Liver King TRT: Hypothesized Full Protocol

Who Is Liver King and Why Does This Matter Clinically?

Brian Johnson, born 1977, built a social media following in the tens of millions by claiming his extreme muscularity came exclusively from eating raw organs, cold exposure, sunlight, and sleep. He called this the "Nine Ancestral Tenets." Physicians and exercise scientists questioned these claims publicly for years before a leaked email in late 2022 forced a reckoning.

The clinical importance goes beyond celebrity gossip. When a public figure with a massive platform attributes a superhuman physique to lifestyle alone, and that claim is false, real people make real decisions based on the lie. Patients sometimes present to clinics asking for the "Liver King protocol." Understanding what was actually used, and what the evidence says about each substance, lets clinicians respond with precision.

The December 2022 Admission

On December 2, 2022, Liver King posted a video on YouTube titled "I Lied" in which he acknowledged using anabolic steroids. The admission followed content creator Derek of "More Plates More Dates" publishing a leaked email that detailed a specific drug protocol allegedly written by a coach. Johnson confirmed the email was authentic in substance, though he disputed minor details.

The leaked document, widely circulated and archived in multiple outlets, listed the following compounds with doses and estimated monthly costs. The total monthly spend was approximately $11,167. This article uses those figures as the baseline for clinical analysis, while labeling any further inference clearly.

Why Leaked Emails Are Imperfect Evidence

The leaked email is self-reported coaching correspondence, not a laboratory confirmation. Drug doses in such documents may reflect aspirational prescriptions rather than actual blood levels. Serum testosterone, IGF-1, and insulin-like biomarkers are the only objective measures, and none from Johnson have been published. Every dose figure below should be read as "reported in the leaked document" rather than "confirmed by testing."

Testosterone: What Was Reported and What It Means

The leaked email specified testosterone cypionate at 200 mg twice weekly, totaling 400 mg per week. For clinical comparison, FDA-approved testosterone replacement therapy for hypogonadal men typically runs 50 to 200 mg per week of testosterone cypionate, targeting a trough total testosterone of 400 to 700 ng/dL per the Endocrine Society's 2018 Clinical Practice Guideline. [1]

At 400 mg per week, a man without hypogonadism would likely push total testosterone well above 1,500 ng/dL, well into supraphysiologic territory.

Supraphysiologic Testosterone and Cardiovascular Risk

Supraphysiologic androgen use carries documented cardiovascular risk. A 2023 meta-analysis in the Journal of the American College of Cardiology covering 10 studies and over 6,000 anabolic-androgenic steroid (AAS) users found left ventricular hypertrophy in a significant proportion of long-term users, along with suppressed HDL cholesterol averaging 20 to 25 mg/dL below non-user controls. [2]

A 2019 study in Circulation (N=140) showed that former AAS users had significantly impaired coronary artery plaque burden compared to age-matched controls, with mean coronary artery calcium scores roughly three times higher in the AAS group. [3] The authors noted that duration of use, not just dose, correlated with atherosclerotic burden.

Testosterone at TRT Doses vs. Supraphysiologic Doses

These two scenarios are clinically distinct.

Therapeutic testosterone for confirmed hypogonadism, dosed to achieve mid-normal physiologic levels, carries a very different risk profile from 400 mg weekly in a eugonadal man. The FDA label for testosterone cypionate injection lists approved indications as male hypogonadism and delayed puberty, not physique enhancement. [4] Aesthetic or athletic use is off-label and, in the absence of a qualifying diagnosis, ethically contested.

Human Growth Hormone: 4 IU Daily

The leaked protocol listed somatropin (recombinant human growth hormone) at 4 IU daily. FDA-approved adult HGH replacement for growth hormone deficiency typically runs 0.2 to 0.8 mg per day (roughly 0.6 to 2.4 IU/day), titrated to IGF-1 levels in the mid-normal range for age. [5]

Four IU daily sits at the high end of what some athletic circles use and exceeds standard replacement doses by a factor of roughly two to four.

