Best Liver Support for Steroids – A Science-Based Approach

When deciding to jump on a cycle, you should always remember that you are fully responsible for your health.

While the mainstream media overdramatizes the side effects of steroids, liver damage is very real. As such, you should always do your best to add the best liver support for steroids that you can find.

More specifically, hepatoxicity occurs to most users that choose to add to their cycle c17-alkylated orals (like Winstrol, Dianabol, Anadrol, etc.).

More specifically, two markers of liver stress that are most commonly elevated when using steroids are ALT and AST.

These enzymes are responsible for the metabolism of amino acids and will leak into the bloodstream when inflammation or damage is caused to the liver. Thus, these should always be measured before, during and after your cycle.

I decided to write this guide to introduce the best liver support products that bodybuilders can supplement with, during their steroid cycles.

Before we get started…

One thing I want to point out before we go into the details is the importance of the Reference (sources) section found at the bottom of this page. 

As there is much misinformation on the web with regards to the effective use of supplements, I kindly ask you to read the studies mentioned at the bottom of the page and make your decision based on scientific evidence.

I have grouped the studies into categories to help you go through them faster.

Another thing to keep in mind before you invest in liver aid supplements is the use of alcohol during your cycle. While cycles that only contain injectable steroids could forgive the occasional consumption of alcohol, it is best to cut alcohol completely when taking heavy orals (like Winstrol, Anadrol or Dianabol).

This is possibly the best safety practice you can implement before looking into any supplementation.

Finally, with any of the options below, it is considered a best practice to start supplementing 2-3 weeks before your cycle and keep supplementing 2-3 weeks after you complete your cycle.

That being said, let’s dive into your options when it comes to the best liver support for steroids.

Best liver support for steroids

In this section, I will talk about all the different supplements you can take to protect your liver while on cycle, and give some recommendations based on my personal preference and extended research.

TUDCA – Tauroursodeoxycholic acid

best liver support for steroids - TUDCA

TUDCA is a relatively new discovery in the bodybuilding world and, due to its limited research on humans, often controversial.

Since it was first introduced to the bodybuilding community, many have treated it as a miracle drug, and consider it to be the best liver support for steroids that cause hepatoxicity.

I have been using TUDCA (on-cycle) for the past 3 years and I absolutely love it! Sure, it may not be the cheapest supplement out there, but it has so many benefits that you simply can’t ignore it.

A number of different studies (seen in the references) have shown that TUDCA is able to:

  • Decrease elevated liver enzyme levels (ALT, AST, GGT, & Alkaline Phosphatase)
  • Act as a potentially safe and effective treatment for liver Cirrhosis
  • Improvement in brain, heart, and retinal health

As you can tell, all of the above benefits are exactly what a bodybuilder needs when looking for the best liver support for steroids.

From my personal experience and my by checking the blood results of many of my clients, I can say that TUDCA works wonders when it comes to your liver health on cycle. 

Note: While the statements here are based on evidence-based results, more clinical research is needed to make bold claims on TUDCA. This supplement is relatively new in the market and athletes that choose it for their cycles do so mostly due to their personal research. 

You can find TUDCA in its synthetic form, which is most commonly used today, or as an organic supplement (bile salt extracted from bears). I personally get my TUDCA from TUDCA.com, since they offer the best value per gram. 

I have also tested Ox Bile and I am pleased with the results.

TUDCA dosage for bodybuilders

Due to the limited amount of studies, TUDCA doesn’t have a set range. While dosages as low as 10mg have shown improvements in ALT levels, there have been studies that show 1500mg per day to offer the most effective solution for lowering enzyme levels.

However, anything above 1000mg has been shown to cause frequent diarrhea, among other side effects. With these, we will deal in the FAQs at the end of this post.

When it comes to the majority of professional bodybuilders that I have had the pleasure to talk with the dosages fluctuated between 500-1000mg per day

The lower doses were usually accompanied by a secondary supplement, such as NAC or Milk Thistle. There are also supplements that contain blends of these three liver aids, such as Advanced cycle support.

What you should remember, when wondering how to take TUDCA, is that there is no perfect dose. Most bodybuilders will start on a certain protocol, which is given to them by their coach or an acquaintance and, because it works for them, they stick to it.

This is not to say that one dosage fits all. When running a mild cycle you should be safe at the low end of the dose (500mg). If you decide to add heavier orals for an extended amount of time, start at 750mg per day, see how you feel and adjust accordingly.

Milk thistle – Silymarin

LPC silymarin

Milk thistle is a sharp prickled flower plant that grows on multiple continents throughout the world.

