Epistane
Active ingredient: Methylepitiostanol. Designer steroid with sulfur bridge in ring A, cannot be aromatized. There is no measurement of the effect on the muscle, but on the liver there are four cases with a much higher bile acid level and an elucidated mechanism: It increases the production of bile acid instead of inhibiting its removal.
Auch bekannt als: Epistane, Methylepitiostanol, Havoc, 2a,3a-Epithio-17a-methyl-5a-androstan-17b-ol
What it is
Epistane is methylepitiostanol, a C17 alkylated testosterone derivative with a 2α,3α-epithio bridge, i.e. a sulfur atom that bridges two neighboring carbons in ring A. The molecular formula is C₂₀H₃₂OS; it is the only common anabolic steroid with sulfur in the molecule.
It was never a medicine. It was sold as an over-the-counter preparation, usually under the name “prohormone”. The term does not apply: A prohormone is a precursor that the body first has to convert, and Epistane is the finished active ingredient. The designation served to keep an oral anabolic steroid on the nutritional supplement shelf.
It is not self-evident that such preparations say what is written on them. Even apparently hormone-free products such as vitamin, mineral and amino acid preparations contained anabolic steroids in studies that were not stated on the label. and the substance was found in a product declared as methylstenbolone as stated, but the detection method first had to be developed for it.
How it works
What the sulfur bridge in ring A means
Ring A carries neither the keto group at position 3 nor a double bond between C4 and C5, but an epithio bridge. This allows them to aromatase nothing to do: No estradiol is produced from Epistane, there is no estrogen-related water retention and no gynecomastia caused by the substance itself. This is the reason for the reputation of the dry appearance.
The further statement that Epistane also has an antiestrogenic effect, i.e. like a SERM on breast tissue, could not be proven in the literature reviewed here. It probably goes back to the parent substance epitiostanol, which was used in Japan to treat breast cancer. There is no measurement for epistane itself, and in practical terms the difference is significant: a substance that does not produce estrogen is different from one that blocks existing estrogen.
A published binding measurement of Epistane am Androgen receptor couldn't be found either. However, it has been proven that the substance activates the receptor, in an unexpected place: in the liver cell.
What the studies show
There is nothing about the effect on the muscle. No controlled examination, no dose determination, no measurement of strength or muscle mass. What there is is an unusually thorough work on liver effects, and that is more important than any efficacy number for this substance.
Four cases and a different mechanism
A Spanish working group recorded four people who developed long-term cholestasis after taking Epistane and determined the bile acid profile of three. The bile acid pool in the blood was on that 14 to 61 times increased, mainly due to conjugated cholic acid, while secondary bile acids were very low.
The interesting part is the mechanism because it is different from that of the other oral steroids. In cultured human liver cells, epistane at just 0.01 micromoles increased the reading of the key genes involved in bile acid production: CYP7A1 by 65 percent and CYP8B1 by 67 percent. At the same time, bile acid transporters, including the bile salt export pump, increased, and the uptake of a labeled bile acid into the liver cell increased by 50 to 70 percent. At 40 microM, epistane additionally activated the nuclear receptors LXR and PXR.
The crucial step takes place via the androgen receptor. Just 0.01 micromole of epistane activated it in the liver cell, and that led to more CYP8B1. In human liver bank samples, androgen receptor readings were positively associated with CYP8B1 in men. The authors conclude that Epistane triggers cholestasis by stimulating bile acid production and promoting their accumulation in the liver cell, at least in part through the androgen receptor.
This is a different picture than at Methasterone or Methandienone, in which the inhibition of transport is the main focus. Here it is not primarily the outflow that is throttled, but rather the inflow that is increased. In practice, both lead to the same clinical picture, but the difference is important in thought: a substance that stimulates production cannot be defusing by supporting the pump.
At the same time, the authors offer an explanation for why it affects some and not others: the level of bile acid enzymes and transporters varies considerably between people, and they see this as the reason for the unpredictability of this liver damage.
How the clinical picture progresses
The prospective series of the American DILIN network provides the framework for this class of substances: 44 men, on average 33 years old, developed liver damage on average 73 days after the onset, all with jaundice, 84 percent with itching and 71 percent in the hospital. Nobody died, nobody needed a liver transplant, and several preparations contained anabolic steroids that were not on the label.
What the substance does in the muscle remains an open question. For the substance class as a whole, a review article describes strength increases of around 5 to 20 percent of the initial value and 2 to 5 kg of body weight with short-term administration, as well as increased blood pressure and reduced HDL cholesterol.
Dosage
- There is no tested dose. The usual 20 to 40 mg daily comes from labels and forums.
- The effective concentration in the liver cell is very low. Just 0.01 micromoles were enough to activate the androgen receptor and increase bile acid production. A dose that feels modest in the muscle is not a small one in the liver.
- Four weeks is not a safe limit. In the DILIN series, an average of 73 days passed until damage occurred. A short application is within the period in which nothing is visible.
