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Designer Steroids and Liver Damage
By William Llewellyn
Designer steroids are often liver-toxic agents. Occasionally they produce serious jaundice and liver strain in users.
Designer steroids are what we call anabolic steroids that were never commercially marketed or approved as prescription drug products, yet are still sold (although illegally). Sometimes these compounds show up in underground steroid products. At other times, they appear in mislabeled “dietary supplements.” These designer steroids have unverified properties in humans, as they were never studied under controlled conditions. Based on their structure and early animal data, however, most are believed to have similar effects and risks as other common synthetic steroids. We just don’t know where these properties stand, relatively speaking. What’s worse, sometimes these drugs are assumed by consumers to be weaker or safer than “real” anabolic steroids. Since these designer agents are very much anabolic steroids in a chemical sense, such assumptions can lead consumers into trouble.
This week I present another designer steroid injury report.1 The background of the individual in this case is unclear, so we don’t know if there was a long history of misusing oral anabolic steroids. What we do know is that the person was a 50-year-old man who went to the hospital after one week of significant jaundice (yellowing of the skin and eyes). He reported using creatine, protein and two bodybuilding supplements for a period of two months. One of these was an oral supplement labeled to contain a substantial dose (25 mg) of the designer steroids epistane (2a,3a-epithio-17a-methyl-5a-androstan-17b-ol) and phera (17a-methyl-etioallocholan-2-ene-17b-ol). Upon admission, he was shown to have a total bilirubin level of 29.4 mg/dL. A normal level is usually .3 to 1 mg/dL. He was diagnosed with cholestatic jaundice as a result of combined herbal and designer supplement use. The supplements were discontinued, and there was no report of lasting injury.
This injury report is not unexpected, unfortunately. These are two strong anabolic steroids with known hepatotoxic properties. Further, nobody has really established the safest or most efficacious way to take them. Instructions about their use are all coming form anecdotal evidence and speculation (I’m guilty of such speculation myself). What is also concerning in this report is that the attending physicians were apparently trying to associate the incident with “combination supplement use.” In other words, the use of multiple bodybuilding products may have been to blame, which happened to include designer and herbal agents. The standout issue in this case, of course, is the substantial dose of two known-to-be-liver-toxic oral designer anabolic steroids. In my opinion, it is unreasonable to extend this to anything beyond the obvious. I see no evidence presented that would suggest any other agents played a role in the injury. Designer steroids are often liver-toxic agents. Occasionally they produce serious jaundice and liver strain in users. There is nothing more to see (or conclude) here.
Steroid Use and “Low T”
A study from the Baylor College of Medicine adds to our discussion last week on the reversibility of anabolic steroid side effects.2 It looked at men seeking treatment for low testosterone (adult hypogonadism), and attempted to determine if there was a previous history of steroid use in these patients. The researchers began by identifying men with “profound hypogonadism,” which they defined as a testosterone level below 50 ng/dL (normal is 300-1,050 ng/dL). After finding that 43% of the patients with this condition (42 out of 97 subjects) admitted to using anabolic steroids, they expanded the study with an anonymous questionnaire for other patients receiving testosterone prescriptions. Approximately 21% of these subjects (n=80) also reported a history of anabolic-androgenic streoid (AAS) use. What is more striking, is that hypogonadal patients who were under the age of 50 were more than 10 times more likely to have previously used anabolic steroids than the older patients. This may further support the long-term suppressive nature of steroid misuse on natural testosterone production.
William Llewellyn is widely regarded as one of the world’s foremost authorities on the use of performance-enhancing substances. He is the author of the bestselling anabolic steroid reference guide ANABOLICS and CEO of Molecular Nutrition. William is an accomplished researcher/developer in the field of anabolic substances, and is also a longtime advocate for harm reduction and legislative change. He built the website anabolic.org, an extensive online database of information on anabolic steroids and other performance-enhancing drugs.
References:
1. Vilella AL, Limsuwat C, et al. Cholestatic jaundice as a result of combination designer supplement ingestion. Ann Pharmacother 2013; Jun 11.
2. Coward RM, Rajanahally S, et al. Anabolic steroid induced hypogonadism in young men. J Urol 2013; Jun 10. E-pub.
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