Liver King TRT: What His Protocol Would Cost a Non-Celebrity

What Liver King Actually Admitted Taking

Brian Johnson publicly denied steroid use for years, framing his physique as the product of his "nine ancestral tenets." That narrative collapsed in November 2022 when fitness content creator Derek of More Plates More Dates published a leaked email allegedly written by Johnson to his coach.

The Leaked Email Breakdown

The email, which Johnson subsequently confirmed as authentic in a YouTube apology video posted November 2022, described a monthly PED expenditure of approximately $11,000. The substances listed included testosterone (injected), human growth hormone (somatropin), insulin, IGF-1 (insulin-like growth factor 1), the peptides BPC-157 and TB-500, and the selective androgen receptor modulator (SARM) RAD-140. Johnson also mentioned Winstrol (stanozolol) and Deca-Durabolin (nandrolone decanoate).

These are not substances a physician would prescribe together for a standard hypogonadal patient. Several of them, including RAD-140 and most SARMs, have no FDA-approved indication. IGF-1 for supraphysiologic use is not approved for healthy adults, and insulin carries serious hypoglycemia risk outside of diabetes management. The FDA has issued multiple warnings about SARMs sold as dietary supplements.

What Testosterone Specifically Was Involved

Johnson did not specify the exact testosterone ester in the leaked communication, but injectable testosterone (cypionate or enanthate) is the most common form used in both clinical TRT and illicit bodybuilding contexts. Supraphysiologic doses used by competitive or aesthetics-focused bodybuilders often exceed 500 to 1,000 mg per week. That compares to the standard FDA-approved therapeutic range of 100 to 200 mg per week of testosterone cypionate for men with confirmed hypogonadism. Testosterone cypionate injection is FDA-approved under NDA 085-548.

Does Liver King Take TRT? The Clinical and Legal Distinction

"TRT" stands for testosterone replacement therapy. Clinically, it describes testosterone prescribed to men whose bodies do not produce adequate testosterone on their own, a condition called hypogonadism. The Endocrine Society defines hypogonadism as two separate morning total testosterone measurements below 300 ng/dL combined with signs and symptoms such as reduced libido, fatigue, or loss of muscle mass. See the full 2018 Endocrine Society Clinical Practice Guideline on testosterone therapy.

What Johnson described in the leaked email goes well beyond replacement. Supraphysiologic testosterone use with stacked anabolic agents is pharmacologically distinct from medically supervised TRT. Calling it "TRT" is technically inaccurate, though the popular press often uses the term loosely.

Why the Distinction Matters for Patients

Men who pursue unsupervised high-dose testosterone face substantially different risk profiles than men on physician-monitored replacement doses. A 2023 meta-analysis published in JAMA covering 35 randomized controlled trials found that physiologic testosterone replacement in men with confirmed hypogonadism was not associated with increased major adverse cardiovascular events over trials up to 36 months. Lincoff et al., NEJM 2023 (TRAVERSE trial, N=5,246) found no statistically significant increase in MACE with testosterone therapy vs. Placebo in men with hypogonadism and elevated cardiovascular risk. Supraphysiologic use, by contrast, carries well-documented risks including erythrocytosis, dyslipidemia, left ventricular hypertrophy, and suppression of the hypothalamic-pituitary-gonadal axis. Baggish et al. (Circulation 2017) found that long-term anabolic-androgenic steroid use was associated with reduced left ventricular systolic function and coronary artery disease in a case-control study of 140 male weightlifters.

What HGH and the Other Agents Would Cost

Human Growth Hormone (Somatropin)

Brand-name recombinant human growth hormone, such as Genotropin, Norditropin, or Humatrope, costs between $500 and $2,000 per month out-of-pocket at physiologic replacement doses (0.2 to 1.0 mg/day). The bodybuilding doses described in Johnson's protocol (reports suggested 4 to 6 IU per day, well above replacement range) would push that cost to $2,000 or more per month. HGH is FDA-approved only for adult growth hormone deficiency diagnosed by stimulation testing, and for specific pediatric indications. FDA prescribing information for Norditropin does not include bodybuilding or anti-aging use.

