Liver Supplements. Worth it, or Scam?
“What liver supplement should I take with my cycle?”
This has to be one of the most commonly asked questions for me during my years of customer care service within this industry. It is a fair question though. Absolutely, anabolic and androgenic steroids are associated with hepatotoxicity cases. Hepatotoxicity is a word that simply means liver damage from a chemically driven source, not one from trauma. An example of a chemically driven source of liver damage could be drug use and an example of trauma based liver damage could be a spinning back-kick to the liver from Joe Rogan. Now, depending on the type of anabolic steroid we are discussing, the degree of hepatotoxicity can vary quite a bit. For example, Testosterone enanthate is of relatively low hepatotoxicity per given mg compared to that of Oxymethelone (commonly known as Anadrol).
I have treated over 1000 + patients and I have witnessed trends among users blood-work. I have also read just about every study paper there is on anabolic steroid use. From RCT’s, case studies and epidemiology papers. And guess what? Liver damage is actually one of the least things that concerns me with anabolic steroid use. I can answer immediately what concerns me the most with anabolic steroid use and that is the cardiovascular system. Absolutely, hands down, the number one concern with anabolic steroids use—is what can happen to your heart. So, why then has the focus on liver health received such a huge focus in the anabolic steroid using community? Good question. I don’t know. I assume the same reason everything else is exacerbated in the health industry. Monkey see, monkey hear, monkey do. This, is still the human condition. In fact, there was once a study paper that studied how humans made decisions about their health and right at the top of the list was “I just know” and right down the bottom of the list was “systematic reviews.” Of course, it should not all be about study papers and scientists. The fact remains that the research we have available for anabolic steroids is minimal, weak. Does that mean we should discard the study papers and follow the [B]ro [S]cience community then? No, it does not mean that either. What we should do is assess what data we have available both in the literature and in the ‘clinic,’ then make an informed decision based on the weight of both anecdotal observations and empirical data.
Talking down the liver problem with anabolic steroid use is a bald claim, I know. I find it better to use a hypothetical example to get my point across. Let’s use a tough case scenario for today’s hypothetical. For arguments sake, let’s say user Joe will be adding in 100 mg daily of Anadrol to his cycle that also includes various injectable oils for a total of 1000 mg weekly. A decent whack of juice, most would agree. Definitely a schedule that would have many bro’s calling out for on cycle liver ‘support.’ Calls for TUDCA, NAC and Milk Thistle do the rounds in the comments section.
But is spending our valued dollars on one of these liver support products effective? Or better yet, is it necessary?
There is little debate on whether or not the above supplements are efficacious in some specific forms of liver healing. TUDCA has shown to be effective for improving liver enzyme management in cholestasis. N-acetyl-l-cysteine (NAC) is a glutathione precursor used in the treatment of acetaminophen hepatotoxicity. Milk Thistle. Well, the research on Milk Thistle sucks, but who knows, right? Well, who knows is about as useful as all of the above supplements are in the context of anabolic and androgenic steroids. Context, context, context. This is what often leads to false claims in the health industry; when someone does not consider the context. There are no known studies (to my knowledge at least) that investigate the effects TUDCA or NAC have with anabolic steroid use. In fact, what you will find in the data books with anabolic steroid use is that there are less reported hepatotoxicity cases with anabolic steroids than there are anti-biotics and NSAIDs! That’s right, your anti-biotics are harming you faster than a shot of tren. How then, did all of this become such a thing for anabolic steroid users to worry about?
Firstly, lets discard any case studies that discuss liver issues with individuals with pre-existing liver conditions. This discussion is similar to the “high protein diet harms your kidneys” myth. There is an enormous difference between someone who has a pre-existing liver condition vs someone with an otherwise healthy liver. With a pre-existing liver condition, about 100,000 + substances could be problematic for that individual.
Let’s throw those outliers aside and talk about your average Joe who is not suffering from any underlying condition. It is at this point why I must remind someone that getting blood work before an anabolic steroid cycle is a good idea. Sometimes, you never know. Pre-cycle blood-work is something you can spend the spare money on instead of liver support supplements. Saving lives and bank accounts I am today. I digress. How much was our user taking for today’s hypothetical? Ah, yes, 1000 mg total of anabolic steroids per week and in there at least 100 mg of Anadrol per day. Shortly after beginning this cycle, Joe’s ALT, and AST liver enzymes will likely will go up and maybe his GGT liver enzymes will raise also. But one question that is not asked here is, “how much do they go up.” I rarely see elevations of ALT and AST more than 3 x the normal reference ranges (ULN) with AAS use and I rarely see GGT elevate, but sometimes it may double at the most. Let’s say Joe’s AST and ALT elevate 3 x the normal range. Does this mean his liver is ruined? No. The answer to that question is no. Here are some examples of liver conditions where large elevations of AST and ALT indicate a likely diagnosis.
- With alcoholic fatty liver disease, the AST would generally be more than eight times the ULN and the ALT more than five times the ULN.
- With non-alcoholic fatty liver disease, the AST and ALT would both be more than four times the ULN.
- With acute viral hepatitis, the AST and ALT would both be 25 times the ULN.
- With chronic hepatitis C, the AST and ALT could be anywhere from two to 10 times the ULN.
- With ischemic hepatopathy (also known as shock liver), the AST and ALT would be over 50 times the ULN.
Of course, your average general practitioner may flip out if he sees an acute elevation ~ 3 x ULN in AST and ALT liver enzymes, but he/she is unlikely to understand the context of which they are interpreting your lab values. After all, this is how I ended up growing my business. I offered help and real advice for those who were unable to seek it from their local doctor. Part of this miss-care for a patient is ignorance on the doctor’s behalf and part of it is that as a general practitioner, you generally know nothing extensive unless you take it on your own behalf to study outside of the curriculum. What needs to be understood is that Joe is experiencing an acute elevation (not long term) in ALT and AST no more than 3 x ULN due to the use of anabolic steroids. This does not mean that his liver is damaged. When Joe ceases use of anabolic steroids, his ALT and AST values will return to normal shortly thereafter without any medical intervention. I am also using 3 x ULN in ALT and AST for today’s hypothetical, but what I more often see is elevations far less than that. When I do see higher elevations, it is often associated with the use of other medications and/or alcohol also. Rarely, does a drug user use one drug. Remember that. Sometimes, I do see elevations in ALT and AST that are likely causal by anabolic steroids only and this is most often due to an undiagnosed pre-existing liver condition or because someone has been hammering anabolic steroids at high doses, for a very long time, without any time off for PCT or cruise. If that is you and you do not monitor your blood-work, then I cannot help you. No one can, not even TUDCA. Mostly sensible people read my texts so I think we are good.
So there you have it. You ensure your liver is otherwise healthy via pre-cycle bloodwork. Then, you engage in anabolic steroid use at reasonable doses for a reasonable period of time with blood-work mid-cycle to ensure all vitals are firing well. If you see some mild elevations in your liver function tests, you do not freak out, you do not buy TUDCA and you let them return to normal on their own. Life goes on, you get jacked and you stay as healthy as possible in what can be an unhealthy sport. I hope this helps.