The link between steroids and liver damage is one of the best-established risks of anabolic-androgenic steroid (AAS) use, particularly for steroids taken by mouth. Oral AAS can cause liver injury ranging from abnormal blood tests to jaundice and, more rarely, serious conditions such as blood-filled cysts and tumors in the liver.
This article explains why some steroids are harder on the liver than others, which liver problems have been linked to AAS, how to recognize warning signs, and why diet and supplements cannot be relied on to protect the liver.
Do anabolic steroids damage the liver?
They can. The US National Institutes of Health’s LiverTox database, a reference on drug-induced liver injury, describes several distinct types of liver injury linked to anabolic steroids (LiverTox, 2020). The risk is concentrated mainly in oral AAS, and it tends to increase with higher doses and longer use.
Injectable AAS, such as testosterone injections, are much less commonly associated with direct liver injury. However, injectable AAS still carry other risks, including effects on cholesterol, blood pressure, and the heart.
Why are oral steroids harder on the liver?
When a drug is swallowed, it passes through the liver before reaching the rest of the body. The liver normally breaks testosterone down quickly, so most oral AAS are chemically modified through a change called 17-alpha-alkylation, which slows this breakdown and allows the drug to remain active.
This modification is also the main reason oral AAS are associated with liver injury (Kicman, 2008). Our guide to the types of steroids explains how oral and injectable compounds differ.
What liver problems are linked to steroids?
Abnormal liver blood tests
Rises in liver enzymes on blood tests are the most common finding. They can be temporary, but they can also be an early sign of liver injury.
Cholestatic liver injury
The most characteristic serious form of AAS liver injury is cholestasis, in which the flow of bile from the liver is disrupted. It typically develops within the first few months of using an oral steroid and causes jaundice (yellowing of the skin and eyes), dark urine, pale stools, and often intense itching. In a Spanish registry of drug-induced liver injury, cases linked to AAS most often presented with jaundice and cholestasis, and recovery could take several months (Robles-Diaz et al., 2015).
Peliosis hepatis
Peliosis hepatis is a rare condition in which blood-filled cysts form in the liver. It is listed in the boxed warning of oxymetholone, the oral steroid sold as Anadrol, as explained in our article on whether Anadrol can cause bloating. The cysts can rupture and cause life-threatening internal bleeding.
Liver tumors
Long-term use of oral AAS has been associated with liver adenomas, which are usually benign tumors, and, more rarely, with liver cancer (LiverTox, 2020). Adenomas can bleed, and some may not cause symptoms until they do.
Do steroids cause other liver-related changes?
Oral AAS also have particularly strong effects on blood lipids, lowering HDL cholesterol, which is linked to how the liver handles fats. Our article on how steroids affect cholesterol levels explains these changes and why they matter for heart health.
Corticosteroids, a different class of steroids used to treat inflammation, can contribute to fat build-up in the liver with long-term use, but they do not cause the specific types of injury linked to oral AAS.
Can diet or supplements protect the liver?
There is no good evidence that any food or supplement prevents liver injury caused by AAS.
A generally healthy diet and limiting alcohol support overall liver health, but they do not offset the effects of a liver-toxic drug. Supplements often marketed for “liver support,” such as milk thistle, have not been shown to prevent AAS-related liver injury. Some herbal and dietary supplements can themselves cause liver injury, and they are a recognized cause of drug-induced liver damage.
Relying on supplements can also create false reassurance, delaying medical evaluation when symptoms appear.
Why liver tests can be misleading in people who lift weights
Routine liver blood tests include enzymes called ALT and AST. These enzymes are also found in muscle, so intense resistance training can raise them even when the liver is healthy. In one study, healthy men who had not trained recently showed markedly raised ALT and AST for several days after a weightlifting session (Pettersson et al., 2008).
This means raised liver enzymes in a person who trains hard do not automatically indicate liver damage, and normal-looking results do not rule it out. Doctors may use additional tests, such as bilirubin and gamma-glutamyl transferase (GGT), or imaging, and it helps to tell your doctor about recent training and any AAS use.
Warning signs of liver problems
Seek medical evaluation promptly for:
Yellowing of the skin or the whites of the eyes.
Dark urine or pale, clay-colored stools.
Persistent itching without a rash.
Pain or discomfort in the upper right abdomen, nausea, or loss of appetite.
Unusual fatigue that does not improve with rest.
Sudden severe abdominal pain, especially with dizziness or fainting, can be a sign of internal bleeding and requires emergency care.
Does the liver recover after stopping steroids?
In many cases of cholestatic injury, liver function improves after the steroid is stopped, although recovery can take months and some cases are severe (Robles-Diaz et al., 2015). Liver adenomas may shrink after use stops, but they require medical follow-up. Anyone who develops liver symptoms should stop and seek medical care rather than attempting to manage them alone.
A note on oxandrolone
Oxandrolone, often described as one of the “milder” oral steroids, carried warnings about liver problems in its prescribing information. In 2023, the US Food and Drug Administration withdrew approval of all oxandrolone tablets and later determined that the drug had been withdrawn from sale for reasons of safety or effectiveness (FDA, 2023).
The bottom line
The link between steroids and liver damage is well established, especially for oral anabolic steroids, which are chemically modified in a way that makes them harder on the liver. Effects range from abnormal blood tests and cholestatic jaundice to rare but serious conditions such as peliosis hepatis and liver tumors.
No diet or supplement has been shown to protect the liver from AAS. Liver blood tests can be harder to interpret in people who train intensely, and warning signs such as jaundice, dark urine, or persistent itching require prompt medical attention.
References
Food and Drug Administration. Determination that Oxandrin (oxandrolone) tablets, 2.5 milligrams and 10 milligrams, were withdrawn from sale for reasons of safety or effectiveness. Federal Register. 2023;88 FR 62799.
Kicman AT. Pharmacology of anabolic steroids. British Journal of Pharmacology. 2008;154(3):502–521.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Androgenic steroids. National Institute of Diabetes and Digestive and Kidney Diseases. Updated 2020.
Pettersson J, Hindorf U, Persson P, et al. Muscular exercise can cause highly pathological liver function tests in healthy men. British Journal of Clinical Pharmacology. 2008;65(2):253–259. Robles-Diaz M, Gonzalez-Jimenez A, Medina-Caliz I, et al. Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids. Alimentary Pharmacology & Therapeutics. 2015;41(1):116–125.
