Q & A: Steroids and the Liver
with Walter Jekot, M.D.
Dear Dr. Jekot, I'm receiving testosterone replacement therapy injections and my liver enzymes SGOT and SGPT are
high. My doctor says they're double the normal value, and if they get to triple we'll have to stop. Are they high because
my body is using more protein or because there is a toxicity? I thought that only the oral steroids like Dianabol were
toxic to the liver. My doctor isn't very clear about this, so I thought I'd ask your opinion.
G.N., Los Angeles
Dear G. N.,
Regarding elevations of SGOT, and SGPT; let's note that the liver is basically a "factory" that manufactures things like
proteins and processes or destroys things like medications. There are many enzymes used in these processes and SGOT
and SGPT are only two of them. However, they are two very important ones and they are the ones with which the state of
the liver is generally measured.
SGPT is fairly specific to the liver, whereas SGOT is found in other organs like muscles. Therefore, it is important to
note that elevated SGOT can sometimes be seen after a good workout, when the muscles have been releasing and
transferring bio-chemicals. So we see that SGOT can be elevated just because of intense muscular activity.
Another thing to remember is that these enzymes will rise when almost any drug is taken by the patient. I have seen the
SGPT go to two times normal when patients take four tetracycline capsules!
So to partly answer the question, I would say that almost all drugs are somewhat "toxic" to the liver, in that there's a
certain amount of work the liver does to remove the drugs from the system. By convention, doctors will stop medications
if liver enzymes approach three times normal - just as a precaution.
But the most important consideration here that we should underline is that the relative "liver toxicity" of anabolic
steroids that are injectable and oil-based is generally not a major consideration, because these compounds are basically
metabolized the same as the natural testosterone that is already in the body. However, we may see liver enzyme
increases just because the liver is working to remove these steroids, the same as it does any other foreign chemical.
It's oral steroids, that are 17-alkylated, that are "liver toxic" or burden
the liver in a dose-related manner, and my experience is that the actual toxicity
is somewhat exaggerated. However, for patients on steroid therapy, I usually
recommend injectable steroids to reduce potential wear on the liver. And while
these aren't actually toxic in the truest sense of the word, I recommend "cycling"
all therapeutically-used anabolic steroids, with breaks between cycles, to give
the body a rest.
(Editor's note: Testosterone that is used for replacement therapy is not
meant to be cycled, as its purpose is to replace the testosterone that the body
produces every day. Testosterone replacement therapy is generally used continuously