ALT and AST: What Elevated Liver Enzymes Mean for Athletes

If you have ever had bloodwork done during or after a steroid cycle, you have seen these two letters: ALT and AST.

Maybe your doctor mentioned them. Maybe you googled them and panicked. Maybe you ignored them entirely.

All three responses are common. None are ideal.

ALT and AST are liver enzymes. They are markers of hepatic stress. When elevated, they indicate that your liver is working hard—or potentially struggling. For athletes using anabolic compounds, understanding these numbers is not optional. It is essential for long-term health.

In this article, we will explain what ALT and AST are, what normal ranges look like, why they rise during cycles, and how to manage them responsibly.

What Are ALT and AST?

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes found primarily in liver cells. They play roles in amino acid metabolism—helping convert proteins into energy.

When liver cells are damaged or stressed, they leak these enzymes into the bloodstream. Blood tests measure the concentration, giving a snapshot of hepatic stress.

Key distinction:

• ALTis more specific to the liver. Elevated ALT almost always indicates liver stress.
• ASTis found also in muscle, heart, and kidneys. High AST can indicate liver stress—or muscle damage from intense training.

This is why doctors look at both, and often at ratios, to interpret results.

Normal Ranges for Men

Reference ranges vary slightly by lab, but general guidelines:

For athletes, mild elevations (40-60 U/L) are common—especially after leg day or during heavy training. Muscle damage from squats or deadlifts releases AST, which can temporarily raise levels without indicating liver disease.

Sustained elevations above 80-100 U/L warrant attention.

Why ALT and AST Rise During Steroid Cycles

Anabolic compounds affect liver enzymes through several mechanisms.

1. Oral Steroid Hepatotoxicity

Oral steroids are structurally modified (17-alpha-alkylated) to survive first-pass liver metabolism. This modification makes them directly hepatotoxic.

Common oral steroids and liver impact:

Even mild orals like Anavar can elevate enzymes, especially at higher doses or longer durations.

2. Increased Metabolic Load

Even injectable steroids increase the liver’s workload. The liver must metabolize higher levels of androgens, process increased nitrogen waste, and maintain protein synthesis at elevated rates. This metabolic demand alone can raise enzymes.

3. Training Intensity

Heavy resistance training causes muscle damage, releasing AST. When combined with steroid-induced liver stress, total AST readings can appear concerning—even if liver-specific damage is minimal.

4. Dehydration

Many athletes under-hydrate. Dehydration concentrates blood and stresses all organs, including the liver. This can elevate both ALT and AST.

What Elevated Enzymes Actually Mean

Mild elevation (40-60 U/L):

• Common during oral cycles
• Often returns to normal post-cycle
• Monitor, but rarely cause for panic

Moderate elevation (60-100 U/L):

• Indicates significant liver stress
•  Consider reducing oral dose or duration
• Add or increase liver support supplements
• Recheck in 2-4 weeks

High elevation (>100 U/L):

• Red flag
• Discontinue oral steroids immediately
• Increase hydration and liver support
• Consult healthcare provider
• Do not start another cycle until levels normalize

Critical distinction: ALT > AST often indicates liver-specific stress. AST > ALT can indicate muscle damage or alcohol use.

How to Protect Your Liver During Cycles

1. Liver Support Supplements

TUDCA (Tauroursodeoxycholic acid)

• Pharmaceutical-grade bile acid
• Reduces hepatotoxicity significantly
• Dosage: 500-1000mg daily during oral cycles

NAC (N-Acetylcysteine)

• Boosts glutathione, the body’s master antioxidant
• Supports liver detoxification pathways
• Dosage: 600-1200mg daily

Milk Thistle (Silymarin)

• Weaker than TUDCA but still beneficial
• Often used in milder cycles or post-cycle

In my experience, TUDCA is non-negotiable for any oral cycle. NAC is excellent added support.

2. Hydration

The liver cannot clear toxins efficiently when dehydrated.

Target: 4-6 litres water daily. More if using orals or training hard.

3. Avoid Alcohol

Zero alcohol during cycles. Ethanol and oral steroids compete for the same liver enzymes. Combining them is synergistic toxicity.

4. Limit Other Hepatotoxins

• Reduce acetaminophen (Tylenol) use
• Avoid NSAIDs like ibuprofen if possible
• Minimize caffeine if enzymes are rising

5. Cycle Length

Longer oral cycles = more liver stress.

Guidelines:

• Most orals: 4-6 weeks maximum
• Anavar: up to 8 weeks (milder)
• Always follow with equal time off orals

Post-Cycle Liver Recovery

After stopping orals, liver enzymes typically return to baseline within 4-8 weeks.

Support recovery with:

• Continued TUDCA/NAC for 4 weeks post-cycle
• Plenty of water
• Clean diet (avoid processed foods)
• Reduced alcohol for at least 4 weeks

Bloodwork confirmation: Retest ALT/AST 4-6 weeks post-cycle to confirm normalization before considering another cycle.

When to Worry — And When Not To

Do not panic if:

• Enzymes are mildly elevated (40-60)
• You just finished leg day (AST may be high)
• You are mid-oral cycle with support supplements
• You feel fine otherwise

Do worry if:

• Enzymes exceed 100 U/L
• Elevation persists 8+ weeks post-cycle
• You have symptoms: fatigue, jaundice (yellowing eyes/skin), dark urine, right-side pain
• ALT is significantly higher than AST (liver-specific damage)

Jaundice is a medical emergency. Stop all compounds immediately and seek care.

The Muscle Gear Approach to Liver Health

At Muscle Gear, we have served Canadian athletes since 2012. We see bloodwork from thousands of customers. The ones who manage liver health best share common habits:

• They use pharmaceutical-grade orals (consistent dosing reduces surprises)
• They take TUDCA and NAC religiously
• They hydrate like it is their job
• They test bloodwork mid-cycle and post-cycle
• They never “push through” warning signs

Quality matters for liver health. Underdosed orals require higher doses to feel effects, increasing liver load. Contaminated orals add unpredictable toxins. Pharmaceutical-grade products from approved manufacturers like Apoxar and Novo-Pharm minimize these variables.

When you order from Muscle Gear, you know exactly what you are taking. Batch numbers. Expiry dates. Third-party testing.

Liver health is too important for guesswork.

Practical Protocol for Liver Management

Pre-Cycle:

• Baseline bloodwork (ALT, AST, GGT)
• Order TUDCA and NAC alongside orals

During Oral Cycle:

• TUDCA 500-1000mg daily
• NAC 600-1200mg daily
• 4+ litres water daily
• Zero alcohol
• Mid-cycle bloodwork at week 4

Post-Cycle:

• Continue TUDCA/NAC for 4 weeks
• Retest ALT/AST 4-6 weeks after stopping orals
• Do not start next cycle until enzymes normalize

The Bottom Line

ALT and AST are not numbers to fear. They are data. And data guides intelligent decisions.

Mild elevations during oral cycles are expected. Moderate elevations require attention. High elevations demand action.

The athletes who thrive long-term are not the ones who never stress their livers. They are the ones who monitor, support, and respect their biology.

Muscle Gear has provided the tools for this approach since 2012. Pharmaceutical-grade orals, ancillaries, and educational support—all delivered discreetly to Canadian customers.

Your liver works for you every day. Support it like it supports you.