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AST (Aspartate Aminotransferase)

AST value and the AST/ALT ratio in strength training

Anyone training heavy reads a liver panel differently. The ratio between AST and ALT, the De Ritis ratio, is the most interesting number on your report, not AST alone. In most liver conditions ALT sits higher than AST. With muscle damage from a heavy squat or deadlift session, that ratio tips the other way. On older reports this enzyme is still called SGOT. This page covers the ratio, the pattern associated with alcohol, and what oral anabolics actually do to your liver values.

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Reference Ranges

See the value that applies to you:

Age years

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range

u/l

14 53 u/l

Reference ranges by group, in u/l
Sex	Age	Reference range (u/l)	Relative scale
Male	· 1–5 years	24–53 u/l	24 53
Male	· 6–12 years	19–42 u/l	19 42
Male	· 13–18 years	14–39 u/l	14 39
Male	· 19 years and older	14–43 u/l	14 43

14 53 u/l

Source: NVKC Reference population: Nederlandse huisartsenpopulatie (NUMBER, n=7.574.327)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

AST (Aspartate Aminotransferase): what this test measures

The test gives the amount of aspartate aminotransferase in your blood, in u/l. Older forms and many foreign reports say SGOT. It is the same measurement carrying an older name.

What you are really measuring is cell loss. The AST enzyme belongs inside the cell. It only appears in blood once the membrane gives way. In a body carrying substantial muscle, the largest store is not the liver but the muscle tissue. AST also comes from heart muscle, kidney and red blood cells.

That makes one number useless and two numbers useful. ALT is far more concentrated in liver cells. The ratio of AST divided by ALT separates the sources in a way neither value can alone.

A third number settles the argument: creatine kinase, CK for short. This enzyme comes almost exclusively from muscle tissue. Is CK clearly high while gamma-GT stays normal? Then your raised AST comes from your training and not from your liver.

Gamma-GT is the proof by contradiction here. It responds to bile flow and to heavy alcohol use, but not to muscle damage. Alkaline phosphatase belongs to that same cholestatic group.

So request CK alongside if you train seriously. Without CK, a raised AST stays an argument instead of a conclusion.

AST (Aspartate Aminotransferase): why this value matters

The De Ritis ratio is AST divided by ALT. For a lifter that number carries the most information.

Ratio below 1. ALT sits higher than AST. This is the pattern of most conditions of the liver, such as hepatitis and early fatty liver disease.

Ratio above 1, with a high CK. Muscle. A heavy squat or deadlift session lifts AST harder than ALT, because muscle tissue contains relatively more AST. Gamma-GT stays normal alongside. This is the most common reason a healthy lifter is alarmed by their report.

Ratio above 2, with raised gamma-GT and AST below roughly 300 u/l. This is the classic pattern with heavy alcohol use. The background is chemical. Alcohol depletes pyridoxal-5-phosphate, a form of vitamin B6. ALT needs it more than AST does. ALT therefore lags behind and the ratio climbs.

Note the trap. Pure muscle damage also produces a ratio above 1, sometimes above 2. Without gamma-GT and CK beside it, the ratio cannot be interpreted.

The magnitude sorts the rest. A mildly raised value fits training or alcohol. A markedly raised value, more than ten times the upper limit, almost always indicates acute viral hepatitis. Some medicines and certain supplements can lift the result too.

Anabolics, without euphemism. Oral 17-alpha-alkylated compounds genuinely burden the liver. That is not an internet myth. The typical picture, however, is a cholestatic pattern. Bilirubin and the bile-flow values stand out most, while the transaminases rise modestly. A markedly raised AST in a lifter therefore comes more often from the training itself. That does not make use harmless; it means you have to look at the right values. Discuss this honestly with a doctor, or your result will be read incorrectly.

This page makes no diagnosis and assesses no cycle. It explains which numbers belong together.

AST (Aspartate Aminotransferase): how to prepare

No hard training beforehand
Required

No heavy training, long endurance sessions or anything that leaves you out of breath in the 48 hours before the draw. Normal walking is fine.

Water is always fine. Drink as usual beforehand, it makes the draw easier.
Take your usual medication, unless your own doctor told you otherwise.

AST (Aspartate Aminotransferase): when is testing worthwhile?

For a lifter, useful blood work comes down to one choice: when you draw.

Not within 48 to 72 hours of a heavy session. After a hard leg day, a new exercise or a max attempt, that window is a floor rather than a target. After a genuinely heavy first exposure the value can stay raised for a week; in research on untrained men that was still the case after seven days.

Draw during a deload week. That is your cleanest measurement point and the only one where a raised AST says something about your liver rather than your programme.

Always request ALT, gamma-GT and CK alongside. A standalone AST gives you a number you can do nothing with. With all four you read the ratio, see whether gamma-GT stays quiet, and know whether CK explains the rise.

Measure as a series. A single measurement against a population reference says less in a muscular body than your own trend across quarters. Pick the same measurement moment in every block.

If the ratio stays raised while you have taken the rest and CK is normal, that is a result to put in front of your GP rather than interpret further yourself.