Within the seeds of the Milk Thistle plant, are 3 biochemicals (flavonoids) that are responsible for its beneficial effects. These substances, which are collectively known as Silymarin, are the active ingredient found in all Milk Thistle supplements.

Silymarin has a diverse range of effects on the body, including:

  • Antioxidant properties – This is very helpful for oral steroid users, as the liver’s ability to self-cleanse reduces steroid-induced hepatotoxicity. 
  • Anti-inflammatory effects – The administration of Silymarin may help decrease the inflammatory effects of oral steroids on the liver, improving overall liver function and health.
  • Prevents hepatic fibrosis – Fibrosis (liver scarring) is one of the potential side effects of oral steroid use. Thus, Silymarin supplementation act as an added preventative measure.

Numerous clinical trials have shown that Silymarin therapy helps to reduce both ALT and AST levels, which in turn improves liver function. This is a direct effect of Silymarin’s hepatoprotective/rejuvenating effects.

Overall, the supplementation of Silimaryn is very common for bodybuilders prior to and during their steroid cycle and is considered by many the best liver support for steroids.

I have personally used LPC as a liver aid for my very first competition since it was recommended to me by the top bodybuilders of the industry at that time. 

My pre-contest cycle included, among others, high dosages of Winstrol (420mg pw), an oral which is well known to be liver toxic. 

With a dosage of 360mg per day (2 capsules), my liver markers came back clean. However, you need to also keep in mind that every individual will react differently, which means that these doses are not an indication or recommendation for what you should be taking.

Silymarin Dosage for bodybuilders on cycle

The dosage of Milk thistle supplements for bodybuilding purposes is not well documented. However, the majority of bodybuilders usually supplement Silymarin on dosages of 350-700 mg per day, depending on the heaviness of their cycle.

  • Cycles that are “light” and do not use 17-alkalic orals may use 350-400mg of Silymarin per day as an added protection measure (better be safe than sorry).
  • On the contrary, heavier cycles that include 17-alkalic orals will usually go towards the higher end of the dosage spectrum.

The specific timings of the dosage will be discussed in the FAQs at the end of this article.

NAC – N-Acetylcysteine

best liver support for steroids - nac

If you like to lure around bodybuilding forums, you might have noticed the popularity of NAC as a liver aid, among its many uses.

N-Acetylcysteine, the active ingredient of NAC, does a number of things to protect your liver from AAS use:

  • It allows the body to produce more glutathione, which acts as an antioxidant to neutralize free radicals, which in turn prevents liver damage.
  • Thanks to its anti-inflammatory effects, it assists and improves liver function.
  • It has been proven to alleviate liver toxicity (studies 7 & 8). This doesn’t only make it one of the best liver protection for steroids but also a hangover remedy after a hard night drinking (which by the way should be avoided in case of oral steroid use).

I have personally tried NAC Thorne because of its inexpensive price and its 500mg capsule content. I don’t only use it for steroid cycles but also when I am off cycle. Here is why.

As I have a chronically-stressed liver due to steroid use, I want to take the best possible care of it also when off cycle. 

For that reason, when I go out to have a few drinks (increasing my ethanol levels), I come home and take 1-2 pills of NAC before going to bed.

NAC dosing for bodybuilders on cycle:

For my cycles, I use 500-1000 mg per day, split into two doses. Much like Silymarin, I will take the low end of the dose when using light cycles (e.g. small amount of Winstrol) and the high end when taking heavier orals (e.g. Anadrol).

  • Most bodybuilders, depending on the heaviness of their cycle, will supplement NAC anywhere between 400-1200mg per day while on cycle.
  • For maximum absorption, each dose is taken on an empty stomach, with water, at least 2 hours before or after a meal. This improves the absorption of N-Acetylcysteine and offers the best protection for your liver.
  • Avoid doses higher than 1200mg per day since studies have shown that it increases oxidative stress (pro-oxidation).

N2Guard – Are such blends worth it?

best liver support for steroids - n2guard

A supplement that has increased in popularity in the last few years, especially among bodybuilding cycles, is N2Guard. 

In essence, this supplement is a combination of all the options discussed above with the addition of a number of vitamins often used by bodybuilders.

Among others, it contains the following:

  • TUDCA – 250MG
  • Silymarin – 300mg
  • NAC – 300mg
  • Curcumin – 125mg
  • Vitamin A – 5000IU
  • Vitamin D – 100IU
  • Vitamin B6 – 25MG
  • Vitamin B12 – 1000MCG

And much, much more…

My honest opinion? It’s very pricey for the value that it offers. In addition to that, we are now looking at liver support, not all-around health supplements. 

