I TAKE ZERO CREDIT FOR THIS POST, I DID NOT WRITE THIS - THIS WAS A COMMENT POSTED BY A MEMBER CALLED 'LANGE' 12 YRS AGO WHO HAS NOT BEEN ON HERE FOR 11 YEARS. I FIGURED IT WOULD BE A SHAME FOR A COMMENT AS LONG AND AS EASY TO UNDERSTAND AS THIS TO GET LOST IN THE ABYSS. IT IS SO GOOD AT EXPLAINING HOW THE LIVER PROCESSES METHYLATED STEROIDS AND HOW DAMAGE OCCURS AND COMPLICATIONS CAN ARISE, THAT I THINK IT DESERVES IT'S OWN POST - SO THERE!!! LMAO

Oral Hormones and Liver Health

Oral hormones are frequently used to kick start cycles. For years rumor and "broscience" has held that they are extremely toxic to the liver and can cause a host of serious medical issues. I was interested in researching this topic as a user, because I like to know what I'm getting myself into, and because pharmocology is a passion of mine. (In other words I like doing research, because I'm weird.)

Here is a summary of the research I have done regarding oral hormones (and specifically 17aa oral hormones) and the potential complications of their use.

Orals versus Injectable Hormones

First off, it's important to understand how oral hormones are different than hormones we use via injection.

When a steroid is injected directly into muscle it enters the blood stream and is able to act on androgen receptors in muscle cells and other bodily tissues before it encounters the liver, which is responsible for breaking down a large percentage of the wastes in our bodies (the kidneys also work on ridding the body of toxins.) By interacting with these androgen receptors the hormone directly increases protein synthesis, leading to faster muscle repair and muscle growth. (1) Basically they make us bigger and stronger faster than our bodies can on their own. Obviously this is a much simplified explanation of how hormones work, but it gives you the basic idea.

Unlike injectable hormones oral steroids must travel through the gastric system (our stomachs and intestines) prior to being released into the blood stream. A step of this process (which is called "first pass metabolism" essentially the first path anything takes in being processed by the body) is travel through the liver which works as a filter and waste remover. The majority of steroids used via injection are broken down almost completely by the liver which is why they are ineffective orally. (2)

So, since these hormones are so effectively metabolized by the liver researchers looked to develop a method of making them orally active while studying the effects of increased testosterone on males. The researchers found that by alkylating the basic hormone molecule at the alpha position of the 17th carbon (by adding either a methyl or ethyl group at that location) the hormone was able to pass through the liver relatively unchanged and into the blood stream. It was then able to act on muscle and other bodily tissue just like an injected steroid. (3) These hormones became known as the 17aa steroids (17-alpha alkylated.) Almost (if not all) orally active steroids belong to the 17aa group including Dianabol, Var, Anadrol, Halo and Winny being the most well known.

A Little History...

Dianabol (methandrostenolone or metandienon) was actually developed back in 1955 by a team of researchers including Albert Wettstein, Alfred Hunger, Charles Meystre, Ludwig Ehmann, Ernst Vischer, Hans Peter Frey and Walter Voser. It was the first orally active hormone. (3) It was popularized in the U.S. by Dr. John Ziegler in 1959 who prescribed it to the U.S. Olypmic lifters, in an attempt to combat the Russians use of testosterone on their lifters. This was at the height of the cold war, remember, and the U.S. needed all the good press they could get. (4)

Since Dianabol has been around the longest it has, arguably, the largest volume of research of any of the oral steroids, however many of the other orals have been studied at length regarding their effects on the liver.

Enough history about their development and how they get into our systems and work. We know they work, ample clinical evidence has demonstrated their ability to cause significant strength and muscle gains in users.

The Real Deal on Oral Steroids and the Liver

I approach everything with a harm reduction view. People are going to use hormones, how can they do so in the most safe way possible? How bad are orals for us really?

