Liver King TRT: Common Misinformation About This Case Debunked

What Liver King Actually Admitted to Taking

Brian Johnson admitted, in a December 2, 2022 YouTube video viewed more than 10 million times, that he used anabolic steroids and human growth hormone. The admission came after fitness content creator Derek of More Plates More Dates published a leaked email that outlined a detailed PED protocol, reportedly costing $11,000 per month. Johnson stated: "I've been doing a lot of hard drugs. The worst of the worst. I've been doing anabolic steroids."

The Leaked Email Protocol

The leaked email, which Johnson did not deny, described a stack that included testosterone cypionate, insulin-like growth factor 1 (IGF-1), human growth hormone, BPC-157, and several other agents. None of these were prescribed for testosterone deficiency or any documented medical condition at the time. This matters because the phrase "Liver King TRT" that circulates online conflates two very different things: physician-supervised testosterone replacement therapy for hypogonadism versus supraphysiologic performance-enhancing drug use.

Testosterone replacement therapy is a clinical intervention. The Endocrine Society's 2018 guidelines define hypogonadism as a total testosterone level below 300 ng/dL combined with symptoms, and recommend starting doses of 75 to 100 mg testosterone enanthate or cypionate weekly to restore levels to the mid-normal physiologic range of 400 to 700 ng/dL. [1] Johnson's reported protocol used doses consistent with bodybuilding-level cycling, not physiologic replacement.

HGH: Not the Same as Prescribed GH Therapy

Human growth hormone appears in the leaked protocol as well. The FDA has approved recombinant human GH (somatropin) for adult growth hormone deficiency, short bowel syndrome, and HIV-associated wasting, among a short list of other conditions. [2] Use outside these indications is off-label at best and illegal for performance purposes under the Anabolic Steroid Control Act and related statutes. Johnson's admitted use was for physique, not a diagnosed deficiency.

The Core Misinformation Claims, Addressed One by One

Several myths spread from Johnson's case and continue to circulate on social media, fitness forums, and podcasts. Each one deserves a direct answer grounded in clinical evidence.

Myth 1: "Liver King Was Just on TRT Like Anyone Else"

This is wrong. TRT targets physiologic testosterone restoration, typically to a range of 400 to 700 ng/dL, using doses of 50 to 200 mg per week depending on preparation. [1] The leaked email described a supraphysiologic protocol with multiple additional agents including IGF-1 and HGH. No legitimate TRT protocol includes IGF-1 or growth hormone unless a separate, documented deficiency exists and the prescription comes from a licensed provider.

Conflating the two harms patients. Men who are genuinely hypogonadal and could benefit from TRT sometimes avoid it because they associate it with what Johnson did, which was not TRT. A 2019 analysis in the Journal of Clinical Endocrinology and Metabolism found that only about 2.1% of men aged 40 to 79 meet clinical criteria for androgen deficiency, yet stigma from celebrity scandals suppresses treatment-seeking. [3]

Myth 2: "You Can Build That Physique Naturally With the Right Diet"

Johnson's entire brand rested on the "ancestral tenets": sleep, sunlight, cold, movement, shield, bond, and eat (raw liver, raw organs, raw eggs). He marketed these as the explanation for his visible muscle mass and very low body fat. Endocrinologists and sports medicine physicians rejected this claim immediately on mechanistic grounds.

Skeletal muscle hypertrophy beyond genetic ceilings requires protein synthesis rates that are largely regulated by testosterone, insulin-like growth factor, and mechanical load. [4] Consuming raw organs adds dietary protein and some fat-soluble vitamins. It does not raise serum testosterone to the levels needed to produce the body composition Johnson displayed, which was an estimated sub-5% body fat with significant muscle mass at his age (47 at the time of the confession).

Myth 3: "HGH Is Just a Peptide, So It's Basically Safe and Legal"

This claim spread partly because Johnson's stack included peptides like BPC-157 alongside HGH. The terms "peptide" and "growth hormone" got blurred in social media coverage. GH is a 191-amino-acid peptide, technically, but that classification does not determine its legal status or safety profile.

