MESO-Rx
Anabolic Steroids
and are "at risk" for other causes of hepatic injury exclusive of AAS use
1) Since no single transaminase elevation has the required sensitivity or specificity to DIAGNOSE the cause of hepatic injury, appropriate testing almost always mandates the use of several assays in conjunction with someone capable answering the question; What are U looking for?
This includes an ability to define terms such as "long term" - "liver damage" since roughly 10% of biopsy confirmed patients with Chronic Hep C or non-alcohol related fatty liver disease have NORMAL transaminase levels.
Consequently some hepatologists use GGT levels to help confirm ETOH (and a few other drugs) as the origin of hepatic cholestasis, but -- other transaminase ratios can provide similar information
2) Im unaware of this prognostic relationship bc it implies transaminase levels can be used to measure the degree of hepatic dysfunction, when hepatic enzyme changes are a better reflection of Hepatocyte integrity or the sludging of bile, as in cholestasis.
3) although useful when obtained in conjunction with other hepatic blood tests, selective testing such as a serum bilirubin lacks the degree of sensitivity or specificity ("accuracy" is the less precise collective lay term) to differentiate or diagnose the varied causes of hepatic injury.
So what LFTs should be obtained in those using AAS.
1) first understand the changes caused by AAS typically BEGIN to rise at around week FOUR
2) and tend to decline at around week SIX, providing the offending agent is discontinued
3 NO SINGLUAR TEST and I MEAN NONE provide the degree of accuracy required to diagnose AAS related hepatic injury
4) consequently several assays must be used IN CONJUNCTION with HISTORICAL factors to enhance the diagnostic accuracy.
5) obtaining "a bunch of tests" wo knowing how to interpret the results is usually an absolute waste of time and money --- so unless one has A LOT of both -- abnormalities require the assistance of a HCP IME.
And why is the latter generally a wise decision? Bc many cyclists have or have had a noteworthy lifestyle
6) So what assays do I find are most useful to SCREEN for the presence of AAS related hepatic changes in PATIENTS I KNOW!
- AST
- ALT
- Bilirubin
- ALP is added in those patients
with suspected EXTRA-hepatic cholestasis like gallstones and perhaps on occasion I'll add a GGT for those with suspected INTRA-hepatic cholestasis, drugs being the more likely etiology OR in those with "mixed" transaminase changes
Sorry about the prolonged post but I hope it will aid a few.
Jim
Damn Jim how about a summary of all that stuff dude.
OK
Useful tests for those who want to check their LIVER
1) AST
2) ALT (in general ALT elevations exceed that of AST when AAS are the cause)
3) Bilirubin
4) ALP ??? is the fourth assay included in many LFT screening "bundles" ----- but
Enzyme changes that exceed 3 X the upper limit of normal warrant discontinuation of the offending agent, ESPECIALLY if associated with an elevated bilirubin.
Other assays that may be useful include;
1) GGT
2) CPK
3) Alkaline Phosphatase (AKA - - - - -ALP)
GGT ---- is often elevated when drugs (ETOH and "hormones" in particular) are the suspected cause of an elevated ALT
CPK --- may also be elevated when exercise is the primary cause of enzyme elevations
however novice endurance enthusiasts who have limited access to WATER are MUCH more likely to develop CPK changes rather than BB !
ALP --- with a few exceptions changes in ALP suggest a NON-AAS etiology is the source of hepatic injury!
JIM
