Liver Tests AST and ALT and GGT Markers

How To Interpret Your Liver Function Tests ALT, AST, ALP.

Note: I am NOT your Dr….

Exercise, supplements, medications and drugs can all cause elevations of enzymes that are commonly included in liver function testing – alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP).

But how do you distinguish pathological elevations vs. those caused by intense exercise ?

ALT and AST are also known as aminotransferases or transaminases. They are considered good markers of liver inflammation that may impair its function. ALT is regarded as a reliable marker of liver damage or liver disease.

The name “liver function testing” is, however, somewhat of a misnomer; these tests are neither specific to the liver – the enzymes are also present in other tissues, e.g. AST is present in a far greater amounts in muscle than the liver – nor true measures of liver function.

Rather than assessing functions of the liver, the release of ALT and ALP (and AST to a much lesser extent) from liver cells to the bloodstream indicates liver cell damage or death, and/or blockage or damage in the biliary system if ALP and bilirubin are elevated).

As such the term “liver injury tests” would be more appropriate.

How high are elevations in ALT and AST are acceptable ?

Even though there is no universal agreement on what constitutes mild, moderate or marked aminotransferase elevation, a general clinical practice guideline is:

– Mild elevation = less than 5 times the upper reference limit.
– Moderate elevation = 5–10 times the upper reference limit.
– Marked elevation = over 10 times the upper reference limit.

Now, let’s compare this to commonly encountered elevations in aminotransferases – and other labs – caused by intense exercise…

Weightlifting results in profound increases in liver related parameters; these elevations can be prolonged, lasting for 1 week after performing an intense weightlifting workout.

Elevations in these enzymes are proportional to body weight, exercise type and exercise intensity. Anabolic steroid use will result in the highest enzyme levels, but steroid-free natural bodybuilders will also have significantly elevated levels of AST.

For drug-induced liver injury, the ALT cut off point of 5-fold over the upper end of the normal range (or 3-fold if total bilirubin exceeds its normal range by 2-fold).

The question becomes then how do you know if enzyme elevations are a harmless response to exercise, or an indication of liver damage ?

The simplest blood test that should be included when examining liver health in people engaging in regular intense resistance exercise is GGT (gamma-glutamyltranspeptidase).

The reason is that GGT distinguishes healthy people with resistance training induced elevations in ALT and AST from patients with hepatitis.

One notable study ( see ref below ) found that bodybuilders (both anabolic steroid non-users and users) both had a GGT level around 30 U/L (normal range for this assay; 8-78 U/L), while hepatitis patients had GGT levels of 212 U/L (i.e. a 2.7-fold elevation above the upper end of normal range).

This was confirmed in another study which showed that resistance exercise can cause highly pathological liver function tests in healthy men; while ALT, AST and CK were greatly elevated, GGT was not.

Therefore including GGT in blood testing for evaluation of liver status will help differentiation between transaminase elevations due to muscle damage vs. liver damage.

While GGT is a simple parameter to measure, it is not included in routine clinical lab panels, and thus has to be specifically requested.

Many doctors, don’t know that intense exercise can cause highly pathological liver function/disease lab tests, and they often refer a perfectly healthy person who happens to be exercising – whose lifestyle history has not been taken – to a liver disease specialist.

An interesting survey assessed whether primary care physicians accurately can distinguish between blood aminotransferase elevations caused by intense resistance training and indicating muscle damage vs. elevation caused by drug use.

Surveys were sent to physicians listed as practicing family medicine or sports medicine in the yellow pages of seven metropolitan areas. Blood test results showed elevated aspartate AST, ALT and CK, but normal GGT. It was found that 56 percent failed to mention muscle damage as a potential diagnosis, despite the markedly elevated CK level of the patient. 63 percent indicated liver disease as their primary diagnosis despite normal GGT levels.

When in doubt, make sure your doctor checks your GGT level together with the transaminases (ALT and AST) and ALP that you get from the standard Comprehensive Metabolic Panel. Because GGT is not included in routine clinical lab panels, you have to specifically request it.


Pettersson, J., et al., Muscular exercise can cause highly pathological liver function tests in healthy men. Br J Clin Pharmacol, 2008.

Dickerman, R.D., et al., Anabolic steroid-induced hepatotoxicity: is it overstated? Clin J Sport Med, 1999.

Bloodwork – increased White Blood Cell Count

Interpreting your Bloodwork – increased White Blood Cell Count

Things your Dr might not know about AAS use and Interpreting your Bloodwork – Item 2

” White blood cells, also called leukocytes, are cells that exist in the blood, the lymphatic system, and tissues and are an important part of the body’s infection defense system.

They help protect against infections and also have a role in inflammation, allergic responses, and protecting against cancer.

The white blood cell (WBC) count totals the number of white blood cells in a person’s sample of blood. It is one test among several that is included in a complete blood count (CBC), which is often used in the general evaluation of a person’s health.

When there is an infection or an inflammatory process somewhere in the body, the bone marrow produces more WBCs, releasing them into the blood, and through a complex process, they move to the site of infection or inflammation. As the condition resolves, the production of WBCs by the bone marrow subsides and the number of WBCs drops to normal levels again.

In addition to infections and inflammation, there are a number of conditions that can affect the production of WBCs by the bone marrow or the survival of WBCs in the blood, such as cancer or an immune disorder, resulting in either increased or decreased numbers of WBCs in the blood.

The WBC count, along with the other components of the CBC, alerts a health practitioner to possible health issues. Results are often interpreted in conjunction with additional tests such as a WBC differential and a blood smear review. A differential may inform the health practitioner as to which type of WBC may be low or high, and a blood smear can reveal the presence of abnormal and/or immature populations of WBCs. ”

However it’s important for AAS users to understand and to predict in some cases an increase in WBC from the administration of AAS even at relatively small dosages.

There are several factors at play here

1, Different Compounds seem to have a greater impact than others. This study shows the impact of Testosterone Enanthate at just 200mg a week.
2, The WBC response is ” dosage-dependent” – surprise, surprise
3, Multiple Injections per Week raises WBC
4, Quality of Product Issues from UGL ” contamination “

Takeaway here ?

IMO ” awareness” is the most important keypoint here.. you dont want to be ” chasing” the underlying cause of an increase in WBC if you know what its likely to be. That said clearly significantly elevated levels will warrant further consideration.