, although it’s not something you should try at home.

The sturdy liver can take a lot of abuse before it finally says, No more! Without a functioning liver, eating even protein would prove poisonous. When that happens, you die, unless you can somehow wrangle a liver transplant. The good news about the bad news is that there are many warning signs before the ultimate hepatic catastrophe ensues—your skin and eyes become jaundiced (yellow) because of the backup of bile in the liver from excessive inflammation. More subtle cues include a rise in liver enzymes that point to inflammation and act as a harbinger of imminent damage.

While elevated liver enzymes are a good barometer of liver health, some enzyme measures can be confounded by intense exercise. The enzyme I’m talking about shows up not only in the liver but also in muscle. When muscles are damaged through intense exercise, it shows up during routine blood tests. A muscle enzyme spike can easily be identified by measuring other liver enzymes. If they aren’t elevated, it’s often a false alarm.

Bodybuilders and athletes have taken various measures to combat the adverse effects of oral steroids on the liver. Several herbs have been shown to help prevent alcohol- or drug-induced liver damage, one of which is the herb silymarin, or milk thistle. I reported in this space a few years ago on a study proving that bodybuilders who simultaneously took silymarin and oral steroids had a lower liver enzyme count, hence far less liver inflammation, than bodybuilders using the drugs minus the silymarin.

Other suggested liver-protecting nutrients include gamma linoleic acid, as found in evening primrose oil or borage oil supplements. Anything that increases gluta-thi-one, the primary liver antioxidant, would also help protect the liver. Supplements that raise liver glutathione include silymarin, N-acetyl cysteine and lipoic acid—plus whey protein because of its rich cysteine content. Glutathione is composed of three amino acids: cysteine, glutamic acid and glycine, with cysteine the most vital to glutathione synthesis.

A soon-to-be-published study from Greece tested the effects of a nutritional supplement they called Compound N for how well it protected liver function in bodybuilders who were on self-prescribed high-dose steroid regimes that includ-ed extensive use of 17-ankylated oral drugs, such as Winstrol and Dianabol. Three hundred and twenty healthy athletes, aged 20 to 45—116 women and 204 men—were divided into three groups:

1) 44 self-administered steroid users who took Compound N, two capsules, three times daily

2) 116 self-administered steroid users who didn’t take Compound N

3) 160 athletes who didn’t use any drugs

All subjects had their liver enzymes tested before, at 10-day intervals and at the end of the eight-week study. They all used the same training program and ate the same diet. At baseline all groups showed normal liver enzymes, with one exception. The amount of creatine kinase, an enzyme linked to exercise-induced muscle damage, was elevated in all groups, but it was considered normal. At the end of the study all groups had elevated liver enzymes, but the amount in both the drug-free control group and the Compound N group were still in the normal range. Those who took steroids but not Compound N had liver enzymes significantly above the normal range as well as liver damage, but those who used the nutrient combination did not.

By this time you’re probably wondering what was in Compound N. The supplement consisted of the following:


1) 300 milligrams of natural phospholipids, mainly phosphatidylcholine, a.k.a. lecithin.

2) 6 milligrams of thiamine, a.k.a. vitamin B1

3) 6 milligrams of riboflavin, a.k.a. vitamin B2

4) 6 milligrams of pyridoxine, a.k.a. vitamin B6

5) 6 micrograms of vitamin B12

6) 30 milligrams of nicotinamide 

7) 6 milligrams of vitamin E


The rationale for those particular ingredients was that lecithin provides both of the unsaturated fatty acids needed to protect cellular membranes and methyl groups, which helps the liver break down fat. Increased fat in the liver is an early sign of impending liver failure. Lecithin has reversed the damage of liver cirrhosis in baboons. Lecithin helps keep liver-cell mitochondria stable and healthy, while the B-complex vitamins in the formula provide an added antioxidant effect that aids the liver detox process.

Because the experiment seems to prove the effectiveness of the supplement, it’s curious that no glutathione-related nutrient was included. That more than likely would have increased the effectiveness of the formula, because glutathione is a big-time liver protector and detoxifier. Nonetheless, the study demonstrates that a degree of liver protection is available to those who use oral anabolic steroid drugs.


Pagonis, T.A., et al. (2007). Multivitamins and phos-pholipids complex protects the hepatic cells from androgenic-anabolic steroid-induced toxicity. Clin Toxicol. In press.  IM

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