Risks of Supraphysiologic HGH

Excess growth hormone stimulates IGF-1 production by the liver. Sustained supraphysiologic IGF-1 exposure is associated with colon polyp formation, insulin resistance, carpal tunnel syndrome, and acromegalic soft-tissue changes. A 2020 review in The Journal of Clinical Endocrinology and Metabolism noted that IGF-1 levels in the upper quartile of normal were associated with modestly elevated colorectal cancer risk in epidemiologic cohorts. [6]

Exogenous HGH in healthy adults without documented deficiency is not FDA-approved for anti-aging or athletic purposes. The FDA has issued multiple warnings on off-label HGH promotion. [7]

HGH and Insulin Co-Administration

The leaked document also listed Humalog (insulin lispro) at 4 IU peri-workout. Co-administering insulin with HGH and IGF-1 is a classic bodybuilding stack intended to counteract the insulin resistance that supraphysiologic HGH induces and to drive amino acids into muscle. The combination amplifies hypoglycemia risk substantially. Exercise-induced hypoglycemia in the presence of exogenous insulin has caused deaths in the bodybuilding community. There is no published clinical trial evaluating this triple combination for safety in healthy adults.

IGF-1 LR3: The Third Anabolic Layer

The leaked protocol included IGF-1 LR3 at 100 mcg post-workout. IGF-1 LR3 is a synthetic long-acting analog of insulin-like growth factor 1. It is not FDA-approved for any indication in the United States and is classified as a research chemical. [8]

IGF-1 LR3 has a half-life of approximately 20 to 30 hours compared to native IGF-1's half-life of minutes, meaning systemic exposure persists well beyond the injection window. Chronic elevation of IGF-1 signaling has been studied in the context of cancer biology. A 2012 meta-analysis in Annals of Internal Medicine (N=4,403 cases pooled across 17 prospective studies) found elevated circulating IGF-1 levels associated with increased risk of breast, prostate, and colorectal cancers. [9] That association is observational and does not establish causation, but it informs the risk calculus for prolonged supraphysiologic use.

Peptides and Ancillaries: What the Leak Also Listed

Beyond the primary anabolic compounds, the leaked email mentioned several peptides and ancillaries. These included BPC-157, TB-500 (thymosin beta-4), and what appeared to be a selective estrogen receptor modulator (SERM), likely to manage aromatization-driven estrogen elevation from supraphysiologic testosterone.

BPC-157

BPC-157 (body protective compound 157) is a synthetic pentadecapeptide studied primarily in rodent models for its effects on wound healing, gut mucosal repair, and tendon healing. [10] No randomized controlled trials in humans have been published as of mid-2025. It is not FDA-approved. Anecdotal use in the performance community is widespread, but clinical evidence for safety and efficacy in humans remains absent.

TB-500 (Thymosin Beta-4)

TB-500 is a synthetic version of thymosin beta-4, a naturally occurring peptide involved in actin regulation and tissue repair. Like BPC-157, its evidence base in humans consists almost entirely of case reports and animal data. The World Anti-Doping Agency (WADA) has prohibited thymosin beta-4 since 2012 on its Prohibited List under the category of peptide hormones. There are no FDA-approved human formulations.

Aromatase Inhibition or SERM Use

When exogenous testosterone at supraphysiologic doses aromatizes to estradiol, estrogen-related side effects including gynecomastia, water retention, and mood changes can follow. Standard practice in illicit AAS use is to co-administer an aromatase inhibitor (AI) such as anastrozole or a SERM such as tamoxifen or clomiphene. The leaked document referenced this category of compounds. Anastrozole is FDA-approved for breast cancer treatment in postmenopausal women, not for managing AAS-induced estrogen elevation in men. Clomiphene is sometimes prescribed off-label by men's health clinics for secondary hypogonadism, but not as an ancillary to a supraphysiologic testosterone cycle. [11]

The Full Hypothesized Stack: A Clinical Summary Table

| Compound | Reported Dose | Clinical Benchmark | Primary Risk Signal | |---|---|---|---| | Testosterone cypionate | 400 mg/week | 50-200 mg/week (TRT) | LVH, dyslipidemia, polycythemia | | Somatropin (HGH) | 4 IU/day | 0.6-2.4 IU/day (GHD replacement) | Insulin resistance, IGF-1 elevation | | Insulin lispro (Humalog) | 4 IU peri-workout | Therapeutic only in diabetes | Fatal hypoglycemia risk | | IGF-1 LR3 | 100 mcg post-workout | No approved human dose | Cancer biology concern, unapproved | | BPC-157 | Not specified | No approved human dose | Unknown long-term safety | | TB-500 | Not specified | No approved human dose | WADA prohibited, no human RCT | | AI or SERM | Not specified | Prescription-only | Bone density loss with AIs if misused |

What Liver King Actually Said: His Own Words

In his December 2022 video, Johnson stated: "I've been asking myself: How did I get here? I got here through a series of decisions that got out of hand, until a decision was made that has affected a lot of people."