AST (Aspartate Aminotransferase): symptoms of a high or low value

Low Levels

A low AST is not a finding that requires action. No condition announces itself this way, and there is no reason to want the number higher.

For a lifter there is one practical point. Someone carrying substantial muscle typically sits higher at rest than the average reference person. A value sitting low in the range is therefore a genuine resting value for you, and a useful calibration point.

That is precisely what makes a series valuable. If you go from 16 to 33 u/l, that stays inside the reference range and no lab will remark on it, while for you it is a doubling. So keep your results side by side, with the date of your last heavy session noted alongside. Without that date a series is worth far less.

High Levels

A raised AST causes no symptoms in itself. What you feel belongs to whatever caused the rise.

Of muscular origin: soreness peaking 24 to 72 hours after the session, stiffness, a clearly reduced range of motion, swelling in the loaded muscle group and strength that temporarily disappears. Familiar ground after a heavy leg day.

Of liver origin: fatigue that rest does not clear, reduced appetite, nausea, a pressing or painful feeling in the upper right abdomen. Yellow eyes or skin, dark urine and pale stools belong to clear liver problems and call for prompt medical contact.

One pattern does not tolerate waiting. After an extreme session, overheating, dehydration or a return to heavy training after a long break, muscle tissue can break down on a large scale. The muscles are then severely painful and swollen, and the urine turns dark like cola. The kidneys are at risk. Head to the out-of-hours GP service or A and E without delay. This is not a situation to order a blood test for.

AST (Aspartate Aminotransferase): what to do about an abnormal value

Male

If Low

Normal AST indicates healthy liver and heart function. Maintain healthy lifestyle habits.

If High

Elevated AST may indicate liver or heart muscle damage. Consider further evaluation including imaging and additional liver tests.

AST (Aspartate Aminotransferase): lifestyle and this value

The biggest mistake lifters make with this number is not lifestyle but measurement timing.

Tie your blood draw to your deload. Fix it in your programme, at the same point in every block. What you get back is a series that is genuinely comparable.

Note your last heavy session with every result. Without that date a raised value cannot be interpreted, not even in hindsight.

Introduce new exercises gradually. The sharpest transaminase spikes come from unaccustomed loading, not from high volume. A new eccentric movement or a max attempt after a break does more than a heavy but familiar week.

Be honest about alcohol. Alcohol shifts the ratio with ALT and lifts gamma-GT with it; training does not do the latter. That difference is your best tool for telling the two apart.

Be equally honest with your doctor about cycles and supplements. Without that information your result will be misinterpreted, and that works against you in both directions. Never stop prescribed medication on your own initiative.

Drink enough and respect heat, especially at high intensity or on long sessions.

AST (Aspartate Aminotransferase): frequently asked questions

What does the AST/ALT ratio tell you in strength training?

With muscle damage from heavy training, AST rises harder than ALT because muscle tissue contains relatively more AST. The ratio then goes above 1 while gamma-GT stays normal and CK is raised. In most liver conditions the opposite happens and ALT sits higher instead.

Why is my AST higher than my ALT?

That is exactly the situation where the source is probably not your liver. Muscle tissue contains proportionally more AST, so a heavy session tips the ratio. Look at CK: if it is clearly raised and gamma-GT stays normal, the picture fits your training. If the ratio stays skewed at rest, put it to your GP.

Do anabolic steroids raise AST?

Oral 17-alpha-alkylated compounds demonstrably burden the liver, but usually with a cholestatic pattern: bilirubin and bile-flow values stand out most, while transaminases rise more modestly. A markedly raised AST in a lifter comes more often from training. Always discuss use with a doctor, or your result will be read incorrectly.

How long after a heavy squat session is my AST normal again?

Count on longer than the soreness. In untrained men the value was still raised seven days after a single heavy session. If you are trained and the session was familiar ground, it usually resolves faster. After a new exercise or a max attempt, waiting a week for a clean measurement is realistic.

Can liver values tell me whether a cycle is doing damage?

Liver values show burden, not a diagnosis, and a single measurement shows very little. With oral compounds you also look primarily at bilirubin and the bile-flow values rather than AST alone. Have this supervised by a doctor who knows what you use; self-interpretation goes wrong here routinely.

What is the difference between ALT, AST and gamma-GT for lifters?

ALT is the most liver-specific. AST also sits in muscle and therefore rises from training. Gamma-GT responds to bile flow and to alcohol but not to muscle damage, which makes it your control value. If gamma-GT stays normal while AST and CK are up, everything points to muscle.

Test Products

This marker is included in the following test panels.

Health Checkups

Complete Metabolic Panel

Comprehensive metabolic panel: electrolytes, kidney, liver, glucose, HbA1c, and protein.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) Calcium ALP (Alkaline Phosphatase) AST (Aspartate Aminotransferase) Bilirubin (Total) Urea (BUN) Creatinine eGFR (Estimated Glomerular Filtration Rate) Glucose (Fasting) Bicarbonate Chloride Sodium Potassium Albumin Total Protein Bilirubin (Direct) Bilirubin (Indirect)

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