Supraphysiologic GH use carries documented risks. A meta-analysis published in Annals of Internal Medicine found that GH administration in healthy adults produced modest increases in lean body mass but also increased rates of fluid retention, arthralgia, carpal tunnel syndrome, and glucose intolerance. [5] The FDA explicitly states that distributing HGH for anti-aging or athletic performance is illegal under 21 U.S.C. § 333(e). [2]

Myth 4: "His Confession Was Forced, So the Drug Use Might Not Have Been as Extensive as Described"

Some supporters argued the confession was coerced by the threat of litigation. The class-action lawsuit filed in Texas in 2023 alleged that Johnson and affiliated entities made fraudulent claims about the ancestral lifestyle producing his physique, harming consumers who purchased supplements based on those claims. Johnson's legal team's posture does not change the pharmacological reality: the leaked email exists, Johnson did not dispute its authenticity, and he confirmed drug use on camera.

Why This Case Matters for Patients Considering TRT or HGH

Johnson's case produced a fog of misinformation at exactly the moment when GLP-1 agonists, TRT, and peptide therapies were gaining mainstream awareness. Patients arriving at telehealth clinics in 2023 and 2024 frequently cited his case as a reason either to avoid or to pursue specific treatments, often based on incorrect premises.

The TRT Patient Who Avoids Treatment Due to Stigma

A man with a testosterone level of 220 ng/dL, fatigue, low libido, and loss of muscle mass has a documented clinical indication for TRT. The Endocrine Society guideline recommends offering testosterone therapy to men with classic hypogonadism symptoms and consistently low testosterone levels measured on two separate morning samples. [1] Conflating physician-prescribed physiologic TRT with Johnson's supraphysiologic PED use leads this patient to delay treatment unnecessarily.

The Fitness Consumer Who Believes PEDs Are Accessible and Low-Risk

Conversely, some consumers interpreted Johnson's admission as evidence that steroids and HGH are widely available, relatively benign, and responsible for all impressive physiques. This is equally false. Supraphysiologic testosterone use is associated with left ventricular hypertrophy, erythrocytosis, hepatotoxicity (particularly with 17-alpha alkylated oral androgens), dyslipidemia with suppression of HDL cholesterol, and suppression of the hypothalamic-pituitary-gonadal axis that may not fully recover after cessation. [6]

A 2017 study in Circulation (N=140) found that long-term anabolic androgenic steroid users had significantly lower systolic function and higher rates of coronary artery plaque compared to non-using athletes and sedentary controls. [7] The cardiovascular risk is real and dose-dependent.

Informed Consent Requires Accurate Baseline Information

When a new patient asks about TRT or peptide therapies after reading about Liver King online, a useful clinical framework separates the conversation into three categories. First: what is the patient's documented lab status (total testosterone, free testosterone, LH, FSH, SHBG, CBC, metabolic panel)? Second: what is the therapeutic goal, physiologic restoration or performance enhancement? Third: what does the evidence say about the specific agent at the proposed dose for the patient's indication? Johnson's case does not belong in any of these three clinical buckets because his use was undisclosed, unsupervised, and supraphysiologic.

The Legal and Regulatory Context

The class-action complaint alleged violations of consumer protection statutes, essentially arguing that Johnson sold supplements and lifestyle products by misrepresenting the source of his physique. This is not a minor branding dispute. The FTC has taken action against supplement companies for similar claims, and the FDA's guidance on structure-function claims prohibits implying a supplement can produce drug-like effects without drug-level evidence. [8]

Johnson's case also highlights a gap in influencer accountability. The FTC's endorsement guidelines require material disclosures about financial relationships and, arguably, about the role of undisclosed drug use when a person's physical appearance is the basis of the promotional claim. No formal FTC action had been announced against Johnson as of early 2025.

What the Science Says About Ancestral Eating and Testosterone

Johnson's dietary claims centered on organ meats, particularly liver, as testosterone-supporting foods. This is worth addressing on the clinical evidence, not just rhetorically.