N2Guard is more like a super multivitamin that contains additional ingredients to protect the liver.

So, why did I add it to this list?

Because I want to highlight the importance of proper research. You see, most blog posts will only focus on the most expensive supplements to get high affiliate commissions if someone buys the product through their link.

This doesn’t mean that N2Guard is the best liver support for steroids. It only means that it’s the most expensive.

The unequal distribution of its contents is unfit for bodybuilders who are looking for the most balanced option. 

If you think about it, it’s kinda pointless to take 16,660% of your daily Vitamin B12 intake, every day, for the duration of your cycle.

A much better alternative, in my opinion, would be Advanced cycle support.

Not only does Advanced cycle support contain more Silymarin and NAC in its 2 capsule serving (instead of N2Guard’s 7 capsule serving) but it also contains CQ-10, an ingredient which is proven to decrease elevated liver enzymes and is very expensive to buy on its own.

Combine it with a good multivitamin, like Orange Triad, and you have better liver protection that N2guard – at less than half the price.

Frequently Asked Questions

How should bodybuilders take Silymarin?

  1. Take your first dose of oral steroids in the morning, with an empty stomach with 500ml water.
  2. Take your first dose of Silymarin 3-4 hours later with one of your meals.
  3. 4-5 hours after that, take your second oral steroid dose on an empty stomach.
  4. Take your second dose of Silymarin 4 hours after your second dose of orals, with food.

While these steps should not necessarily be followed to the point, they do ensure the most productive and successful results. When you take oral steroids on an empty stomach with water, the synthetic methylated hormones will be absorbed into your system faster.

Taking your Silymarin supplement with food will not only help the absorption of the herbal extracts but also the vitamins and minerals that your product may contain in addition.

Note: Make sure that the meal you eat when taking your liver protection supplement has at least some fat in it. This will aid the breakdown of fat-soluble vitamins and minerals that your supplement may contain.

What foods cleanse your liver naturally?

Before you start researching the best liver support for steroids, consider adjusting your diet to maintain a healthy liver. The following options are great when it comes to liver protection:

  • Garlic
  • Grapefruit
  • Green tea
  • Green (leafy) vegetables
  • Avocados
  • Walnuts
  • Turmeric root (curcumin)

What are the best TUDCA supplement options?

My favorite options are:

  • 3-pack deal from TUDCA.com 
  • Alphaform TUDCA capsules

Should I take TUDCA on an empty stomach?

No, Tudca should be taken with food. Make sure that the meal you eat when taking your TUDCA has at least some fat in it. This will aid the breakdown of fat-soluble vitamins and minerals that your supplement may contain.

What is the best on cycle support for orals that do not cause hepatoxicity (e.g. Anavar)?

In these cases, LPC (Milk Thistle) or Liv-52 can be taken as a preventative measure just in case. However, it is possible to skip liver support supplements as a whole if your doses are low.

References

The following bibliography was referred to when writing this article. Please consider reading through the studies to get a better idea of the potential effects/side effects of the supplement you intend to use.

Hepatoxicity caused by AAS use

  1. J Clin Gastroenterol. 2002 Oct;35(4):350-2. Androgenic/Anabolic steroid-induced toxic hepatitis. Stimac D, Milić S, Dintinjana RD, Kovac D, Ristić S.
  2. Clin Ther. 2001 Jun;23(6):789-801; discussion 771. Review of oxymetholone: a 17alpha-alkylated anabolic-androgenic steroid.Pavlatos AM1, Fultz O, Monberg MJ, Vootkur A, Pharmd.
  3. HIV Hotline. 1998 Dec;8(5-6):10-1. Does the choice of alpha-AAS really make a difference? Mutzebaugh C.
  4. Minerva Med. 1971 Jun 27;62(51):2605-11. [Hepatotoxicity of anabolic steroids]. Rozman C, Urbano A, Galera H.
  5. J Gastroenterol 2000;35(7):557-62, Multiple hepatic adenomas caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis. Nakao A, Sakagami K, Nakata Y, Komazawa K, Amimoto T, Nakashima K, Isozaki H, Takakura N, Tanaka N.
  6. Medical Hypotheses 93 (2016) 150–153. Anabolic-androgenic steroid-induced hepatotoxicity. Peter Bond, William Llewellyn, Peter Van Mol
  7. Med Sci Sports Exerc. 1999 Feb;31(2):243-50, Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids. Molano F, Saborido A, Delgado J, Moran M, Megias A.
  8. Lancet 1979 Nov 24;2(8152):1120-3, Hepatic angiosarcoma associated with androgenic-anabolic steroids. Falk H, Thomas LB, Popper H, Ishak KG.
  9. J Pharmacol Toxicol Methods 1995 Aug;33(4):187-95, Toxic effects of anabolic-androgenic steroids in primary rat hepatic cell cultures. Welder AA, Robertson JW, Melchert RB.
  10. Arch Toxicol 1999 Nov;73(8-9):465-72, Evaluation of acute and chronic hepatotoxic effects exerted by anabolic-androgenic steroid stanozolol in adult male rats. Boada LD, Zumbado M, Torres S, Lopez A, Diaz-Chico BN, Cabrera JJ, Luzardo OP.
  11. Clin J Sport Med 1999 Jan;9(1):34-9, Anabolic steroid-induced hepatotoxicity: is it overstated? Dickerman RD, Pertusi RM, Zachariah NY, Dufour DR, McConathy WJ.
  12. Int J Sports Med 1996 Aug;17(6):429-33, Body composition, cardiovascular risk factors and liver function in long-term androgenic-anabolic steroids using bodybuilders three months after drug withdrawal. Hartgens F, Kuipers H, Wijnen JA, Keizer HA.

