Blood Work for Steroid Users

If you're using anabolic steroids, regular blood work isn't optional. Many of the worst complications creep up silently and only show themselves once the damage is done. Here's what to test for, when, and the reference ranges that matter.

TeleTest Team
TeleTest Team
Jan. 26, 2024 · 12 min read

Check blood work pricing: Compare prices for CBC, ALT, AST, ALP, total testosterone, free testosterone, estradiol, HbA1c, PSA, and SHBG on our Lab Test Price Comparison tool.

Common Issues & Risks of Using Anabolic Steroids

The risks worth watching for:

  • Silent liver damage: rising liver enzymes can signal stress or injury well before you feel sick. Left unchecked, this can progress to hepatitis, fibrosis, or liver failure.
  • Hormonal disruption: steroids suppress your natural production. The result is often Anabolic Steroid-Induced Hypogonadism, with knock-on effects on fertility, muscle mass, and mood.
  • Elevated cardiovascular risk: lipid panels track HDL and LDL. Without testing, you won't see the LDL climb or the HDL crash that pushes you toward atherosclerosis, heart attack, or stroke.
  • Kidney strain: steroids tax the kidneys. Without bloodwork, changes in function can slip by until you hit chronic kidney disease or acute injury.
  • General health: blood pressure, blood sugar, and immune markers all drift on cycle. Catching them early is the whole point of routine testing.

What to test for while on steroids?

The lab tests you need depend on your Performance Enhancing Drug (PED) regimen. This guidance is based on modifications of Bonnecaze et al's recommendations:

SARM / Injectable Anabolic Androgenic Steroids (AAS):

Oral AAS:

Fat Burning Compounds (like T3):

Human Growth Hormone (HGH) and Derivatives:

  • Injectable AAS screen
  • Magnesium (Mg) & Potassium (K) tests

For Human Chorionic Gonadotropin (hCG):

Generally, no specific testing is needed unless you suspect product impurity. In such cases, include HGH and Derivative Screen.

For Site Oil Enhancement:

  • CBC
  • eGFR
  • Lipid Profile
  • Serum Calcium

Free testosterone and estradiol aren't strictly needed for safety, but many users add them in to fine-tune a cycle.

Bloodwork alone isn't enough. A proper physical with a doctor matters too. That means blood pressure, heart rate, abdominal exam, and cardiovascular check. Hypertension is one of the bigger red flags from steroid use and a major driver of stroke and heart attack risk. Heart rhythm can shift on cycle, so picking up an arrhythmia early matters. Long-term steroid use also raises the risk of left ventricular hypertrophy, an enlargement of the heart's left ventricle that can progress to heart failure. A physical catches early signs of strain you won't see on a panel.

If your gear comes from underground sources, run a broader panel. Impurities can hit your liver, kidneys, and bone marrow.

What blood test should you get before a steroid cycle?

Before you start a cycle, you want a baseline to compare against later and a snapshot of your current health. The usual tests are:

Blood Tests:

  • Complete Blood Count (CBC): To measure the levels of red cells, white cells, and platelets.
  • Lipid Profile: To check cholesterol levels, including LDL, HDL, and triglycerides.
  • Liver Function Tests: Steroids can impact liver health, so it’s crucial to check the levels of liver enzymes.
  • Kidney Function Tests: To ensure the kidneys are functioning properly.
  • Testosterone Levels: Both free and total testosterone levels should be assessed.
  • Estrogen Levels: To monitor the risk of estrogen-related side effects.
  • Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH): To understand the baseline state of these hormones which are crucial in the regulation of testosterone.

Heart Health Assessments:

  • Electrocardiogram (ECG): To check for heart rhythm abnormalities.
  • Echocardiogram: To assess heart function and structure.

Endocrine Evaluation:

  • Thyroid Function Tests: Steroids can affect thyroid hormone levels.

Other Hormonal Tests:

  • Cortisol Levels: To understand the adrenal glands' baseline function.
  • SHBG (Sex Hormone Binding Globulin): Which influences the levels of free and bound hormones in the body.

These flag pre-existing issues that steroids could make worse, and they give you something to compare against during and after the cycle. A proper consult with a healthcare provider is worth the time so you go in with eyes open.

What blood test should you get after a steroid cycle?

Post-cycle, follow-up tests track recovery and catch any lingering damage. The standard list:

Post-Cycle Blood Tests:

  • Complete Blood Count (CBC): To detect any changes that might have occurred during the cycle.
  • Lipid Profile: Since steroids can negatively impact cholesterol levels.
  • Liver Function Tests: To check for any liver stress or damage post-cycle.
  • Kidney Function Tests: Ensuring that the kidneys are still functioning well.
  • Hormonal Profile:
    • Testosterone Levels: It's important to check if the body has resumed natural testosterone production.
    • Estrogen Levels: To ensure they have returned to normal, reducing the risk of side effects like gynecomastia.
    • FSH and LH: These should ideally return to pre-cycle levels if the body has recovered.

Cardiovascular Monitoring:

  • Blood Pressure: Steroid use can raise blood pressure, so it's essential to monitor it after the cycle ends.
  • Electrocardiogram (ECG): To ensure there are no new cardiac issues.

