Oxandrin may cause Liver toxicity

by Michael Mooney (Original article in issue #7, October, 1998. Updated July, 2001)

(See also Dr. Donald Abrams review in The AIDS Reader March, 2001;11(3)

While Oxandrin is promoted as being non-toxic to the liver, the truth is Oxandrin is a 17-alpha alkylated oral anabolic steroid so it has the potential to burden the liver, just like any other oral 17-alpha alkylated steroid.

We have questioned that its potential for liver toxicity would be enhanced when it is used with other liver-challenging drugs like protease inhibitors and other standard AIDS medications, or with higher dosages. We have an answer.

At the Geneva AIDS Conference, Dr. Carl Grunfeld presented the preliminary results of a placebo controlled dose-ranging study that used 20, 40 and 80 mg daily doses that showed that doses of 40 and 80 mg cause incidence of elevated transaminases (SGOT and SGPT), which may indicate liver toxicity.

Doses above 20 mg per day were tested because 20 mg was found to be relatively ineffective for lean mass gain in some men. Oxandrin is a better option for women who need about half the men’s dose. Children need much less.

Although most studies tell us that Oxandrin is relatively safe for HIV-negative people, oxandrolone produced evidence of liver toxicity in studies of boys with kidney failure in 1980.1 We have been somewhat surprised at the number of HIV(+) men who report to us that Oxandrin caused elevations in the blood tests that can indicate liver toxicity. Physician’s should monitor liver tests carefully when Oxandrin, or any oral anabolic steroid is used, especially in higher doses.

Winstrol, another oral steroid is a less expensive option for males. It appears to be somewhat more anabolic than Oxandrin, and a 6 to 18 mg. daily dose has produced good muscle gains without detectable liver burden in males we’ve observed. Anadrol is another powerful option, and while it is thought to be toxic to the liver, we had not had one report of Anadrol at doses as high as 150 mg per day causing elevated liver enzymes until July, 1999, after Anadrol had been on the market for about a year and a half. 

This male reported that he had used Anadrol with no negative effect on his liver enzymes when he was using the anti-HIV medications Viracept, Zerit, and Epivir. About nine months after he ended the first Anadrol cycle he started a new cycle of Anadrol, but this time his HIV medications consisted of a cocktail of Videx, Viramune, Hydroxyurea, and Ziagen.

Within a few months of this second cycle of Anadrol, blood tests that can indicate liver problems became elevated. It appears that one or more of the medications he was using had some problematic interaction with Anadrol. While we do not know conclusively which medication(s) may have promoted the problem, we have been hearing reports of liver toxicity being associated with hydroxyurea used in combination with other medications in HIV, so this should be taken into consideration.

Interestingly, he also said, “… Anadrol produced much quicker, better results regarding muscle growth. It seemed that just looking at weights added mass! I went from about 185 lbs to about 203 lbs in about 4 months. After stopping the Anadrol and continuing the workouts, I leveled out at 195. The Oxandrin seems to be less effective, although to be fair, I’ve only been on it for 3 weeks.”

Added July, 2001: As time has passed since Anadrol has been introduced into the HIV community, evidence of liver toxicity has appeared, but generally with higher dose use. It appears that oral steroid doses over 20 mg per day, in general, should be considered to have potential for liver toxicity. Anadrol has been prescribed in HIV medicine in doses up to 150 mg per day, and at this dose we have had some reports of liver enzyme elevations, including GGT, a discreet liver function test.

Compare Drug Toxicity at Equal Doses

It is important to note that comparisons of studies that showed a seeming lack of a negative effect of Oxandrin on liver enzymes with HIV(-) and HIV(+) people related to studies of Anadrol that showed a negative effect are not credible.

When we consider that liver toxicity is a dose-related phenomena, and then consider that the typical doses that Anadrol has been used and studied at are often 100 mg per day, and the doses that Oxandrin has been used and studied at are usually about 10 to 15 mg per day, there is no credible way to use data from these studies to compare the potential for toxicity of the two steroids. To accurately compare them each steroid must be given at the same dosage to matched subjects.

The Grunfeld study that showed that Oxandrin caused elevated SGOT and SGPT enzymes raises questions about whether Oxandin is just as potentially toxic as any other steroid at higher doses. 

Those who’ve had liver disease or are using protease inhibitors (especially Norvir) should have their liver function tested regularly while using any oral steroid and take liver protectants like evening primrose oil, silymarin, lipoic acid, glutamine, and N-acetyl-cysteine.

Also, because oral steroids can decrease the “good” HDL cholesterol and increase the “bad” LDL cholesterol, oral steroids can increase the risk of cardiovascular disease (CVD). If you use oral anabolic steroids consider taking 400 to 800 IU of Vitamin E, and 1,000 to 2,000 mg. of Vitamin C with each meal. These vitamin antioxidants help to protect cholesterol from the oxidation that is associated with CVD.

References

Jones RW, et al. J Pediatr, 97(4):559-66 1980