Can anabolic testosterone, Sustanon (testosterone), use affect Carbohydrate Antigen 19-9 (CA 19-9) levels?

Effect of Anabolic Testosterone (Sustanon) on CA 19-9 Levels

There is no direct evidence that anabolic testosterone or Sustanon specifically affects CA 19-9 levels, but anabolic steroids can cause hepatotoxicity which might indirectly influence tumor marker levels through liver dysfunction.

Understanding CA 19-9 as a Tumor Marker

CA 19-9 (Carbohydrate Antigen 19-9) is primarily used as a tumor marker with the following characteristics:

• CA 19-9 is a tumor-associated antigen originally defined by a monoclonal antibody produced from murine spleen cells immunized with human colorectal cancer cell lines 1
• It exists as an epitope of sialylated Lewis A blood group antigen 1
• Approximately 5-10% of the population is genotypically Lewis ab-negative and cannot produce CA 19-9, making testing ineffective in these individuals 1

Clinical Significance of CA 19-9

CA 19-9 has several important clinical applications:

• It serves as a nonspecific marker that can be elevated in biliary tract cancer (BTC) and other gastrointestinal malignancies 1
• Elevated levels are associated with poorer prognosis in cancer patients and can be useful for assessing treatment response 1
• CA 19-9 is not recommended as a screening test for pancreatic cancer due to inadequate specificity and sensitivity 1
• It can be elevated in many non-malignant conditions, including:
  • Inflammatory conditions of the hepatobiliary system 1
  • Biliary obstruction (both benign and malignant) 1, 2
  • Various benign conditions (e.g., thyroid disease) 1
  • Pneumonia, pleural effusion, renal failure, and SLE 2

Anabolic Steroids and Liver Effects

Anabolic steroids, including testosterone preparations like Sustanon, can affect liver function:

• Anabolic steroids are synthetic derivatives of testosterone that can cause hepatotoxicity 3
• The 17-α-alkylation modification (present in some oral steroids) increases hepatotoxicity due to slower clearance in the liver 3
• Hepatotoxic effects can manifest as:
  • Elevated liver transaminases
  • Acute cholestatic syndrome
  • Chronic vascular injury
  • Hepatic tumors
  • Toxicant-associated fatty liver disease
  • Significant changes in lipoproteins 3

Potential Relationship Between Anabolic Steroids and CA 19-9

While no direct evidence links testosterone/Sustanon use to CA 19-9 elevation, the following mechanism is plausible:

• CA 19-9 can be elevated in hepatobiliary conditions and biliary obstruction 1
• Anabolic steroids can cause liver dysfunction and cholestatic syndromes 3
• Therefore, anabolic steroid-induced liver injury might potentially lead to elevated CA 19-9 levels through hepatobiliary dysfunction

Clinical Implications

When interpreting CA 19-9 levels in patients using anabolic steroids:

• Recognize that CA 19-9 is not specific for malignancy and can be elevated in benign conditions 2
• Consider that liver dysfunction from anabolic steroids might potentially affect CA 19-9 levels
• Interpret elevated CA 19-9 in the context of the patient's clinical presentation 2
• Be aware that many anabolic steroid effects on the liver can stabilize or reverse with cessation of use 3

Monitoring Recommendations

For patients using anabolic steroids with elevated CA 19-9:

• Evaluate liver function tests to assess for steroid-induced hepatotoxicity 3
• Consider temporary discontinuation of anabolic steroids if clinically appropriate
• Re-evaluate CA 19-9 levels after steroid discontinuation to determine if levels normalize
• If CA 19-9 remains elevated after steroid discontinuation, further investigation for other causes is warranted 1