Toxic side effects of anabolic steroids: liver damage

In the category of the toxic side effects of anabolic / androgenic steroids, the potential effects on the liver are most apparent. These can manifest themselves in various dysfunctions of the liver. In the literature, cases have been mentioned where it came to a cholastasis (bile obstruction in the liver), a peliosis hepatis (bloodfilled cavities in the liver tissue, cysts), or liver cancer with the use of anabolic/ androgenic steroids. It is of great importance that these manifestations could almost exclusively be seen in those patients who previously had undergone a long-term steroid therapy and already had extensive liver damage or suffered from other internal diseases prior to the intake of anabolic steroids. It is of further interest that the administered steroid medication consisted almost exclusively of the 17-alpha alkylated, oral androgenic steroids. Especially the potentially liver-toxic substances methyltestosterne and oxymetholone were given in the course of therapy without suspension for several years. Evidence that steroids cause similar liver damage in healthy athlete could only be found in one or two rare cases, which is neither of statistic relevance nor allows for the preconception to expect liver damage by consumption of anabolic/androgenic steroids. "Insofar as a connection between steroid intake and tumor development could be established, until now, there is no evidence where testosterone or a testosterone ester is responsible for liver cancer. The reason had always been the androgen/anabolic with an alkyl substitute on the C-1 7 alpha of the steroid molecule... Accordingly it seems that testosterone and its esters are not (or are slightly) liver-toxic...

Toxic liver damage: this, as mentioned above, is only expected with 17alpha alkyl derivatives... With a proper choice of the drug, there is no danger here." (From: Doping - verbotene Arzneimittel im Sport, Dirk Clasing, Manfred Donike, et al, pages 60 and 63). At this time it once again must be stressed that nearly all the liver-damaging results have been found in patients whose physicians prescribed steroids for the treatment of already existing, serious diseases. Although one cannot exclude the possibility of liver damage and delayed reaction in the future, empirical data shows that even with repeated, excessive, and prolonged intake of the potentially liver-toxic 1 7-alpha alkylated steroids by athletes, these symptoms rarely occur. In order to avoid any possible risks, one should. forego the use of I 7-alpha alkylated steroids. Since a total abandonment of these steroids is impossible for most athletes one should follow strict guidelines regarding the duration of intake and the dosage. Far-sighted athletes will therefore interrupt their steroid regimes in regular intervals by either stopping steroid intake alltogether or switching to a (potentially) non-toxic steroid (usually injectable). In many cases the problematic steroid will be combined with one or more "milder" steroids which interact in order to keep the dosage of the first at a moderate rate level without diminishing the effectiveness. In conclusion, one can say that the toxic, critical side effects on the liver occur mostly in those patients who have previously been ill and have received 1 7-alpha alkylated steroids as their treatment over longer periods of time.

It is recommended that athletes using oral steroids have their liver function routinely checked by a qualified physician.

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