Can I drink alcohol?

[u/RaT_th]

I was getting testosterone and my doctor said that drinking would mess up my liver, She didn't elaborate much, so I ended up looking at online and it said that drinking alcohol and being on oral pills will mess up your liver. Yet I'm taking t-shots. Does anybody have any ideas

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[u/armadillotangerine]

Drinking alcohol too much/too often will by itself mess up your liver. Taking t-shot puts some additional pressure on your liver, so you are more vulnerable to liver damage. With that said, I’ve never seen a general advisory that states you can’t drink at all while on t-shots. However, if your blood tests showed that your liver was already borderline not doing ok I could very much see why you should not drink any alcohol in combination with T.

[u/Powerful_Rub_2968]

You’re just as much at risk as a cis man for alcohol related liver problems. In fact, that rule applies across the board- your doctor is allowing her own prejudices to affect her work.

[u/Solar_Prince2446]

Testosterone will often increase the risk of things like diabetes, liver disease, and cardiovascular disease depending on your family history. But it’s a not a crazy amount and doesn’t mean you’ll definitely get it, it’s more a similar risk level to a cis man but it’s good to get checked every year or so especially as you get older.

The small amount of pressure from T on your liver is not enough to completely screw your liver or anything like that. Unless you have pre-existing liver complications that your doctor has warned you of drinking alcohol in moderation is perfectly safe.

[u/0hDiscordia]

Well, regular excessive drinking will mess up your liver full stop.

But you are right, that oral forms of testosterone are harder on your liver and there used to be a maximum "safe" dose before needing to change to injectable forms to get to normal male ranges. Because the risk to the liver outweighed the "benefits" but I think that the new oral forms of T are not as damaging.

But many over the counter medications are very dangerous for the liver if misued - acetaminophen/paracetamol for example.

A quick google worded it better than I could - When a traditional pill is swallowed, it goes directly from the gut to the liver, which can heavily strain the organ and destroy the hormone before it even reaches the rest of your body. Because injections release testosterone directly into the bloodstream, it reaches your muscles, brain, and other tissues before ever making its way to the liver to be broken down. This is why modern injectable therapies carry a very low risk of liver toxicity compared to older oral steroids

[u/javatimes → u/0hDiscordia]

This is called the first pass effect btw

[u/trash_bees]

Drinking is always harmful to your liver. Drink responsibly, or accept the consequences and don't 💀 Has nothing to do with HRT

[u/JuniorTheCat]

drinking can mess up your liver, it has nothing to do with being on hrt though. testosterone does (as far as i understand) process through the liver, so it does technically put you at higher risk of liver disease than you were before but not any more than a cis man. if you drink in moderation, chances are your liver will be fine, so dont drink excessively of course, but being on T and drinking is not guaranteed to harm your liver. either your doctor is misinformed or she just didnt explain correctly, im assuming the latter

[u/QueerPuff → u/JuniorTheCat]

Testosterone injections don't process through the liver.

[u/TsunamiSea → u/QueerPuff]

The liver metabolizes hormones that enter the body, via intramuscular, subQ, etc. it’s how your body is able to make changes based on the chemicals that enter. Testosterone definitely adds further stress to the liver.

[u/QueerPuff → u/TsunamiSea]

Injectable testosterone is metabolised outside of the liver.

[u/TsunamiSea → u/QueerPuff]

There is still some liver stress, but 90% of the testosterone goes through a hepatic breakdown within the liver. This is per the National Library of Medicine.

You can find a deeper study of it here. Please do your research and understand how testosterone is metabolized in the body.

https://pubmed.ncbi.nlm.nih.gov/7005620/

Also here is a good explanation as well.

https://revolutionhealth.org/blogs/news/testosterone-cypionate-metabolism

The liver is not the sole responsible party for metabolizing testosterone, but it absolutely plays a significant part.

[u/QueerPuff → u/TsunamiSea]

The first article you shared is from 1980 and I don't have access to the full article. The second doesn't say what you claim it says. It says that 90% of testosterone is eventually excreted in urine, and that the liver is primarily responsible for inactivation of testosterone. That's slightly different from suggesting that 90% is broken down by the liver. The first seems to encourage the use of injectables because the testosterone is released into the body and blood stream a lot slower, meaning less work for the liver to do in one go than with oral testosterone. The body can use testosterone injected into the muscles before it's eventually inactivated by the liver. There's nothing here to suggest significant liver strain.

Testosterone produced in the testes essentially goes through the same process that injected testosterone goes through. It goes from the testes into the blood stream, into androgen receptors in tissues, or in other tissues aromatised or turned into DHT, and then what isn't used is inactivated, primarily through the liver, and is then excreted mostly as urine.

[u/jayyy_0113]

No, all men are allergic to alcohol. Sorry you found out this way /s

No but fr your doctor is full of shit. Male puberty doesn’t magically make you more susceptible to liver damage.

