Transaminases are the most widely used biochemical indicators of hepatocellular damage in clinical practice. People often have various misconceptions about aminotransferases, such as elevated aminotransferases means hepatitis; abnormal aminotransferases are infectious; aminotransferase levels are directly proportional to the degree of liver cell damage. Is this really true? We will explain each of them below. Does elevated aminotransferases mean hepatitis? There are many causes of elevated aminotransferases. In addition to hepatitis, alcohol consumption, overexertion, liver-damaging drugs, skeletal muscle injury, cardiac muscle injury, thyroid disease, strenuous exercise, heat stroke, hemolysis, Wilson’s disease, hemochromatosis, and alpha-1 antitrypsin deficiency can increase aminotransferases. In addition, serum aminotransferases also have variation in physiological states, such as strenuous activity, physical exercise, and during menstruation, aminotransferases can also be temporarily elevated. Therefore, simple elevation of aminotransferases does not necessarily mean hepatitis. There are many causes of transaminase abnormalities, and only viral hepatitis is contagious, so not all elevated transaminases are contagious. Are aminotransferase levels directly proportional to the degree of liver cell damage? In acute hepatitis, transaminases are often high, up to 2000 U/L or more (normal values <40 U/L), but most have a good prognosis. However, in acute severe hepatitis and liver failure, because there are fewer normal hepatocytes, the amount of transaminases released into the blood is reduced, and the phenomenon of "bile enzyme separation" occurs, i.e., bilirubin is high but transaminases are reduced or even normal. In addition, bile duct obstruction and stasis-type hepatitis can also occur with deep jaundice, but not high transaminases. If transaminases return to normal, is the liver disease cured? Elevated aminotransferases are a sign of liver damage, but just because they have come down does not mean that "liver disease is cured". For example, in chronic hepatitis B, hepatitis C, autoimmune hepatitis and long-term alcohol drinkers, transaminases are often normal or only mildly elevated, but in fact the liver has undergone serious lesions. For example, in some patients with cirrhosis and liver cancer, the liver function is very bad, but the transaminases are still normal. Can I stop the medication once the transaminases return to normal? The transaminases of patients with chronic hepatitis B and C are often normal, but they still need antiviral treatment, otherwise they will also progress to cirrhosis and liver cancer. The transaminase level can be considered before stopping the medication, but it is not the only indicator for stopping the medication, otherwise it may lead to the rebound of the disease. Do I need enzyme-lowering drugs for elevated transaminases? For most chronic hepatitis B or C, antiviral treatment is the "cure". When the liver function test results suggest elevated transaminases, you must not blindly take medicine, remember not to simply eat enzyme-lowering drugs, so as not to treat the symptoms but not the root cause, you must go to a specialist hospital as soon as possible to clarify the cause and treat the symptoms. If the aminotransferase is high due to hepatitis B, you should pay more attention to it and treat it as soon as possible.