From the Guidelines
Oral anabolic steroids associated with liver cysts include C-17 alpha-alkylated steroids such as methyltestosterone, oxymetholone, stanozolol, and methandrostenolone, which can cause peliosis hepatis, a condition characterized by blood-filled cysts in the liver. These medications can cause liver toxicity, including abnormal liver function tests, cholestasis, and jaundice, as noted in the study by 1. The C-17 alpha-alkylation, which allows these steroids to survive first-pass metabolism in the liver, is directly responsible for their hepatotoxicity. Some key points to consider when prescribing or using these compounds include:
- The risk of liver cysts increases with higher doses and longer duration of use, typically developing after months or years of steroid abuse
- Users should be aware that these cysts can develop silently without symptoms until complications occur, such as liver failure or rupture with internal bleeding
- Regular liver function tests and imaging studies are essential for anyone using these compounds, as recommended by clinicians to avoid liver toxicity associated with 17-alpha-alkylated androgens 1
- Discontinuation of the steroids typically leads to regression of the cysts, though permanent liver damage can occur in severe cases
- Clinicians should not prescribe alkylated oral testosterone, given the availability of other approved testosterone therapies, as stated in the study by 1.
From the FDA Drug Label
Prolonged use of high doses of androgens (principally the 17-α alkyl-androgens) has been associated with development of hepatic adenomas, hepatocellular carcinoma, and peliosis hepatis – all potentially life-threatening complications The oral anabolic steroids associated with liver cysts are the 17-α alkyl-androgens.
- Liver complications include hepatic adenomas, hepatocellular carcinoma, and peliosis hepatis 2
From the Research
Oral Anabolic Steroids and Liver Cysts
- The use of oral anabolic steroids has been associated with various liver-related side effects, including hepatotoxicity, peliosis hepatis, and the formation of hepatic tumors 3, 4.
- Specifically, 17-α-alkylated anabolic-androgenic steroids, such as oxymetholone, have been linked to liver cysts and other hepatic side effects 4, 5.
- The mechanism of liver damage is thought to be related to the slower clearance of these steroids in the liver, leading to increased hepatotoxicity 3.
- Examples of oral anabolic steroids that may be associated with liver cysts include:
- It is essential to note that the frequency and severity of side effects depend on several factors, including the formulation of the drug, route of administration, dosage, duration of use, and individual sensitivity and response 3.