TUDCA and UDCA should be considered first above all else when using hepatotoxic anabolic steroids, as they treat the mechanisms specific to cholestasis. NAC is very beneficial as well. The other options, are just secondary aids as they are not nearly as beneficial for C17aa.

Choline & Inositol
For Additional Information & Studies On Choline, Be Sure To Visit The Examine Page

Choline can be used as a daily supplement for general health and/or a liver protector while on oral steroid course. Choline cannot replace TUDCA and should be used in addition to TUDCA while taking oral steroids. Choline should be used in conjunction with Inositol and many products that you will find will contain both anyway.

Deficiency in dietary choline can lead to triglyceride accumulation (hepatic fatty acids) and impair TG release from the liver due to less phosphatidylcholine being made.

For general liver health take 250-500 mg of choline once per day

For liver protection while on oral steroids take 1-2 g in two even doses per day (ie 1000mg or 1 g is 500 mg twice a day, 12 hours apart or so)

For Additional Information & Studies On Inositol, Be Sure To Visit The Examine Page

Inositol may also be used as both a daily supplement for general health and/or as adjunct liver protection to TUDCA while on oral steroids. Again, taking inositol and choline together is important.

Inositol the word itself refers to a group of 9 molecules that all have similar structures, termed stereoisomers. The key isomer that we are focusing on is MYO-INOSITOL and this is the isomer that we want to supplement and take. Pretty much all OTC supplements with inositol will be this isomer, but always double check to be sure you are getting the right one.

Inositol shows promising effects in restoring insulin sensitivity and decreasing LDL and acne, and has many other slight positive beneficial effects which can be found under the "Human Effect Matrix" category on the examine.com page linked just above.

For general liver health and oral steroid protection, inositol doses will typically be in the 2g-4g range, and it is advised to take these doses in two split even doses per day, roughly 12 hours apart.

Milk Thistle
For Additional Information & Studies, Be Sure To Visit The Examine Page

Milk thistle, which contains silymarin and silybin are known as being powerful antioxidants in the liver in particular. Many studies have been conducted on the efficiency and have demonstrated them to exhibit a plethora of beneficial properties in liver tissue. However, milk thistle is not very effective for treating cholestasis in particular. As a general liver health support, it is not too bad. However, almost all of the studies performed on milk thistle’s effectiveness had administered the test subjects the compound via injection, which would provide near 100% bioavailability. Milk thistle consumed orally is a different story. Milk thistle can serve as a beneficial addition to TUDCA and UDCA, but should not be substituted as a first-line treatment for cholestasis. TUDCA should be reserved for the first-line treatment of cholestasis and should be the primary liver protectant while on a cycle of C17-alpha alkylated oral anabolic steroids.

Liv.52 (LiverCare)
Liv.52 is an herbal medicine used widely in Europe and Asia to support metabolic and liver health. While in some countries this product is regarded as a drug, it contains all natural ingredients including capparis spinosa, terminalia arjuna, cichorium intybus, achillea millefolium, solanum nigrum, tamarix gallica, and cassia occidentalis. There have been medical studies have been conducted on Liv.52 in recent years, many of which involve its ability to protect the liver from damage by alcohol or other toxins. Note that while these studies lend support for the use of a natural remedy like Liv.52 during hepatotoxic steroid administration, they do not provide complete assurance that this remedy can prevent liver damage. Also some of the studies may have some bias, so be sure to use caution when reviewing them.

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