TUDCA (Tauroursodeoxycholic Acid) – Personally the best liver support for steroids.

  1. Crosignani A , et al. “Tauroursodeoxycholic Acid for Treatment of Primary Biliary Cirrhosis. A Dose-response Study. – PubMed – NCBI.” National Center for Biotechnology Information, 4 Apr. 1996.
  2. Drack AV , et al. “TUDCA Slows Retinal Degeneration in Two Different Mouse Models of Retinitis Pigmentosa and Prevents Obesity in Bardet-Biedl Syndrome Type 1 Mice. – PubMed – NCBI.” National Center for Biotechnology Information, 5 Jan. 2012.
  3. Fernández-Sánchez L , et al. “Controlled Delivery of Tauroursodeoxycholic Acid from Biodegradable Microspheres Slows Retinal Degeneration and Vision Loss in P23H Rats. – PubMed – NCBI.” National Center for Biotechnology Information, 25 May 2017.
  4. Invernizzi P , et al. “Differences in the Metabolism and Disposition of Ursodeoxycholic Acid and of Its Taurine-conjugated Species in Patients with Primary Biliary Cirrho… – PubMed – NCBI.” National Center for Biotechnology Information, 29 Feb. 1999.
  5. Kent D and Sheridan C. “Choroidal Neovascularization: a Wound Healing Perspective. – PubMed – NCBI.” National Center for Biotechnology Information, 22 Dec. 2003.
  6. Larghi A , et al. “Ursodeoxycholic and Tauro-ursodeoxycholic Acids for the Treatment of Primary Biliary Cirrhosis: a Pilot Crossover Study. – PubMed – NCBI.” National Center for Biotechnology Information, 11 Apr. 1997.
  7. Pan XL , et al. “Efficacy and Safety of Tauroursodeoxycholic Acid in the Treatment of Liver Cirrhosis: a Double-blind Randomized Controlled Trial. – PubMed – NCBI.” National Center for Biotechnology Information, 17 Apr. 2013.
  8. Panella C , et al. “Does Tauroursodeoxycholic Acid (TUDCA) Treatment Increase Hepatocyte Proliferation in Patients with Chronic Liver Disease? – PubMed – NCBI.” National Center for Biotechnology Information, 27 June 1995.
  9. —. “Does Tauroursodeoxycholic Acid (TUDCA) Treatment Increase Hepatocyte Proliferation in Patients with Chronic Liver Disease? – PubMed – NCBI.” National Center for Biotechnology Information, 27 June 1995.
  10. Phillips MJ , et al. “Tauroursodeoxycholic Acid Preservation of Photoreceptor Structure and Function in the Rd10 Mouse Through Postnatal Day 30. – PubMed – NCBI.” National Center for Biotechnology Information, May 2008.
  11. Rivard AL , et al. “Administration of Tauroursodeoxycholic Acid (TUDCA) Reduces Apoptosis Following Myocardial Infarction in Rat. – PubMed – NCBI.” National Center for Biotechnology Information, 2007.
  12. Rodrigues CM , et al. “Neuroprotection by a Bile Acid in an Acute Stroke Model in the Rat. – PubMed – NCBI.” National Center for Biotechnology Information, 22 Apr. 2002.
  13. Setchell KD , et al. “Metabolism of Orally Administered Tauroursodeoxycholic Acid in Patients with Primary Biliary Cirrhosis. – PubMed – NCBI.” National Center for Biotechnology Information, Mar. 1996.
  14. Tauroursodeoxycholic Acid Dampens Oncogenic Apoptosis Induced by Endoplasmic Reticulum Stress During Hepatocarcinogen Exposure.” PubMed Central (PMC), Sept. 29.
  15. Tauroursodeoxycholic Acid Reduces Apoptosis and Protects Against Neurological Injury After Acute Hemorrhagic Stroke in Rats.” PubMed Central (PMC), 13 May 2003
  16. Tsochatzis EA , et al. “Liver Cirrhosis. – PubMed – NCBI.” National Center for Biotechnology Information, 17 May 2014.
  17. Woo SJ , et al. “Ursodeoxycholic Acid and Tauroursodeoxycholic Acid Suppress Choroidal Neovascularization in a Laser-treated Rat Model. – PubMed – NCBI.” National Center for Biotechnology Information, 26 June 2010.
  18. Zhang T , et al. “Chemical Chaperone TUDCA Preserves Cone Photoreceptors in a Mouse Model of Leber Congenital Amaurosis. – PubMed – NCBI.” National Center for Biotechnology Information, 5 June 2012.

