AB - Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced, or indeterminate ALF, and whether this benefit varies according to the severity of illness. We conducted a retrospective analysis of autoimmune, indeterminate, and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998-2007. The primary endpoints were overall and spontaneous survival (SS, survival without transplant). In all, 361 ALF patients were studied, 66 with autoimmune (25 steroids, 41 no steroids), 164 with indeterminate (21 steroids, 143 no steroids), and 131 with drug-induced (16 steroids, 115 no steroids) ALF. Steroid use was not associated with improved overall survival (61% versus 66%, P=), nor with improved survival in any diagnosis category. Steroid use was associated with diminished survival in certain subgroups of patients, including those with the highest quartile of the Model for Endstage Liver Disease (MELD) (>40, survival 30% versus 57%, P=). In multivariate analysis controlling for steroid use and diagnosis, age (odds ratio [OR] per decade), coma grade (OR grade 2, grade 3, grade 4), MELD (OR ), and pH< (OR ) were significantly associated with mortality. Although steroid use was associated with a marginal benefit in SS overall (35% versus 23%, P=), this benefit did not persistent in multivariate analysis; mechanical ventilation (OR ), MELD (OR ), and alanine aminotransferase () were the only significant predictors of SS. Conclusion: Corticosteroids did not improve overall survival or SS in drug-induced, indeterminate, or autoimmune ALF and were associated with lower survival in patients with the highest MELD scores.
Testosterone can be administered parenterally , but it has more irregular prolonged absorption time and greater activity in muscle in enanthate , undecanoate , or cypionate ester form. These derivatives are hydrolyzed to release free testosterone at the site of injection; absorption rate (and thus injection schedule) varies among different esters, but medical injections are normally done anywhere between semi-weekly to once every 12 weeks. A more frequent schedule may be desirable in order to maintain a more constant level of hormone in the system.  Injectable steroids are typically administered into the muscle, not into the vein, to avoid sudden changes in the amount of the drug in the bloodstream. In addition, because estered testosterone is dissolved in oil, intravenous injection has the potential to cause a dangerous embolism (clot) in the bloodstream.
The number of players who have admitted using steroids in a confidential survey conducted by the NCAA since the 1980s has dropped from percent in 1989 to percent in 2003.  During the 2003 season, there were over 7,000 drug tests, with just 77 turning up as positive test results.  Scukanec claims that methods were used to get around the drug testing, whether it be avoiding the tests by using the drugs during the off-season, or flushing the drugs out of your system. This was used with a liquid he referred to as the "pink."  He stated: