UNIVERSITY Health Liver Interpretation and Intervention Lesson Overview Functions of the Liver AAS Impact on Liver Signs of Liver Dysfunction Liver Health Intervention Strategies Liver Functions • Main site for detoxification of harmful substances in the body This can range from alcohol, drugs, hormones (AAS and estrogen), bilirubin, and ammonia • Produces bile to carry away waste products and aid in fat digestion • Site of carbohydrate metabolism If blood sugar is to low the liver can release glucose from stored glycogen to restore normal serum glucose The liver can also convert glycerol from fat and amino acids into glucose via gluconeogenesis • The liver is a site of protein metabolism It produces albumin, a major transport protein and necessity for oncotic pressure in the vascular system It produces many anticoagulant factors as well for proper blood clotting Conversion of Ammonia to Urea • The liver regulates cholesterol metabolism, by being the site for lipoprotein production The liver produces “the good” HDL that help remove cholesterol from arteries • It is a storage site for fat soluble vitamins (A,D,E,K), B12, folate, iron, and copper • Site of conversion of growth hormone to IGF-1 Supraphysiological PED Impact on Liver Steroid Delivery Method and Toxicity Oral: 17alpha-alkylated allows protection from 17 beta-HSD in liver (17aa) steroids associated with liver damage ( cholestatic jaundice, peliosis, hepatitis, nodular regeneration, hepatic adenoma and carcinoma Hepatotoxicity and transient serum enzyme elevations AAS increase oxidative liver stress via increase in CTP1 Androgen receptor action increase ROS formation leading to hepatic mitochondrial degeneration Degree of AR binding affinity may dictate hepatotoxicity methandienone vs oxandrolone Cholestasis Most common issue, bile flow decreased via bile duct obstruction Increased bile salts and bilirubin in blood Most common issue Decreased appetite, malaise, nausea, upper abdominal pain Esterified testosterone derivatives causing liver issues is rare Case Studies Issues Solimini et al 2017 Lab evaluation Lab Reference Range Definition Albumin 3.5-5.5 g/dL Protein produced in liver, low levels associated with poor hepatic function globulin 1.5-4.5 g/dL Protein produced in liver high levels associated with liver dysfunction Total protein 6.0-8.5 g/dL Total of albumin and globulin both low and high can indicate liver stress Bilirubin 0.1-1.2 mg/dL Waste product from breakdown of RBC GGT