Physical Examinations:

  • Physical check-ups: Regular check-ups to monitor for physical changes or developments.

Timing of Post-Cycle Blood Work

When you draw the labs matters as much as which ones you run. A rough schedule:

Immediate post-cycle:

  • Within the first week after the cycle ends. This gives you an "end of cycle" reading on liver, kidney, and lipid function.

Mid post-cycle:

  • About 3 to 4 weeks out, especially if you're running PCT. This checks how well recovery is going and whether the PCT is doing its job on natural hormone levels.

End of PCT:

  • Usually 4 to 6 weeks after the cycle. Focus on testosterone, FSH, and LH to confirm they're tracking back toward baseline.

Long-term follow-up:

  • 8 to 12 weeks out or beyond, depending on how recovery's going. This confirms hormones and organ function have actually returned to normal.

How often should you get blood work?

TeleTest's approach is harm reduction. We don't endorse PED use, but if you're going to do it, we'd rather you monitor properly. Our recommended schedule:

Quarterly Tests

Run these every three months to track the key indicators:

  • Complete Blood Count (CBC):
  • Liver Enzymes (ALT, ALP)
  • Total Testosterone
  • Creatinine (eGFR)
  • Bilirubin
  • Potassium
  • Serum Calcium

Annual Tests

Once a year, for a wider snapshot:

  • Electrocardiogram (ECG)
  • Lipid Profile
  • Fasting Blood Glucose
  • HbA1c

Not Required for Harm Reduction

These add detail but aren't necessary for safety monitoring:

  • Estradiol
  • Prolactin
  • Sex Hormone Binding Globulin (SHBG)
  • Free Testosterone
  • Prostate Specific Antigen (PSA)
  • Luteinizing Hormone (LH)
  • Follicle Stimulating Hormone (FSH)

See here for an estimate of costs of private-pay tests in Ontario, Canada. You can also use our Lab Test Price Comparison tool to compare prices across providers.

[Embedded image: Anabolic Steroid Blood Testing Frequency]

Targets & Reference Range:

Our steroid panel includes a follow up consultation with our physicians to discuss your results but below are the reference ranges of common biomarkers for men:

CBC

  • White Blood Cells (WBC): 4500 to 11,000/mm3
  • Red Blood Cells (RBC): 4.3 to 5.9 million/mm3
  • Hemoglobin: 13.5 to 17.5 g/dL
  • Hematocrit: 41% to 53%
  • Mean corpuscular volume (MCV): 80 to 100 µm3
  • Mean corpuscular hemoglobin (MCH): 25.4-34.6 pg/cell
  • Mean corpuscular hemoglobin concentration (MCHC): 31%-36% Hb/cell
  • Platelets: 150,000-400,000/mm3

Hormones

  • Total Testosterone: >= 500 ng/dL
  • Free Testosterone: >= 2% of Total Testosterone
  • Estradiol: 20 to 50 pg/mL
  • Sex Hormone Binding Globulin (SHBG): 15 to 64 nmol/L
  • Luteinizing Hormone (LH): 1.24 to 7.8 IU/mL
  • Follicle Stimulating Hormone (FSH): 1.6 to 8 mIU/mL

Liver Enzymes:

  • Alanine Transaminase (ALT): 0 to 45 IU/L
  • Aspartate Transaminase (AST): 0 to 35 IU/L
  • Alkaline Phosphatase (ALP): 30 to 120 IU/L

Thyroid

  • TSH: <= 2.5U/mL
  • Free T3: >= 3.7 pg/mL

Lipid Panel

  • HDL: >= 40 mg/dL
  • LDL: < 100 mg/dL
  • Triglycerides: < 150mg/dL or 1.7mmol/L

Blood Glucose

  • Fasting Blood Glucose: 70 mg/dL (3.9 mmol/L) to 100 mg/dL (5.6 mmol/L)
  • HbA1c: <5 .7%

Others

  • Prostate Specific Antigen (PSA) <= 4ng/mL
  • Blood Pressure: <= 135/85 mmHg
  • Estimated Glomerular Filtration Rate (eGFR): >= 60mL/min/1.73 m2
  • Prolactin: <= 18 nd/dL
  • Ferritin: 55 to 270 ng/mL
  • Iron: 55 to 160 micrograms/dL
  • Bilirubin: 0.2 to 1.3 mg/dL
  • Magnesium: ​​1.3 to 2.1 mEq/L or 0.65 to 1.05 mmol/L
  • Potassium: 3.5 to 5.3 mmol/L
  • Serum Calcium: 8.9 to 10.2 mg/dL

Common Abnormalities

Liver function tests:

  • Elevated AST (aspartate aminotransferase)
  • Elevated ALT (alanine aminotransferase)

Lipid profile:

  • Decreased HDL (high-density lipoprotein) cholesterol
  • Increased LDL (low-density lipoprotein) cholesterol

Hormonal changes:

Hematological changes:

Other changes:

  • Elevated creatine kinase (CK), especially if engaging in intense exercise
  • Potentially elevated prostate-specific antigen (PSA) in men

In some cases:

Regimens and doses vary too much for us to give one-size-fits-all guidance. Talk to your healthcare provider about anything that comes back off.

See our FAQ for more information on blood work for steroid users.

Related Resources

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.

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