Liver and Cholesterol Precursors

Beef liver contains cholesterol, which is the structural precursor to all steroid hormones including testosterone. A 3-ounce serving provides roughly 330 mg of dietary cholesterol. However, dietary cholesterol intake has minimal effect on serum testosterone in men with normal gonadal function. Testosterone synthesis is rate-limited by LH signaling at the Leydig cell, not by substrate availability in most healthy men. [4] Eating more liver does not meaningfully raise testosterone production in a person who is not deficient in cholesterol, zinc, or vitamin D.

Zinc and Vitamin D

Two nutrients in organ meats, zinc and vitamin D, do have modest evidence for supporting testosterone levels when a patient is deficient in them. A study published in Hormone and Metabolic Research found that zinc supplementation in zinc-deficient men raised testosterone from 8.3 ± 6.3 nmol/L to 16.0 ± 4.4 nmol/L over 6 months. [9] Correcting a deficiency is not the same as supraphysiologically boosting testosterone. Men with normal zinc and vitamin D levels do not see meaningful testosterone changes from increasing intake of either nutrient.

Sleep and Testosterone

Johnson's ancestral tenets did include sleep, which has legitimate support. A study published in JAMA (N=10) found that restricting sleep to 5 hours per night for 1 week reduced daytime testosterone levels by 10 to 15% in young healthy men. [10] Optimizing sleep is genuinely useful for supporting endogenous testosterone production. It does not produce the physique Johnson displayed.

Separating Evidence-Based TRT From the Liver King Narrative

Clinically supervised TRT is a different medical intervention from everything discussed in Johnson's leaked protocol. Several key distinctions apply.

Diagnosis Comes First

Legitimate TRT begins with confirmed hypogonadism on two morning blood draws, symptom assessment, and a review of secondary causes (e.g., pituitary adenoma, hemochromatosis, obesity-related suppression). The Endocrine Society states: "We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels." [1]

Dosing Targets Physiology, Not Performance

A starting dose of testosterone cypionate 100 mg intramuscularly every 7 days typically brings total testosterone to the 500 to 700 ng/dL range in a hypogonadal man. That is a physiologic level. It is not the supraphysiologic level associated with the cardiovascular and endocrine risks described above. Monitoring includes periodic CBC to track hematocrit, lipid panels, and PSA in men over 40.

Outcomes Are Modest and Specific

The TRAVERSE trial (N=5,204), published in the New England Journal of Medicine in 2023, found that TRT in men with hypogonadism and cardiovascular risk factors was non-inferior to placebo for major adverse cardiovascular events over a median follow-up of 33 months, clearing a major safety concern. [11] TRT produced statistically significant improvements in sexual function, bone density, and lean mass. It did not produce the extreme body composition associated with Johnson's physique.

A Note on Peptides in Johnson's Stack

BPC-157 appears in the leaked email. This is a synthetic pentadecapeptide derived from a protein found in gastric juice. It has shown tissue-protective effects in rodent studies of tendon and gut injury. [12] There are no completed Phase III clinical trials in humans. The FDA has not approved BPC-157 for any indication, and the agency issued a statement in 2022 noting that compounded BPC-157 and TB-500 raised significant safety concerns due to the absence of human clinical data. [8]

Calling BPC-157 a "peptide" and implying it is therefore safe or similar to TRT is a category error. Peptide is a structural description. It says nothing about a compound's regulatory status, safety data, or mechanism of action in humans.

Clinical Takeaways for Patients

Patients researching TRT or hormonal optimization after encountering Liver King content online should approach the topic with a few anchoring facts.

First, Johnson's physique required a supraphysiologic and multi-drug protocol, not ancestral eating. Second, physician-supervised TRT targets physiologic restoration, not bodybuilding-level performance. Third, HGH and IGF-1 carry distinct risk profiles that differ from those of testosterone. Fourth, the cardiovascular, endocrine, and hepatic risks of unsupervised steroid use are dose-dependent and well-documented in peer-reviewed literature.

Any patient interested in optimizing testosterone levels should begin with a fasting morning total testosterone draw, ideally before 10 a.m., combined with a free testosterone, SHBG, LH, FSH, prolactin, and metabolic panel. A result consistently below 300 ng/dL combined with symptoms warrants a conversation with a licensed provider, not a raw liver diet. [1]