- An aromatase inhibitor is irrelevant. Epistane does not produce estradiol; an inhibitor just lowers estradiol from other sources in the stack.
- Not next to a second oral steroid and not next to alcohol. Both attack at the same point.
- Bilirubin is measured, not just transaminases. The bile buildup occurs with little cell destruction, which is why the transaminases can only increase moderately.
Side effects
Bile buildup in the liver
What happens: Epistane increases the production of bile acids and their absorption into the liver cells; bile accumulates, bilirubin increases, the skin turns yellow and itches. In three affected people examined, the bile acid pool in the blood was increased 14 to 61 times. The symptoms lasted for a long time in all four cases.
What it depends on: From the dose and duration, and from the personal supply of bile acid enzymes and transporters, which the authors see as the reason for the unpredictability. In the DILIN series, up to 20 percent of those affected carried a variant in the bile salt pump gene. What follows from this is: Is measured Bilirubin and alkaline phosphatase, not just the transaminases. What you can do: If yellow discoloration, dark urine or itching occurs, stop using immediately and seek medical advice. For TUDCA There is no controlled study on this clinical picture, and there is another caveat with this substance: If bile acid production has increased, it is not immediately plausible to add additional bile acid. The only measure with proven effectiveness is discontinuation.
Your own axis
What happens: An supplied androgen drives the HPTA axis down, LH and FSH fall. Since Epistane does not provide estradiol, androgen and estrogen are released at the same time, see Estrogen.
What it depends on: Of dose and duration. A measurement of LH, FSH and testosterone under Epistane could not be found; For this class of substances, the disorder can persist for months after discontinuation. What follows from this is: Lack of motivation, loss of libido and joint problems after discontinuation are the expected course. What you can do: Keep the application short and plan the exit. For the restart HCG and Clomiphene the established remedies, both requiring a prescription.
Blood lipids and blood pressure
What happens: Oral 17-alpha-alkylated steroids increase the breakdown of HDL particles in the liver; that HDL falls, LDL rises. For this class of substances, a review article names increased blood pressure and reduced HDL and its subfractions as the significant risk changes.
What it depends on: From the oral route and from the dose. There are no figures specifically for Epistane; the liver work did not take blood lipids as an end point. What follows from this is: Since no estradiol is produced, the proportion that has a beneficial effect on blood lipids in men is missing. What you can do: Lipid profile and blood pressure before the start and after four weeks, see Cardiovascular risks associated with AAS.
What's really in the can
What happens: Preparations of this type are manufactured without medical control. Studies found undeclared anabolic steroids in apparently hormone-free dietary supplements, and in the DILIN series, several preparations contained steroids that were not on the label.
What it depends on: From the manufacturer and the batch. What follows from this is: A substance that you do not know cannot be dosed, and an incident cannot be assigned afterwards. For tested athletes, an undeclared admixture can produce a positive sample without the user knowing about it. What you can do: Keep the package so that in the event of damage you can analyze what was inside later. A test before consumption is not available to the buyer.
Classification
Epistane is a substance whose harm side is better understood than the effect side, and the clarification is remarkable. Four people with long-term cholestasis, a multifold increased bile acid pool, and a mechanism that was traced down to the level of individual genes in human liver cells. However, there is no single measurement for the effect on strength or muscle mass.
The mechanism distinguishes this substance from other oral steroids. The focus here is on inhibiting the removal of bile salts, here the boosted production, triggered via the androgen receptor in the liver cell itself. The concentration required for this is very low, and the same work also explains why it doesn't affect everyone: the level of bile acid enzymes varies considerably between people.
Two attributions of trade do not hold up. The term “prohormone” is incorrect because the substance is the finished active ingredient. And the anti-estrogenic effect with which it was advertised could not be proven for itself; what is proven is the simple impossibility of flavoring, and that is something different.
What would decide the matter would be a measurement on the other side of the scale: strength and body composition under a usual dose over eight weeks, with liver values next to it. For a substance whose effect on the liver has been described down to the gene level and whose effect on muscles no one has measured, the benefits cannot be weighed against the harms because only one side has a number.
Sources
- Petrov PD et al. Epistane, an anabolic steroid used for recreational purposes, causes cholestasis with elevated levels of cholic acid conjugates, by upregulating bile acid synthesis (CYP8B1) and cross-talking with nuclear receptors in human hepatocytes. Arch Toxicol. 2020. PubMed
- Stolz A et al. Severe and protracted cholestasis in 44 young men taking bodybuilding supplements: assessment of genetic, clinical and chemical risk factors. Aliment Pharmacol Ther. 2019. PubMed
- Parr MK et al. Analytical strategies for the detection of non-labelled anabolic androgenic steroids in nutritional supplements. Food Addit Contam. 2004. PubMed
- Cavalcanti Gde A et al. Detection of designer steroid methylstenbolone in nutritional supplement using gas chromatography and tandem mass spectrometry: elucidation of its urinary metabolites. Steroids. 2013. PubMed
- Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004. PubMed
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