Liver King TRT and the Ethics of Celebrity Prescription Disclosure

What Liver King Actually Admitted to Taking

Brian Johnson admitted in a December 2022 YouTube video that he had been using anabolic steroids and human growth hormone, directly contradicting years of public statements attributing his physique to raw organ meat, sunlight, sleep, and cold exposure. The admission followed a leaked email, reported by More Plates More Dates, detailing a monthly PED budget of approximately $11,000.

The Leaked Email: What Was Listed

The leaked document, attributed to Johnson and shared publicly in late 2022, described a stack that included testosterone, insulin-like growth factor-1 (IGF-1), HGH, and additional compounds. Johnson did not dispute the email's authenticity in his video confession. Specific doses were listed in the original leak but were not confirmed by Johnson in his public statement, so they are treated here as unverified and are not reproduced.

Why HGH Is Not Legal for This Purpose

The FDA prohibits the distribution or possession of HGH for any use not specifically authorized under 21 U.S.C. § 333(e) [1]. Approved indications for somatropin (recombinant HGH) include adult growth hormone deficiency, short stature secondary to Turner syndrome, and Prader-Willi syndrome, among others listed in prescribing information for products such as Genotropin and Norditropin [2]. Bodybuilding and physique enhancement are not approved indications. A physician who prescribes HGH for appearance or athletic performance may face DEA and FDA enforcement action.

Testosterone: Prescription vs. Illicit Use

Testosterone replacement therapy (TRT) is an FDA-approved treatment for hypogonadism, defined clinically as a total serum testosterone below 300 ng/dL on two morning measurements with associated symptoms [3]. The Endocrine Society's 2018 Clinical Practice Guideline on male hypogonadism specifies that TRT should not be offered to men who do not have confirmed biochemical deficiency [4]. Supraphysiologic testosterone dosing for physique goals falls outside any approved labeling and carries risks including erythrocytosis, dyslipidemia, and HPG axis suppression that may be prolonged or permanent.

The Timeline of Public Deception

Johnson built a following estimated at several million across social media platforms by presenting himself as proof that ancestral living, specifically consuming raw liver and other organ meats, could produce elite muscularity without drugs. That narrative was commercially monetized through supplement sales, branded products, and paid appearances.

2021 to Late 2022: The "Ancestral" Brand

Between early 2021 and November 2022, Johnson made repeated direct statements across podcast appearances and Instagram posts denying drug use. These statements were not ambiguous. He told interviewers that his physique was "100% ancestral," and he positioned the denial as part of his brand's value proposition.

December 2022: Admission and Lawsuit Context

In December 2022, Johnson posted a multi-minute video apology on YouTube acknowledging PED use. A civil lawsuit filed by consumers who purchased his supplements citing false advertising preceded or coincided with the admission, depending on jurisdiction and filing date. The lawsuit alleged that the "ancestral" marketing was materially deceptive because the advertised results were not achievable through the promoted methods alone.

The Settlement and Ongoing Brand Activity

Johnson continued operating his supplement brand after the admission. No criminal charges related to personal PED use were publicly confirmed as of the date of this article's review. The civil matter proceeded through settlement discussions. Johnson's case became a widely cited example in discussions of FTC endorsement guidelines and dietary supplement advertising law.

Clinical Consequences for Followers Who Tried to Replicate His Regimen

The public-health dimension of this case extends beyond one individual's drug use. Followers who believed the "ancestral" claims and attempted to replicate Johnson's diet and training without the undisclosed pharmacological support faced a specific and predictable set of harms.

Unrealistic Expectations and Delayed Medical Care

Men who fail to achieve the physique presented as drug-free by a celebrity figure may attribute their results to personal inadequacy rather than the actual pharmacological gap. Research on body image and social media suggests that unrealistic physique comparisons contribute to exercise dependence and disordered eating patterns [5]. When the comparison point is secretly pharmacologically enhanced, the gap is not closeable through lifestyle alone, yet followers may increase training volume, restrict calories further, or purchase additional supplements in pursuit of a result that is pharmacologically gatekept.

Testosterone Suppression From Self-Administered Androgens

Some followers, having seen Johnson's physique and believing it required only lifestyle modification, may have pursued self-administered androgens obtained without a prescription. Exogenous androgen administration suppresses endogenous luteinizing hormone (LH) and follicle-stimulating hormone (FSH) via negative feedback on the hypothalamus and pituitary [6]. The degree and duration of suppression are dose-dependent and compound-dependent. A 2020 paper in the Journal of Clinical Endocrinology and Metabolism found that recovery of the HPG axis after cessation of supraphysiologic testosterone use required a median of 3.6 months but extended beyond 12 months in a subset of men [7].

