Anabolic Steroids, Liver Function and AST and ALT Blood Test

Q: “How do I evaluate the AST and ALT values of my blood test? I wanted to have before-cycle values, but waited till the last minute to order a test online. By the time I actually did the test, I was a week into my cycle. I’m using testosterone 500 mg/week plus Dianabol 50 mg/day and letrozole 1 mg/day. Already these values are very elevated. Could I have liver problems already from the Dianabol?”

A: AST and ALT values often provide false positives for diagnosing liver problems. By false positives, I mean that levels flagged as abnormally high often do not mean that a real problem exists. We need to look at other values to come to such a conclusion.

AST and ALT are enzymes found within many types of cells, including liver and muscle cells. Some amounts always exists in the blood. Even where individuals are healthy, the amounts found will vary. For either of these enzymes, 97.5% of healthy people will have an amount no greater than the top end of the reference range.

However, another 2.5% of healthy individuals will have no liver problem at all while having an amount exceeding the limit of the reference range.

This is simply how the reference range is defined. Rather than it defining healthy versus unhealthy, it’s purposely set such that 2.5% of healthy individuals will be outside the range. It will be up to the doctor or individual to decide whether a high value is a matter of concern. A high value is a flag that there could be an issue, rather than that there is an issue.

Cell damage can cause release of these enzymes, thus elevating blood levels. Liver damage is one possible cause of this. High levels could indicate liver damage.

Another possible cause is muscle damage, including the type of muscle damage commonly occurring in weight training. There are still further possible causes.

Problematically, weight training can elevate AST and ALT levels to many times the upper limit of the reference range. As your other values are good, it’s highly likely that your high values for AST and ALT are entirely from your exercise program and not at all from your current oral anabolic steroid usage.