Part 1 – the liver and potential complications

What is the Liver

The liver is the largest internal organ in the human body. It is located on the right side of the abdominal cavity under the diaphragm (in the right hypochondrium).

Liver function disruption in various diseases leads to disorders in the metabolism and excretion of bilirubin with bile, resulting in jaundice, characterized by yellowing of the skin and sclera. The bile produced in the liver is vital for digestion. Therefore, the liver can be considered a large chemical factory synthesizing and transforming a vast number of substances.

Liver dysfunction is life-threatening. Therefore, constant blood test monitoring and examinations are essential during cycles of anabolic steroids to control health status.

Functions of the liver

The liver performs crucial functions in our body. Components of food absorbed in the gastrointestinal tract first reach the liver, where they are transformed, and essential substances for life activities are formed. The liver has many functions, but the most important are:

  • Participating in all types of nutrient metabolism – protein, fat, and carbohydrate.
  • The liver produces essential proteins like albumin and many blood clotting factors.
  • It produces and stores glycogen – a source of energy for the body.
  • The liver is involved in the metabolism of vitamins and microelements.
  • An important function is detoxification. All substances entering the body pass through the liver. Some of these can be toxic, and in the liver, they are converted into less toxic products. It also deactivates hormones and other substances.

Blood tests determining liver health

Liver health is a cornerstone in your well-being and longevity, as well as in short-term sports results. These blood tests are used to detect key liver damage:

ASAT and ALAT

Alanine aminotransferase (ALT) - an endogenous enzyme widely used in medical practice for laboratory diagnosis of liver damage. When the liver is damaged due to cell destruction, this enzyme enters the blood, detected by laboratory methods.

Aspartate aminotransferase (AST, ALT) - an endogenous enzyme synthesized intracellularly, and normally only a small part of this enzyme enters the blood.

Firstly, these enzymes are present in high concentrations in the liver, and they are also found in other tissues, such as muscle tissue. Both can also increase due to muscle exercises. Many other drugs can affect the results of the study. The readings of the tests can be distorted when treated with antidepressants, antibiotics, diuretics, and other drugs.

In addition, it is forbidden to conduct ultrasound, radiological examination, and physiotherapeutic procedures immediately before visiting the procedural office. In addition, factors such as alcohol consumption, drug use, skin burns, injuries, fractures, and even heat or sunstroke, as well as training, can contribute to the increase in these enzyme levels.

GGT

Gamma-glutamyl transpeptidase (GGT) can be found in the cell membranes of various organs, including the kidneys, pancreas, and, of course, the liver. GGT increases in most diseases affecting the liver, gallbladder, and bile ducts. An increase in GGT is a sensitive indicator of cholestatic liver disease. It can be considered a marker of cholestasis and obstruction of the bile ducts. However, again, it can also be elevated for reasons unrelated to the liver (as well as in non-cholestatic liver diseases).

Alkaline phosphatase

To get a more complete picture of liver damage, it might also be advisable to measure the level of alkaline phosphatase. The most pronounced increase in alkaline phosphatase is observed in diseases associated with cholestasis, but a lesser increase can be observed in all types of liver diseases.

How to take blood tests

To increase the reliability of the blood test, some rules and restrictions should be followed. So, on the eve of the study, one should refrain from consuming fatty and smoked foods, as well as confectionery products. It is best if the test is conducted in the morning on an empty stomach. Or AST and ALT tests can be taken after a light meal (after 4-6 hours). The indications of the test can be distorted when treated with antidepressants, antibiotics, diuretics, and other drugs. In addition, it is forbidden to conduct ultrasound, radiological examination, and physiotherapeutic procedures immediately before visiting the procedural office.

Potential toxicity of anabolic steroids

Anabolic steroids can be harmful to the liver (hepatotoxic), especially C-17a-alkylated steroids (almost all oral ones, except for proviron and methenolone acetate). This is reflected in the blood by an increase in the levels of aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT). Both of these indicators can increase due to liver damage.