Milk Thistle (Silymarin)

  1. Ladas EJ, Kroll DJ, Oberlies NH, et al.: A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL). Cancer 116 (2): 506-13, 2010. [PUBMED Abstract]
  2. Vailati A, Aristia L, Sozzé E, et al.: Randomized open study of the dose-effect relationship of a short course of IdB 1016 in patients with viral or alcoholic hepatitis. Fitoterapia 64 (3), 219-28, 1993.
  3. Salmi HA, Sarna S: Effect of silymarin on chemical, functional, and morphological alterations of the liver. A double-blind controlled study. Scand J Gastroenterol 17 (4): 517-21, 1982. [PUBMED Abstract]
  4. Ferenci P, Dragosics B, Dittrich H, et al.: Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 9 (1): 105-13, 1989. [PUBMED Abstract]
  5. Lucena MI, Andrade RJ, de la Cruz JP, et al.: Effects of silymarin MZ-80 on oxidative stress in patients with alcoholic cirrhosis. Results of a randomized, double-blind, placebo-controlled clinical study. Int J Clin Pharmacol Ther 40 (1): 2-8, 2002. [PUBMED Abstract]
  6. Velussi M, Cernigoi AM, De Monte A, et al.: Long-term (12 months) treatment with an anti-oxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatol 26 (4): 871-9, 1997. [PUBMED Abstract]
  7. Seeff LB, Curto TM, Szabo G, et al.: Herbal product use by persons enrolled in the hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial. Hepatology 47 (2): 605-12, 2008. [PUBMED Abstract]
  8. Palasciano G, Portincasa P, Palmieri V, et al.: The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs. Current Therapeutic Research 55 (5): 537-45.
  9. Ferenci P, Scherzer TM, Kerschner H, et al.: Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy. Gastroenterology 135 (5): 1561-7, 2008.

NAC (N-Acetylcysteine)

  1. Ben-Ari Z, Vaknin H, Tur-Kaspa R. N-acetylcysteine in acute hepatic failure (non-paracetamol-induced). Hepatogastroenterology, 2000;47:786-9.
  2. Multicenter Study Group. Long-term oral acetylcysteine in chronic bronchitis. A double-blind controlled study. Eur J Respir Dis 1980;61:111:93-108.
  3. Estensen RD, Levy M, Klopp SJ, et al. N-acetylcysteine suppression of the proliferative index in the colon of patients with previous adenomatous colonic polyps. Cancer Lett 1999;147:109-14.
  4. Kleinveld HA, Demacker PNM, Stalenhoef AFH. Failure of N-acetylcysteine to reduce low-density lipoprotein oxidizability in healthy subjects. Eur J Clin Pharmacol 1992;43:639-42.
  5. Brumas V, Hacht B, Filella M, Berthon G. Can N-acetyl-L-cysteine affect zinc metabolism when used as a paracetamol antidote? Agents Actions, 1992;36:278-88
  6. R. D. Scalley, C. S. Conner. Am J Hosp Pharm Acetaminophen poisoning: a case report of the use of acetylcysteine. 1978
  7. A dual effect of N-acetylcysteine on acute ethanol-induced liver damage in mice. An-Lian Wang, Jian-Ping Wang, Hua Wang, Yuan-Hua Chen, Lei Zhao, Long-Shou Wang, Wei Wei, De-Xiang Xu. Hepatol Res. 2006

Dimitris Tsapis

Dimitris writes articles related to his experiences as a coach and bodybuilding athlete.

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