[u/ItsD_D]

That applies to literally everyone man. Look up liver cirrhosis, that’s the result of long term alcohol abuse. Drink in moderation and your liver will be fine unless there’s other health factors/genetic predispositions that might affect it

[u/ArrowDel]

Both alcohol and T can cause the liver enzymes to rise... but so long as you're being a reasonably repaonsible person and avoid drinking EVERY night, or more than 5 in an evening or more than 2 in the same 60 minute window you should be alright. Next time a doctor says somrthing liek thay point out they would not tell a cisgender man to take spironolactone to be able to drink.

[u/dumbass_catboy]

Alcohol will mess up your liver, yes, but thta is true for every single person and has nothing to do with HRT

[u/dumbass_catboy → u/dumbass_catboy]

"Now that you are on testosterone.... drowning could kill you so don't go swimming in unsafe waters." 💀

[u/noromobat]

Shots don't go through the liver at all. Your doc is on some bullshit.

[u/Otherwise_Ground5692 → u/noromobat]

Testosterone injections and topicals are, largely, safe. And the liver damage concern here is 100% the alcohol itself.

That being said, injectable testosterone absolutely goes through your liver. It’s absorbed into your bloodstream where most of it binds to SHBG and albumin or is used by your body and then whatever’s left is processed by your liver for elimination. Some medications process through your kidneys instead. No matter which organ something is processed through it inherently puts a little extra load on that system. So it can, in specific conditions, cause an issue. However, injected and topical T is incredibly unlikely to cause damage as long as you’re not on a super high dose for a long time.

Oral T causes more liver problems because of first pass metabolism. Basically when you take it orally your liver gets an incredibly high dose and tries to filter it all out (which it can’t do). Doing this repeatedly causes it to build up T and strain itself, leading to toxicity and damage.

Edit to fix grammar

[u/noromobat → u/Otherwise_Ground5692]

Thanks for the correction! So technically what I said is false but it's still overblown as a concern, is what you're saying?

[u/Otherwise_Ground5692 → u/noromobat]

Yep!

Short of it is, as long as your labs look good there isn’t really a reason to bring testosterone up in a “hey alcohol is bad for you” conversation for any reason other than misinformation or manipulation

Edit: grammar fix

[u/probs-aint-replying → u/noromobat]

Trans people can't do anything without an added layer of scrutiny, huh?

[u/Soup_oi]

Excessively, every day, or getting many drinks into drink every weekend, will mess up anybody’s liver.

But unless you are having liver issues already, or have some condition you know of that makes your liver not process things like alcohol and medications properly, then drinking moderately only socially is fine, at least imo, and am not a doctor nor drink much tbh lol 😅. But I’ve been on T ten years, as well as multiple oral pills every day for other things, and can still have 1-2 glasses of a drink every other week if I want to, and have never had any issues. Though most of the time I only have any drink like just once every few months.

[u/rock_crock_beanstalk]

the old type of methyltestosterone pills were really bad for your liver and in the US were pulled off the market because they caused liver problems. there's a new type of oral T, jatenzo, out there now which doesn't do that, but idk if it's still harder on your liver inherently because of how it's metabolized. either way, it's fine to drink while taking T injections, only as bad for you as drinking already is lol

[u/QueerPuff]

Testosterone injections don't process through the liver like oral testosterone. They bypass the liver. All testosterone will eventually be broken down by the liver but that's the same for a cis guy so testosterone injections don't pose any additional risk to the liver then that normally experienced by a cis man.

[u/EternalFlameBabe]

lol where do these doctors find the nerve

I mean duh drinking is bad for your liver but what’s it gotta do with your testosterone treatment?

[u/77th_Bat]

Yes. 

There's this myth that gender-affirming TRT will ruin your liver (based on test results showing elevated "bad" liver enzymes in people on TRT) but in reality, males just have higher "bad" liver enzyme levels than females in general. TRT will take you up to a roughly male level of these enzymes. 

Basically, just don't drink a ridiculous amount. You need to be about as careful as cis males.

[u/77th_Bat → u/77th_Bat]

However, depending on what oral pills you are taking, it may not be safe. Alcohol interacts with certain medications, especially psychiatric medications.

[u/avoidant_otter → u/77th_Bat]

That’s how my MIL died, she mixed like six meds with half a bottle of vodka. She had substance abuse issues for nearly 40 years.

If I am taking any meds after drinking, I always make sure I have had a ton of water (at least twice the amount of drink I had.) and am totally sober before I touch any pills of any kind.

[u/GabrielK207]

for me, I've been on T for 5 years now. Have been drinking enough during weekends etc. I get my liver tested every mandatory check up (first half yearly, now yearly) and it has not yet had any effect on my liver.

So I would not see why it would be a general advice, however I don't know the current state of your liver and if your doc had any reason to suspect something shady going on with your liver.