Raw Organ Meat: Separate Risks

Johnson also promoted consumption of raw liver, raw testicle, and other uncooked organ meats. The CDC notes that raw or undercooked meat carries documented risk of Salmonella, E. Coli O157:H7, and Campylobacter infection [8]. Liver consumed in very high quantities also poses a risk of hypervitaminosis A, given the liver's role as the primary storage site for retinol. These dietary recommendations, while separate from his PED use, were part of the same commercially presented package.

Ethics of Celebrity Health Disclosure: A Clinical Framework

The Liver King case illustrates a gap between what existing law requires and what clinical ethics would demand of a person with millions of health-influencing followers. Below is a structured framework that the HealthRX medical team uses to evaluate celebrity health claims for clinical credibility.

Tier 1: What Is Legally Required

Under FTC guidelines, material connections between an endorser and a brand must be disclosed [9]. If a celebrity is paid to promote a supplement, that relationship must be clear. However, the FTC does not currently require a celebrity to disclose their personal drug regimen unless the regimen is directly presented as the mechanism behind a product's claimed benefit. Johnson's case occupied a grey area: his body was the product's testimonial, yet no law explicitly required him to disclose HGH use as part of supplement advertising.

Tier 2: What Clinical Ethics Would Require

The American College of Physicians Ethics Manual states that physicians have an obligation to provide accurate information and to avoid misrepresenting treatment outcomes [10]. While Johnson is not a physician, the principle applies by analogy to any person presenting medical or physiological claims to a large audience in a clinical or quasi-clinical context. A clinically ethical standard for celebrity health influencers would require:

• Disclosure of any pharmaceutical or supraphysiologic hormonal agent that materially contributes to the displayed or claimed outcome.
• Clear separation between lifestyle recommendations and pharmacological contributions to those outcomes.
• Avoidance of before-and-after comparisons where the "after" state was achieved with undisclosed pharmacological assistance.

Tier 3: Regulatory Proposals Under Discussion

As of 2024, the FTC has expanded scrutiny of endorsement disclosures in health and wellness categories. The revised Endorsement Guides (16 CFR Part 255), updated in 2023, require that testimonials reflect typical results and that atypical results be clearly labeled [9]. The Liver King case is a useful illustration of why physique testimonials, when the presenter is the influencer, may be harder to regulate than a traditional paid endorsement.

What TRT Actually Does and Does Not Do

Separating the Liver King controversy from the legitimate clinical use of testosterone therapy is necessary. TRT, when appropriately prescribed and monitored, addresses a real medical condition.

Approved Indications and Expected Outcomes

The Endocrine Society guideline recommends TRT for men with classic androgen deficiency presenting with low testosterone plus symptoms including decreased libido, reduced muscle mass, fatigue, and depressed mood [4]. A 2016 placebo-controlled trial, the Testosterone Trials (TTrials, N=788), found that testosterone treatment in men 65 and older with low testosterone improved sexual function (P<0.001) and modestly increased bone density but did not significantly improve physical function at 12 months [11].

What TRT Does Not Produce

Supraphysiologic physique changes of the scale Johnson displayed require supraphysiologic androgen doses, typically combined with other anabolic agents. A 2013 NEJM study by Bhasin et al. Demonstrated a clear dose-response relationship between testosterone dose and lean mass accrual in healthy men, with the largest gains (approximately 6.1 kg of lean mass) occurring at doses well above the replacement range (600 mg/week of testosterone enanthate) over 20 weeks [12]. Standard TRT targets a total testosterone of 400 to 700 ng/dL. The physique Johnson displayed is not achievable at replacement doses alone.

Monitoring Requirements for Legitimate TRT

Patients on TRT require regular monitoring of hematocrit (target below 54%), PSA, lipid panel, and testosterone levels. The Endocrine Society recommends follow-up at 3 to 6 months after initiation, then annually [4]. These monitoring requirements exist because supraphysiologic levels, erythrocytosis, and changes in lipid profiles carry cardiovascular risk. A 2023 randomized trial, TRAVERSE (N=5,246), found that testosterone therapy in middle-aged and older men with hypogonadism and cardiovascular risk factors did not increase major adverse cardiovascular events compared to placebo over a mean follow-up of 33 months, though the confidence interval for cardiovascular events was wide [13].

Why This Case Matters for Patients Considering TRT

Men researching TRT online are likely to encounter content featuring physiques that were not achieved through TRT alone. Distinguishing medically supervised testosterone replacement from illicit supraphysiologic androgen use is a clinical necessity.