Additional biochemical markers, such as lactate dehydrogenase (LDH) and gamma-glutamyl transpeptidase (GGT), as well as serum bilirubin (especially in more severe liver damage), may also be elevated. Clinically, this can manifest as jaundice, but at later stages. At the same time, the skin and the whites of the eyes acquire a yellowish tint due to an increase in the level of bilirubin in the serum. The markers of liver damage listed above often increase during a cycle of anabolic steroids, but the risk of developing clinical signs of liver damage, such as yellowing of the eyes when using anabolic steroids, remains relatively low.

How dangerous is this

It is quite difficult to answer the question of how exactly the increase in liver enzymes is harmful to the liver and what are the chances of developing something more serious, such as jaundice, due to the use of anabolic steroids. There have been not so many clinical trials in which this drug was evaluated at doses similar to those used by bodybuilders. However, trials that have done this seem to suggest that the risk is quite low, although we know of such cases in practice.

The cumulative increase in ASAT, ALAT, GGT, bilirubin, and Alkaline Phosphatase during simultaneous use of anabolic steroids should be interpreted as liver damage and, cautiously, as obstruction of the bile ducts. (Measuring bilirubin levels can give an idea of this).

What to do if ALT and AST are elevated?

The liver is the only organ in the human body, capable of self-recovery. As a rule, a one-month course of the oral form of methandienone will only lead to minor deviations in AST and ALT within normal limits. Given the liver's ability to regenerate, it is not necessary to take any means. At this stage, it is necessary to follow a diet, consume more raw fruits and vegetables, and it is advisable to exclude fatty foods. At the same time, water consumption should be increased to three liters.

But in some athletes, liver enzymes increase above normal values and sometimes exceed them by one and a half or two times. In such a case, we recommend using hepatoprotectors. 

Hepatoprotectors are drugs that positively affect liver function. You can also use it in any cycle using oral steroids as a preventive measure. All these drugs have a general strengthening effect on the body through various mechanisms of action and have other beneficial effects in addition to affecting the liver. One of the most effective hepatoprotectors is TUDCA.

It should be understood that the increase in the level of liver markers will depend on the drug itself (some of them are more hepatotoxic, some less), on dosages, on the duration of administration, as well as on individual characteristics. For someone, 50 mg of methandienone per day will be a dosage that will raise ASAT and ALAT slightly above the upper limit of normal, and for someone, such a dose will raise their level 3 times above the upper limit of normal. This should always be taken into account when choosing the dosage of the drug and the duration of its administration during the cycle.

Are injectable steroids toxic to the liver?

Most often, injectable anabolic steroids are not hepatotoxic, and only occasionally in some athletes, the level of ASAT, and ALAT is one and a half times higher than the upper values of the norm, for example, from such drugs as trenbolone and boldenone. Try not to use oral anabolic steroids for more than 8 weeks and do not combine two oral steroids together.

Keep your liver in good condition

Oral intake of AS can impair the function of your liver, which, in turn, can lead to the fact that aromatizing drugs will be too actively aromatized and increase estradiol in the blood, and the level of IGF-1 in the blood will drop, and the level of SHBG will increase, which can have a significant impact on the performance of the cycle. A healthy liver is an important aspect for achieving your sports results.

PART 2 – TUDCA as a solution for liver problems

What is TUDCA

Tauroursodeoxycholic acid is a compound originally approved for the treatment of liver diseases, but recent studies show that it may have a broader application. TUDCA is closely related to ursodeoxycholic acid (UDCA), with some structural differences. Tauroursodeoxycholic acid is an organic compound derived from taurine and ursodeoxycholic acid. TUDCA is one of the compounds found in bile acids. Bile acid is produced by the liver, stored in the gallbladder, and aids in digestion. Recently, TUDCA has been tested in various therapeutic areas to study its effectiveness.

Tauroursodeoxycholic acid, like some other cholelitholytic drugs, integrates into the hepatocyte membrane, interacting with lipid membrane structures, stabilizes them, protecting liver cells from toxic factors. It inhibits the absorption of lipophilic bile acids in the intestine, increases their hepato-intestinal circulation, stimulates the excretion of toxic bile acids through the intestine. The drug reduces the synthesis of cholesterol in the liver and its absorption in the intestine. By forming liquid crystals with cholesterol molecules, ursodeoxycholic acid reduces the ability of bile to form stones, lowers the cholato-cholesterol index, promotes the dissolution of cholesterol stones, and prevents the formation of new crystals.

