Stanozolol-induced Liver Injury: A Distinctive Cholestatic Clinical and Biochemical Phenotype at Presentation

Abstract

Background & aims

The misuse of Anabolic Androgenic Steroids (AAS), including Stanozolol, for performance enhancement has emerged as a significant cause of liver damage. This study aims to elucidate the distinctive hepatotoxicity profiles induced by Stanozolol.

Methods

Eighteen individuals were prospectively evaluated by the Latin American DILI Registry from 2013 to 2023. Data regarding Stanozolol administration, symptoms onset, and clinical manifestations were collected. Comprehensive assessments including serologies, abdominal imaging, and in some cases, liver biopsies were performed to identify Stanozolol-induced liver injury and exclude other etiologies.

Results

All patients were young males aged between 19 and 48, utilizing Stanozolol for aesthetic purposes. The mean latency to symptom onset was 55 days. Predominant symptoms included jaundice and pruritus. Elevated total bilirubin levels were observed in all cases, while gamma-glutamyl transferase levels remained within or slightly above normal ranges. Concurrent use of other substances was reported in ten cases, showcasing a trend of poly-substance abuse.

Conclusions

The study identified a specific biochemical profile of Stanozolol-induced liver injury in young men using it for aesthetic purposes. The characteristic liver injury profile has marked elevation of bilirubin, mild rise in transaminases, and near-normal GGT.