Know about 17-alkylated steroids
You may have heard that 17-alkylated steroids are harder for the liver to metabolize and therefore require more effort to break them down. All 17-alkylated steroids are toxic to the liver. Non-17-alkylated steroids are not toxic to the liver. All these views are not true.
17-alkylated steroids are known to be toxic to the liver. How toxic depends on who you believe in. The media and many doctors think they are deadly, while many people online think they are actually harmless. There seems to be a lot of confusion on this topic, even among people who know a lot about steroids. The fact is that it depends how you use steroid and the actual instructions you get. Dose and duration are the main fators when it comes to steroid use. Hopefully we can dispel some rumors about how toxic substances are and how to reduce or prevent toxicity.
Toxic effect of steroid
What are the toxic effects of oral steroids? By far the most common toxicity is intrahepatic cholestasis. Generally, cholestasis is any condition in which bile ceases to flow, and oral allergy occurs in the liver. Normally, bile is released into the small intestine and its main function is to help absorb fats and lipids. This prevents bile salts from being released into the bile ducts, leading to the buildup of liver cells. This accumulation may be toxic to hepatocytes over time. Jaundice is the yellowing of the skin and eyes and is associated with cholestasis. This is because bilirubin (a product of the breakdown of red blood cells) is usually excreted through the bile. During cholestasis, the skin and eyes gradually turn yellow, a sign that something bad is happening. Jaundice is rare except in newborns, and if you notice these symptoms, you should seek professional health care. The type of cholestasis usually seen in oral steroids is clinically classified as “mild cholestasis” because there is no inflammation associated with cholestasis. This type of cholestasis is completely reversible when the pathogenic agent is stopped.
In addition to cholestasis, other reported toxic effects are cirrhosis of the liver and hepatic adenoma. Liver disease is a cavity in the liver that is filled with blood. This is a rare condition in which the theory is that cirrhosis of the liver is caused by blocked outflow of hepatic blood at the junction of the sinus vein and the lobular central vein. What causes this? It is thought to be associated with cholestasis, which causes the growth (swelling) of liver cells. In patients with AAS, obstruction may be due to prolapse of hepatocyte proliferation into the hepatic vein wall. This is good news because it means that if cholestasis can be prevented, cirrhosis can also be prevented.
Hepatic adenoma has been mentioned many times in the literature as a possible effect of oral steroids. This is extremely rare and appears to occur only after months or years of continuous use. It may also be associated with prolonged cholestasis. In my opinion, don’t worry unless someone in your family has contracted cholestasis from oral steroids (including birth control pills). The real focus of safety should be preventing cholestasis.
Function of Liver
The liver has many important functions in the body, but these include drug metabolism and excretion, and the secretion of bile salts and bicarbonates for digestion.
For 17-alkylated steroids, the conversion from 17-hydroxyl to 17-ketone steroids is prevented. That’s the key. The main difference between 17-aa and regular steroids is that the former retains a free 17-hydroxyl group in the liver, while the latter does not. The reason 17-aa is toxic is that the free hydroxyl group can combine with glucuronic acid to form d-ring 17-glucuronolactone. It is not the 17-aa steroid that is toxic to the liver, but the 17-glucan metabolite. It’s not that these steroids are harder to metabolize, it’s the way they’re metabolized that makes them toxic.