Anabolic steroid-induced hepatotoxicity: is it overstated?

Area of Science:

• Sports Medicine
• Hepatology
• Biochemistry

Background:

• Anabolic steroid use is often linked to hepatic dysfunction, indicated by elevated serum aminotransferases (AST, ALT).
• Distinguishing steroid-induced hepatotoxicity from exercise-related changes in liver enzymes is clinically important for elite bodybuilders.

Purpose of the Study:

• To differentiate between serum aminotransferase elevations caused by intense resistance training and anabolic steroid-induced hepatotoxicity in elite bodybuilders.
• To evaluate the role of gamma-glutamyltranspeptidase (GGT) and creatine kinase (CK) in assessing liver health in steroid users.

Main Methods:

• A case-control study comparing serum chemistry profiles of anabolic steroid users (n=15) and non-users (n=10).
• Control groups included viral hepatitis patients (n=49) and medical students (n=592).
• Key enzymes analyzed were AST, ALT, GGT, and CK.

Main Results:

• Bodybuilders, both steroid users and non-users, showed elevated CK, AST, and ALT, with normal GGT levels.
• Patients with hepatitis exhibited elevated AST, ALT, and GGT.
• CK was elevated in all exercising groups, and a correlation between aminotransferases and GGT was only observed in hepatitis patients.

Conclusions:

• Previous reports of anabolic steroid-induced hepatotoxicity based solely on elevated aminotransferases may be overstated.
• GGT levels are essential for identifying true hepatic dysfunction, as elevated aminotransferases in bodybuilders may reflect muscle damage rather than liver injury.
• Comprehensive assessment of hepatic function in anabolic steroid users should include CK and GGT alongside AST and ALT.