The more serious liver problems attributed to anabolic steroid use include hepatocellular carcinoma (liver cancer) and peliosis hepatitis (blood-filled sacs within the liver). But the majority of cases reporting liver problems have dealt with extremely sick and elderly patients treated with C-17 alkylated oral steroids for years of continuous use, and many of these patients had a particular type of anemia linked to liver tumors even without anabolic steroid therapy. A computer search of the medical literature looking for steroid-associated liver tumors could find only three in athletes (Friedl, 1990). Of the three athletes, one was using 700 mg of oxymetholone a week for five straight years, and one had a tumor more indicative of classic liver cancer than of steroid-associated tumors. Virtually all of the reported liver problems seemed to occur with the 17 alpha-alkylated oral steroids. There have been no cysts or liver tumors reported in athletes using the 17 beta-esterified injectable steroids (Wright & Cowart, p. 61). It has been noted that injectable steroids generally appear to have little effect on the liver at all (Haupt, 1993, p. 469).
Recent studies continue to suggest that reports of serious adverse effects of anabolic steroids upon the liver in healthy athletes may be highly overstated. In a study of athletes, of the 53 current or past steroid users who underwent laboratory testing, only one subject displayed an abnormal liver test (Pope & Katz, 1994, p. 379; incidentally, on physical examination, not one user displayed evidence of any major abnormalities possibly attributable to steroids, such as high blood pressure, edema, acne or hair loss.) Another study tested one of the most powerful and reputedly dangerously toxic anabolic steroids for 30 weeks on HIV positive men and women (Hengge et al.). Oxymetholone, formerly known as Anadrol in the U.S. and a C-17 alkylated oral steroid, was administered in a dosage of over 1,000 mg per week (more than that used by many bodybuilders, and for a much longer duration of uninterrupted use). The results were significant gains in lean muscle mass -- even without any weightlifting. Even more importantly - and surprisingly -- there were no significant problems with liver function, water retention, or virilization side effects (it will be interesting to see whether further studies yield consistent findings at such high dosages).
While the dangers of anabolics to athletes' livers appear to have been highly exaggerated, it must be recognized that an apparently healthy athlete with a previously existing but undiscovered liver problem could do serious damage to himself by self-administering C-17 oral anabolic steroids. For this reason alone, it would be quite irresponsible for any athlete to use anabolic steroids without having a physician regularly conduct blood tests to monitor liver function.