Anabolic-androgenic steroids: a possible new risk factor of toxicant-associated fatty liver disease

Liver Int. 2011 Mar;31(3):348-53. doi: 10.1111/j.1478-3231.2010.02346.x. Epub 2010 Oct 11.


Background: Industrial toxin and drugs have been associated with non-alcoholic fatty liver disease (NAFLD); in these cases, the disease has been termed toxicant-associated steatohepatitis (TASH).

Aim: This study hypothesizes that the use of anabolic-androgenic steroids (AAS) could also be a risk factor to TASH or better toxicant-associated fatty liver disease (TAFLD) development.

Methodology: Case-control study including 180 non-competitive recreational male bodybuilders from August/2007 to March/2009. Ninety-five had a history of intramuscular AAS use (cases; G1) and 85 were non-users (controls; G2). They underwent a clinical evaluation and abdominal ultrasound, and their blood levels of aminotransferases, creatine phosphokinase (CPK), lipids, glucose and insulin were measured. TAFLD criteria: history of AAS use >2 years; presence of hepatic steatosis on ultrasound and/or aminotransferase alterations with normal CPK levels; exclusion of ethanol intake ≥20 g/day or use of other drugs; and exclusion of obesity, dyslipidaemia, diabetes and other liver diseases. Homeostasis model assessment for insulin resistance ≥3 was considered insulin resistant. Independent t-test, odds ratio (OR) and 95% confidence intervals (95% CI) were calculated.

Results: All cases were asymptomatic. Clinical and laboratorial data were similar in G1 and G2 (P>0.05). TAFLD criteria were observed in 12.6% of the G1 cases and 2.4% of controls had criteria compliant with non-alcoholic fatty liver related to metabolic conditions. OR was 6.0 (95% CI: 1.3-27.6).

Conclusions: These results suggest that AAS could be a possible new risk factor for TAFLD. In this type of fatty liver disease, the individuals had a low body fat mass and they did not present insulin resistance.

MeSH terms

  • Adult
  • Anabolic Agents / administration & dosage
  • Anabolic Agents / adverse effects*
  • Androgens / administration & dosage
  • Androgens / adverse effects*
  • Brazil / epidemiology
  • Case-Control Studies
  • Chemical and Drug Induced Liver Injury / blood
  • Chemical and Drug Induced Liver Injury / epidemiology
  • Chemical and Drug Induced Liver Injury / etiology*
  • Fatty Liver / epidemiology
  • Fatty Liver / etiology
  • Humans
  • Injections, Intramuscular
  • Insulin Resistance / physiology
  • Liver / drug effects*
  • Male
  • Non-alcoholic Fatty Liver Disease
  • Performance-Enhancing Substances / adverse effects*
  • Sports*
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / etiology
  • Transaminases / blood
  • Young Adult


  • Anabolic Agents
  • Androgens
  • Performance-Enhancing Substances
  • Transaminases