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Steroids and Hepatic Effects on Livers

Steroids should only be taken under close supervision of a doctor. The information provided here should not be taken as medical advice.

Liver problems can cause serious problems for athletes due to the obvious health implications but also the recovery time can leave an athlete out of action for several months. A range of liver problems have been attributed to ASS especially the 17a methyl derivatives. Illicit steroid abuse especially at high doses has been blamed for causing diseases such as cholestatic jaundice, impaired excretion function, benign and malignant liver tumours, cholestasis, hepatocellular necrosis and hepatocellular hyperplasia.

Androgens also increase the synthesis of clotting factors such as hepatic triglyceride lipase, sialic acid, a1-antitrypsin, and Haptoglobin (Bagatell and Bremner (1996). However the evidence that ASS has and can cause these diseases is largely unsubstantiated. Few studies have found any common trends in liver disease caused by a specific ASS dose, type and duration of use. Several studies though have shown rare occurrences in which ASS are to blame for acute liver failure and hepatitis.

A case study in which a 26 year-old body builder was admitted to hospital with liver damage was presented by Stimac et., al (2002). They found very high values of the liver enzymes aspartate aminotransferase (AST) (5,870 IU/L) and alanine aminotransferase (ALT) (10,580 IU/L). High values of both AST and ALT in the blood are usually directly associated with injury to liver cells. Normal values consist of 0 to 40 IU/L and 0 to 45 IU/L respectively. This was a rare case in which ASS induced hepatitis was predominantly associated with hepatocelluar necrosis and not intrahepatic cholestasis. However it’s worth noting that raised ALT levels can also stem from the muscle due to intense strength training. Alen (1995) found that the average ALT and levels were raised when investigating steroids in power athletes (31 IU/L) compared to the control (24 IU/L) as were but the values still remained in normal range. The recovery of the subjects to baseline values took 12-16 weeks which was found to be statistically different (P<0.05). In addition AST levels were also found to be raised but in normal range in the study group and the same throughout for the control group even though they were on an intensive training regime. It’s therefore suggested that ASS may expose athletes to leaking of AST from muscles to serum (Alen (1995).

A similar case in which a 40 year-old body builder was suspected to have acute liver failure following anabolic steroid abuse was presented by Bispo et., al (2009). After being admitted to hospital with severe acute liver failure the patient was found to have an ASS induced dilated cardiomyopathy with a large thrombus in both ventricles. It is the first reported case of liver failure due to an unrecognized ASS-induced cardiomyopathy.

Hepatocellular carcinoma (HCC) is thought to be another result of ASS abuse especially in males. Expression of hepatic androgen receptors is not down-regulated by testosterone over a relatively short follow-up which may partially explain the preferential development of HCC in males (Parssinen et.,al (2002). Elevated serum testosterone, together with decreased serum estrogens, may promote the development of HCC in cirrhosis (Tanaka et al., (2000).

Liver problems seem to vary depending on dose, duration of use and the type of steroid being used. Although severe liver disease appears to be rare and not yet conclusively attributed to steroid use the risk is still there especially for acute liver disease.

End of steroids and hepatic effects