Alpha-Fetoprotein (AFP)
Other marker
Alpha-Fetoprotein
Alpha-Fetoprotein (AFP)
A protein normally produced by the fetal liver and yolk sac that falls to low levels after birth. In adults it is used as a tumour marker, principally for hepatocellular carcinoma (primary liver cancer) and for certain testicular germ-cell tumours, and it can also rise with benign liver injury.
PED Notes
Relevant to long-term AAS users because of liver risk. Oral 17-alpha-alkylated steroids are associated with cholestasis, hepatic adenomas, peliosis hepatis, and, rarely, hepatocellular carcinoma; AFP is one screening tool for liver tumours alongside imaging. Note that AFP also rises modestly with ordinary hepatocyte regeneration, so a mild elevation during a period of raised liver enzymes may reflect benign liver stress rather than cancer. In men it is also part of the germ-cell tumour panel alongside beta-hCG and LDH.
When high
When elevated (>10 ng/mL):
- Mild elevations (roughly 10-100 ng/mL) are frequently benign and seen with hepatitis, cirrhosis, or active hepatocyte regeneration; recheck after addressing liver stress and correlate with ALT/AST, GGT, and bilirubin
- Markedly elevated or steadily rising AFP raises concern for hepatocellular carcinoma, especially with underlying liver disease; ultrasound or cross-sectional liver imaging is the next step
- In men, consider a testicular germ-cell tumour: examine the testes and pair with beta-hCG and LDH
- Trend matters more than a single value: serial rising AFP is more worrying than a stable mild elevation
Action for AAS users:
- Discontinue or minimise hepatotoxic oral 17-alpha-alkylated compounds while investigating
- Support the liver (see TUDCA and NAC guidance under liver markers) and arrange imaging; a confirmed or rising elevation needs specialist (hepatology or oncology) referral, not self-management
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Frequently Asked Questions
Reference Ranges
Standard Range