Questions a Clinician Should Ask Before Prescribing

Before initiating TRT, a physician should confirm:

1. Two morning total testosterone measurements below 300 ng/dL.
2. Symptoms consistent with hypogonadism.
3. Secondary causes of low testosterone ruled out (e.g., hyperprolactinemia, hemochromatosis, pituitary adenoma).
4. PSA and digital rectal exam to rule out prostate pathology.
5. Hematocrit below 50% at baseline.

The Endocrine Society guideline specifies that TRT should not be initiated in men who want to preserve fertility, given the suppression of FSH and spermatogenesis [4]. This is a point frequently omitted in celebrity-adjacent TRT promotion.

Red Flags in Direct-to-Consumer TRT Advertising

Direct-to-consumer TRT telehealth platforms that advertise physique outcomes rather than symptom resolution, or that show before-and-after images without disclosing concurrent diet, training, and pharmacological regimen details, apply the same misleading framework Johnson used, even if they stop short of outright denial. Patients should ask any prescribing clinician to document their baseline testosterone level, their target range, and the specific monitoring schedule before initiating therapy.

What Liver King's Case Revealed About the PED Information Environment

Johnson was not operating in a vacuum. The broader fitness influencer system has a well-documented pattern of PED use denial, colloquially termed "natty fraud." What distinguished Johnson's case was the scale of the commercial operation built on the denial, the specific targeting of a wellness-oriented audience less familiar with PED culture, and the velocity of follower growth tied to an explicitly anti-pharmaceutical identity.

The Natty Fraud Problem in Fitness Media

Surveys of gym-using populations suggest PED use is substantially more common than publicly acknowledged. A 2014 paper in PLOS ONE estimated that 3.3% of the global population and up to 6.4% of male gym users have used anabolic-androgenic steroids, with use concentrated in fitness-oriented demographics [14]. The gap between public prevalence acknowledgment and actual use creates a systematic misinformation environment in which drug-free claims are difficult to refute without direct admission or analytical testing.

Social Media Amplification

Platforms including Instagram and YouTube use engagement-optimized algorithms that reward extraordinary physical transformation content. A body that is pharmacologically unachievable through disclosed means receives algorithmic promotion equivalent to one that is achievable. The algorithm does not penalize for undisclosed PED use. This structural feature means the Liver King case will have successors unless platform-level or regulatory-level disclosure requirements change.

What Physicians Can Do in Clinical Practice

Clinicians can address the celebrity PED misinformation environment directly in patient encounters. When a male patient presents requesting TRT while citing a fitness influencer's physique as a reference point, the physician should:

• Ask specifically which influencer the patient is referencing.
• Explain that influencer physiques in that category frequently involve undisclosed pharmacological assistance.
• Provide the patient's actual testosterone value and explain what TRT can realistically produce at replacement doses.
• Document the conversation.

The American Urological Association's 2018 guideline on testosterone deficiency recommends shared decision-making that includes realistic outcome expectations as a core component of the consent process [15].

Direct Quotations and Named Positions

The FTC's 2023 revised Endorsement Guides state: "An endorsement must reflect the honest opinion of the endorser and can be used to convey only what the endorser actually believes." [9] This standard, applied to Johnson's statements about his drug-free physique during 2021 and 2022, would represent a clear violation of the guideline's intent, even if enforcement against individual fitness influencers has been limited in practice.

The Endocrine Society's 2018 Clinical Practice Guideline on male hypogonadism states: "We recommend against making a diagnosis of androgen deficiency in men with conditions or on medications that affect SHBG or in men with acute illness." [4] This framing underscores that TRT is a condition-specific medical therapy, not a physique optimization tool.

Regulatory and Legal Accountability Gaps

The Liver King case exposed specific gaps in existing enforcement structures.

FTC Jurisdiction Over Physique Claims

The FTC can pursue enforcement when a false or misleading claim is tied to a product being sold. Johnson's supplements were sold with implicit physique testimonials. The connection between his body and his product was direct and commercial. Whether his physique itself constitutes a "testimonial" under 16 CFR Part 255 is a legal question the civil litigation addressed, though settlement terms were not fully public at the time of this review.

DEA Scheduling of Anabolic Steroids

Anabolic-androgenic steroids are Schedule III controlled substances under the Controlled Substances Act [16]. Unauthorized distribution carries felony penalties. Personal possession for non-medical use is a federal misdemeanor. Johnson's admission did not result in confirmed federal charges as of this article's review date, illustrating that enforcement against high-profile personal users is rare even when public admission is explicit.

HGH-Specific Federal Prohibition

As noted above, 21 U.S.C. § 333(e) makes it a federal offense to distribute or possess HGH "for any use in humans other than the treatment of a disease or other recognized medical condition." [1] This is a strict-liability statute with no intent requirement for distribution. The admitted use Johnson described, physique enhancement, falls clearly outside approved indications.