Where TUDCA comes from

Interestingly, TUDCA has been used in traditional Chinese medicine for centuries to treat a range of ailments. In Chinese medicine, bear bile was used, and bear bile consists of more than 50% TUDCA.

Indications for using TUDCA for liver problems

Thanks to its comprehensive hepatoprotective action, TUDCA is used for many liver and biliary tract diseases. The supplement is effective in the treatment of biliary dyskinesia, cholestasis, and gallstone disease. In acute and chronic hepatitis, cirrhosis, fibrosis, and alcoholic liver damage, the immunomodulatory and membrane-stabilizing action (aimed at preventing the destruction of liver cell membranes) of tauroursodeoxycholic acid comes to the fore. TUDCA is used preventively when taking medications that promote the formation of gallstones.

TUDCA has a proven effect in following cases:

  • Elevated liver enzymes and other functional changes in the liver as a result of using anabolic steroids;
  • Gallstone disease;
  • Primary biliary cirrhosis of the liver;
  • Alcoholic liver damage;
  • Acute and chronic hepatitis with cholestatic syndrome;
  • Primary sclerosing cholangitis;
  • Biliary dyskinesia;
  • Atresia of intrahepatic bile ducts

Mechanism of action and effects

TUDCA is a hepatoprotector with complex action. Tauroursodeoxycholic acid affects many biochemical and physiological processes underlying bile formation and bile acid metabolism, stabilizes hepatocyte (liver cell) membranes, reduces the severity of immunopathological reactions in hepatitis, and inflammation in biliary tract diseases. TUDCA improves the circulation of bile acids and their salts in the portal vein system (the vein that enters the liver).

Regular intake of the supplement improves the biochemical composition of bile. TUDCA has a choleretic (bile-stimulating) effect and normalizes bile flow, helps dissolve cholesterol concretions, and prevents their reformation, thus preventing the formation of gallstones.

Another effect of taking TUDCA is the reduction of immunopathological reactions in the liver. Tauroursodeoxycholic acid reduces the expression of histocompatibility complex genes in hepatocytes, and reduces the production of cytokines and interleukins. This explains the effectiveness of this hepatoprotector in hepatitis, in the pathogenesis of which an autoimmune component is present.

TUDCA and oral anabolic steroids

One of the common problems among athletes taking oral anabolic steroids is digestive problems and reduced appetite due to the bile becoming thicker and less fluid. TUDCA is a supplement that solves this problem due to its positive effect on bile.

Other possible uses

Recently, TUDCA has been used and tested in various therapeutic areas to study its effectiveness. Among other things, TUDCA has been studied for how it may alleviate symptoms of inflammatory diseases. It is believed that the drug acts by preventing programmed cell death (also known as apoptosis).

Effects:

  • Helps eliminate toxic substances from bile;
  • Regulates cholesterol levels in the liver;
  • Protects liver nerve cells from infections;
  • Aids in the digestion and absorption of necessary nutrients;
  • Improves fat breakdown.

There are also studies suggesting that the drug may be useful for treating the following diseases, but research is still ongoing, and official approval for treating these diseases has not yet been granted:

  • Alzheimer's disease;
  • Parkinson's disease;
  • Huntington's disease;
  • Eye disorders;
  • Strokes;
  • Obesity;
  • Cardiovascular diseases;
  • Gastrointestinal diseases;
  • Kidney damage.

Dosage

The usual doses are 500-1000 mg per day, preferably before bedtime.

How Long to Use

For dissolving gallstones, the drug is used for a longer period (from 6 months to 2 years); for other diseases — for 4-6 weeks. If you are taking TUDCA during your steroid cycle, you can start taking it immediately, or as soon as your blood tests are above normal values, and stop using it when your liver indicators return to normal.