Peptides: BPC-157 and TB-500

BPC-157 (body protective compound) and TB-500 (a synthetic fragment of thymosin beta-4) are research peptides with no FDA-approved human indication. They are not legal for sale as dietary supplements. The FDA classifies BPC-157 as a substance that has been withdrawn from the list of bulk drug substances that may be used in compounding. See the FDA's 2022 guidance on bulk drug substance nominations for compounding. Injectable research peptides sold online can run $50 to $200 per vial. Monthly costs at bodybuilding protocols easily reach $400 or more.

RAD-140 (Testolone) and SARMs

RAD-140 is a non-steroidal SARM that has completed only Phase 1 clinical testing as of early 2025. It carries no approved human indication. The FDA warned in 2017 that SARMs present serious safety concerns including liver toxicity, cardiovascular risk, and potential effects on the hypothalamic-pituitary axis. FDA 2017 safety warning on SARMs. A monthly supply of research-grade RAD-140 typically costs $60 to $150.

Insulin and IGF-1

Insulin is a legal prescription medication for diabetes. Off-label, non-diabetic use for anabolic purposes carries serious risk of fatal hypoglycemia. Deaths among bodybuilders have been attributed to insulin misuse. IGF-1 (mecasermin) is FDA-approved only for severe primary IGF-1 deficiency in children (brand name Increlex). Bodybuilding-grade recombinant IGF-1 purchased outside a pharmacy is unregulated. Monthly costs for illicit IGF-1 sourcing are estimated at $300 to $1,000 depending on dose.

What Legitimate TRT Would Cost a Non-Celebrity

A standard medically supervised TRT program for a man with confirmed hypogonadism is far simpler than the stack Johnson described, and far less expensive. Here is a realistic cost breakdown for 2025.

Diagnosis and Initial Labs

Before any testosterone is prescribed, a physician should order at minimum two fasting morning total testosterone levels (before 10 AM), plus LH, FSH, prolactin, complete blood count, comprehensive metabolic panel, and PSA for men over 40. Lab costs range from $100 to $400 out-of-pocket depending on whether insurance covers them. The Endocrine Society 2018 guideline states: "We recommend against making a diagnosis of androgen deficiency in men who have conditions or who use medications that can transiently suppress serum testosterone concentrations." This underscores that testing context matters as much as the number itself.

Monthly Medication Cost

Testosterone cypionate 200 mg/mL (10 mL vial) is a generic injectable available at most pharmacies. The cash price at GoodRx pricing is approximately $30 to $80 per 10 mL vial, which at 100 mg per week represents a two to five month supply. Testosterone gel (AndroGel 1.62%) runs higher, often $200 to $400 per month without insurance. Subcutaneous testosterone pellets (Testopel) cost $500 to $1,500 per insertion, with insertions every three to six months.

Telehealth-based TRT programs, which include provider visits and prescription coordination, typically bundle costs at $150 to $300 per month all-in for injectable testosterone. Some programs charge $99 per month.

Monitoring Costs

Men on TRT require periodic lab monitoring: total testosterone, hematocrit, PSA, and metabolic panels. The Endocrine Society recommends checking testosterone levels three to six months after initiation, then annually once stable. Hematocrit should be monitored because testosterone increases red blood cell production, and a hematocrit above 54% is a threshold for dose reduction or temporary cessation per standard clinical practice. Mulhall et al., J Urology 2018, provides evaluation and management framework for testosterone deficiency. Annual monitoring labs cost roughly $150 to $300 out-of-pocket.

Total Annual Cost Comparison

A non-celebrity male patient on a medically supervised injectable testosterone program should expect to pay roughly $1,500 to $4,500 per year total, inclusive of labs, provider fees, and medication. Johnson's admitted protocol, at $11,000 per month, equals approximately $132,000 annually. The difference is not just financial. The clinical risk profile of a supervised 100 mg/week testosterone program and an $11,000/month polysubstance stack are not remotely comparable.

The Physiology Behind Why His Physique Required More Than TRT

Testosterone's Ceiling at Physiologic Doses

Testosterone replacement to eugonadal levels (typically 400 to 700 ng/dL total testosterone) produces measurable improvements in lean mass, strength, and bone density in hypogonadal men. The TRAVERSE trial (N=5,246, published NEJM 2023) confirmed these benefits alongside a manageable safety profile at replacement doses. But at physiologic levels, testosterone alone does not produce the degree of muscularity and leanness Liver King displayed publicly, particularly at his reported body fat percentage of roughly 6 to 8 percent.