Well, the biggest issue with orals is that we're overworking the liver by putting a chemical through it that it is unable to break down easily. This leads the liver to produce additional enzymes to aid in breaking down the substance (AST and ALT, which are often elevated in labs of those using oral hormones.) Because the liver is working so hard to try to break these compounds down it can lead to inhibition in its ability to break down not only the hormone but everything else it is trying to deal with. Another complicating factor is that the breakdown of 17aa hormones leads to the creation of 17-glucuronides which are toxic metabolites and which also (arguably) can lead to the majority of the negative liver effects seen with 17aas. (10) This also causes the liver to produce additional biles (called bile salts) which work to clear toxins out of the liver and into the excretory system. When these bile sites become saturated they can stop working as effectively as they normal do and decrease or stop the production and elimination of bile from the liver. (5) Current research is inconclusive as to the mechanism of action that 17aa hormones exhibit which specifically causes this decrease in bile production and excretion. (7) (Obviously this is an oversimplified description of the process, but it works for this explanation.)

This decrease in the liver's ability to process and expel bile results in a condition known as choleostasis. When a liver becomes choleostatic it greatly reduces or loses it's ability to process toxins out of itself. This can lead to liver damage as toxins remain in the liver, causing continued damage to hepatic (liver cells) tissues. This buildup can lead to lesions within the liver. (6) The liver responds by increasing enzymatic activity (leading to higher AST/ALT levels) and the circle repeats unless treated, which I'll go into later.

Multiple studies indicate that after an extended period of oral steroid use clinical liver damage will occur, including the aforementioned lesions, drug induced hepatitis and jaundice*. However studies indicate that the extent of this damage is time and dose mediated, that is, if one is taking reasonable dosages for a period no greater than 2 months (although periods of up to 6 months have been observed with similar results) lasting damage should be non-existent. (7) ( 8 )

*As a side note, just because I thought it was an interesting fact) Jaundice is an interesting symptom of liver dysfunction. Jaundice is caused by a buildup of bilirubin. Bilirubin is a waste product of the breakdown of red blood cells, which is normally processed through the liver and excreted in bile. (Fun fact, bilirubin is what causes the yellow color of bruises.) When the liver is unable to process bile bilirubin builds up leading to a yellow tone to the skin and eyes of the patient. This is jaundice. If you turn yellow do not pass go, do not collect 200 fucking dollars, go to the hospital.

Current research indicates that if 17aa oral hormones are not used for extended periods and at sane dosages any changes in liver functioning (i.e. increased AST/ALT/Bilirubin values in labwork) should self correct with time. (6)

Conclusions

So, the conclusion we can draw from current peer reviewed research is that common "bro-science" of the severity of liver damage associated with oral hormone use has been, if not completely over-estimated than blatantly blown out of proportion.

Now, I'm not saying go out and gobble down Dbol by the dozens. As noted dosage and length of use are the two highest indicators of adverse liver issues with oral 17aa hormone use. However I feel that following this review I would not place too much concern on responsible oral hormone use and long term liver complications provided orals are maintained to short dosing periods and run at sane doses.

Safer Oral Hormone Use

That being said, there are some very simple methods for providing support to the liver while running oral cycles.
The first method is stupid easy. If you cannot do it you should 100%, absolutely, no fucking way, I'm not even kidding, not use hormones at all. DON'T DRINK ALCOHOL WHILE USING ORAL HORMONES. NOT ANY. Not a beer. Not a shot. Just don't do it. Your liver is already being taxed eliminating the orals from your body. Alcohol causes inflammation* of liver cells, hardening of liver cells and is generally just shitty to your liver. DON'T DRINK!

The second method takes a little bit of work. Get some TUDCA. Then you have to take it orally. TUDCA is effective at decreasing liver damage because when you take it it causes your body to more effectively create and clear bile in liver tissue, which moves toxins out of the liver. TUDCA also increases the expression (creation) of certain proteins in the liver which are associated with pumping bile out of the liver, so it also helps in clearing other biles from the liver, allowing it to more effectively process all toxins coming through it. (6) (9) Dosing protocol is 250mg-500mg per day for maintenance with doses for up to 1000mg per day if lab works indicates significantly elevated liver values.

TUDCA has also been shown to increase insulin sensitivity which is something we all want. For more information on this see my post here.

Milk Thistle (or, more accurately Silymarin, the active component in Milk Thistle) has shown good evidence of liver protection. If you want to be extra safe consider taking a supplement containing Milk Thistle. Make sure to look for one with at least 150mg of Silymarin standardized, as this will be the most effective. Dose like it says on the bottle. If you have to choose between Milk Thistle and TUDCA go with TUDCA, it has much more evidence backing it's efficacy.

Finally, do the simple stuff. Make sure you are staying extremely hydrated. Eat right. Get enough rest.