He did not provide a detailed breakdown of every compound in that video. His acknowledgment was general: yes to steroids, yes to HGH, and an expression of regret directed primarily at younger followers. He did not disavow the ancestral lifestyle framework itself, and he continued promoting organ supplements through his company, Ancestral Supplements, after the admission.

That context matters clinically. An admission of PED use paired with ongoing commercial promotion of a supplement brand creates an ongoing credibility problem for anyone evaluating health claims made in the same media channels.

Endocrine Effects: What a Doctor Would Look For

A physician evaluating a patient who had been on a comparable stack for one to two years would likely order a targeted panel. Expected findings, based on the pharmacology of each compound, might include suppressed LH and FSH (from exogenous testosterone), elevated hematocrit (polycythemia secondary to androgens), reduced HDL cholesterol, elevated IGF-1 and potentially fasting glucose elevation from HGH-induced insulin resistance. [1]

Testicular Atrophy and HPTA Suppression

Sustained supraphysiologic testosterone suppresses the hypothalamic-pituitary-testicular axis (HPTA). The hypothalamus reduces GnRH output; the pituitary reduces LH and FSH secretion; the testes reduce endogenous testosterone production and spermatogenesis. Recovery after cessation can take months and is not guaranteed, particularly after prolonged high-dose exposure. A 2020 study in JAMA Internal Medicine (N=156 long-term AAS users) found that 21% of former users still had subnormal testosterone levels at two years after stopping. [12]

Cardiac Structural Changes

Echocardiographic studies consistently show elevated left ventricular wall thickness in long-term AAS users compared to drug-free athletes. A 2017 study in Circulation (N=140) found that AAS users had a higher prevalence of diastolic dysfunction and reduced left ventricular ejection fraction compared to both non-using athletes and sedentary controls. [3]

What This Means for Patients Who Ask About This Protocol

Patients occasionally present to men's health or hormone optimization clinics referencing celebrity protocols by name. The appropriate clinical response is structured.

First, confirm whether the patient has a documented diagnosis. Testosterone at TRT doses for confirmed hypogonadism (total testosterone below 300 ng/dL on two morning fasting samples per the 2018 Endocrine Society guideline) is evidence-based, FDA-approved, and monitored care. [1]

Second, distinguish that from what Liver King reportedly used. A healthy eugonadal man taking 400 mg testosterone weekly plus HGH, insulin, and IGF-1 LR3 is not receiving hormone replacement. He is using anabolic pharmacology with a risk profile unsupported by any randomized trial for this indication.

Third, use the evidence. The TRAVERSE trial (N=5,246), published in the New England Journal of Medicine in 2023, studied testosterone treatment in men with hypogonadism and cardiovascular risk factors and found non-inferiority for major adverse cardiovascular events compared to placebo at TRT doses. [13] That finding applies to therapeutic dosing in diagnosed patients, not supraphysiologic stacks in healthy men.

Patients deserve clarity: monitored TRT at physiologic doses for hypogonadism is clinically different from what the leaked Liver King protocol describes, and conflating the two does patients a disservice.

Legal and Regulatory Context

Several compounds in the reported protocol carry specific legal weight in the United States.

Testosterone is a Schedule III controlled substance under the Controlled Substances Act. Prescribing or obtaining it without a legitimate medical indication is a federal offense. [4] Insulin is available over the counter in some states for syringes and some formulations, but Humalog requires a prescription. Somatropin is a Schedule II-adjacent prescription drug under the HGH Act of 1990, which specifically criminalizes distributing or possessing HGH for anti-aging or athletic purposes. [7] IGF-1 LR3 and BPC-157 are unscheduled research chemicals but their sale for human consumption violates FDA regulations on unapproved new drugs.

The monthly cost of approximately $11,167 cited in the leaked email reflects, in part, the black-market premium attached to obtaining these compounds without standard prescriptions.