The Role of HGH in Body Composition

Growth hormone acts on adipose tissue lipolysis and on IGF-1 secretion from the liver, promoting both fat loss and lean mass accretion. Supraphysiologic GH use can reduce body fat to single-digit percentages while preserving or increasing muscle mass. A meta-analysis of growth hormone administration in healthy adults (Liu et al., Annals of Internal Medicine 2007) found that GH supplementation significantly decreased body fat (by approximately 2.2 kg) and increased lean body mass (by approximately 2.1 kg), but also increased soft-tissue edema and carpal tunnel syndrome. Liu et al., Ann Intern Med 2007. That analysis did not study the supraphysiologic doses described in the Johnson email.

Why the Full Stack Matters

The combination of testosterone, HGH, insulin, and IGF-1 creates overlapping anabolic signals that no single agent reproduces. Insulin drives nutrients into muscle cells post-workout. IGF-1 amplifies the anabolic response of both testosterone and GH. The result is a body composition that is physiologically unachievable through diet, training, or single-agent replacement therapy. Presenting that physique as the product of organ meat consumption and cold plunges was the central deception Johnson ultimately acknowledged.

How to Tell If You Actually Need TRT

Clinical Criteria

The Endocrine Society 2018 guideline recommends testosterone therapy only in men with both biochemical evidence of hypogonadism (two morning total testosterone levels below 300 ng/dL) and classic symptoms: decreased libido, erectile dysfunction, depressed mood, fatigue, or loss of body hair. Absent symptoms, a low testosterone number alone is generally not an indication for treatment.

What to Avoid

Men pursuing testosterone based on physique goals rather than hypogonadism should understand that unsupervised use suppresses the HPG axis. Exogenous testosterone signals the hypothalamus to reduce gonadotropin-releasing hormone, which reduces LH and FSH, which in turn shuts down endogenous testosterone production and often spermatogenesis. Recovery after extended supraphysiologic use may take 12 to 24 months and may be incomplete. Coward et al., J Urology 2013, documented prolonged hypogonadism lasting more than 12 months in 27% of men following anabolic steroid cessation.

The Right First Step

A single lab draw (total testosterone, free testosterone, LH, FSH, SHBG) ordered by a licensed provider, reviewed in the context of your symptoms, is how legitimate evaluation starts. That workup costs $100 to $250 at most and takes one to two business days.

HealthRX TRT Candidacy Decision Framework

The framework below summarizes how a HealthRX clinician evaluates a new patient inquiry for testosterone therapy. It is not a substitute for individualized medical assessment.

1. Symptom screening: Does the patient report two or more classic hypogonadal symptoms (low libido, fatigue, mood changes, reduced morning erections, decreased muscle mass)?
2. Initial lab draw: Two fasting morning total testosterone values obtained on separate days.
3. Threshold check: Both values below 300 ng/dL per Endocrine Society criteria? If yes, proceed to step 4.
4. Secondary hormone panel: LH, FSH, prolactin to distinguish primary from secondary hypogonadism. Elevated LH/FSH suggests testicular failure. Low or normal LH/FSH with low testosterone suggests pituitary or hypothalamic etiology.
5. Comorbidity screen: PSA (men over 40), hematocrit, liver function, lipid panel, sleep apnea screening.
6. Shared decision-making: Review fertility implications (testosterone suppresses sperm production), cardiovascular risk, and monitoring schedule before prescribing.
7. Prescribe and monitor: Start at 100 mg testosterone cypionate weekly. Recheck total testosterone, hematocrit, and PSA at 12 weeks.

Men who do not meet biochemical criteria but present with fatigue and low libido may have other treatable causes: thyroid dysfunction, sleep apnea, depression, or nutritional deficiency. A complete workup, not a testosterone prescription, is the appropriate starting point.

At a standard dose of 100 mg testosterone cypionate per week, a non-celebrity male patient on a supervised HealthRX TRT program maintains total testosterone in the 500 to 700 ng/dL range in most cases. Hematocrit should be checked every six months for the first year, with a therapeutic phlebotomy threshold of 54%.