Blood Work for Steroid Users

Bodybuilders and individuals who use anabolic steroids should undergo regular blood tests. Without these tests, there is a risk of developing serious health problems that may not be immediately noticeable but can become critical if not addressed. In this post, we'll walk through common risks, what to test for depending on one's regimen, and reference ranges for test results.

Common Issues & Risks of Using Anabolic Steroids

Some common risks and issues that could arise include the following:

  • Unnoticed Liver Damage: Without blood work, increases in liver enzymes indicating stress or damage can go undetected. This can lead to liver conditions like hepatitis, fibrosis, or even liver failure, all of which might not show symptoms until advanced stages.
  • Hormonal Imbalances Ignored: Steroids can disrupt the body's natural hormonal balance. Without monitoring, this can lead to conditions like Anabolic Steroid-Induced Hypogonadism (reduced function of the gonads), which affects testosterone production in men, leading to issues like reduced fertility, decreased muscle mass, and mental health challenges.
  • Elevated Cardiovascular Risk: Regular blood tests check cholesterol levels. Without this, imbalances like high LDL (bad cholesterol) and low HDL (good cholesterol) can progress unnoticed, increasing the risk of heart diseases such as atherosclerosis (plaque buildup in arteries), heart attacks, or strokes.
  • Hidden Kidney Damage: Steroids can strain the kidneys, but without blood work, changes in kidney function can go unnoticed. This can lead to chronic kidney disease or acute kidney injury, where the kidneys suddenly stop working properly.
  • Overall Health Risks: Other than these specific risks, a lack of regular blood work means general health concerns, such as changes in blood pressure, blood sugar levels, or immune system function, might not be identified and addressed timely.

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):

  • Complete Blood Count (CBC)
  • estimated Glomerular Filtration Rate (eGFR)
  • Lipid Profile
  • Prostate-Specific Antigen (PSA - only if age-appropriate)
  • Electrocardiogram (ECG)

Oral AAS:

  • Injectable AAS screen
  • Alanine Aminotransferase (ALT)
  • Alkaline Phosphatase (ALP)
  • Bilirubin tests.

Fat Burning Compounds (like T3):

  • ECG, Thyroid-Stimulating Hormone (TSH)
  • Injectable AAS screen, especially if using DNP.

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

Additional tests, like free testosterone and estradiol, are not essential for safety monitoring but many steroid users opt for these to optimize their cycle.

Beyond lab tests, a thorough physical examination by a doctor is essential for individuals using steroids. This examination includes checking blood pressure and heart rate, as well as conducting abdominal and cardiovascular evaluations. High blood pressure is a critical indicator, as it may lead to hypertension, increasing the risk of stroke, heart attack, and other cardiovascular diseases. Monitoring heart rate is also vital since steroids can impact heart rhythm. Regular checks help in identifying any arrhythmias or irregular heartbeats, which might indicate underlying cardiac issues. Moreover, steroid use is linked to an elevated risk of heart disease. This includes conditions like left ventricular hypertrophy, an enlargement of the heart's left ventricle, potentially leading to heart failure. Cardiovascular examinations are crucial for detecting early signs of heart strain or damage, ensuring timely intervention and treatment.

If your PEDs are sourced illicitly, consider comprehensive screening due to the risk of pharmacologic impurities that can affect your liver, kidneys, and bone marrow.

How often should you get blood work?

At TeleTest, our focus is on minimizing the potential harm and health risks associated with steroid use. We do not condone the use of PEDs. With this goal in mind, we advise the following schedule for health tests:

Quarterly Tests

These tests are recommended every three months to monitor key health indicators.

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

Annual Tests

Conducted once a year, these tests provide a broader overview of your health.

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

Not Required for Harm Reduction

While these tests can provide additional information, they are not essential for reducing the harm associated with steroid use.

  • 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.

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:

  • Decreased testosterone (in men, due to suppression of natural production)
  • Estradiol out of Reference Range
  • Decreased luteinizing hormone (LH)
  • Decreased follicle-stimulating hormone (FSH)

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:

  • Altered thyroid function tests
  • Changes in blood glucose levels

As there is too much variation in regimen and dosing, it is not possible to offer specific guidance. As always, it is important to speak with your healthcare provider to address any concerns or abnormalities.

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

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.