Baseline (pre-cycle) testing is generally very broad. This is done to make sure there are no underlying health conditions that may be worsened by anabolic steroids, and to have a baseline for determining the on-cycle and post-cycle impact. To begin with, a profile of steroid hormones (male users only) is done to identify the current natural state. This can be especially important to know for post-cycle follow up, as the range of what is considered normal for testosterone on a standard blood test can be quite broad. If you started on the high end of normal, for example, you might want to make sure you are not stuck on the low end of normal following your cycles. A full liver panel is usually conducted as well, especially if hepatotoxic oral or injectable steroids are planned. Since cardiovascular disease is one of the most tangible risks with long-term steroid use, lipid profiling is always important, and is usually conducted here and during all other phases of testing. Additionally, other general markers of health are generally examined here including blood, kidney, electrolytes, minerals, glucose, and prostate.
Lipids (Standard Full Set)
Full Liver Panel
Electrolytes, Minerals, and Glucose
On-cycle testing is usually conducted 3 to 4 weeks after steroid therapy began. The individual will generally look at those indicators of health most directly affected by steroid use. A full lipid examination is conducted, and is often regarded as the single most important set of health tests that can be initiated. It is here that the cardiovascular impact of the steroids will begin to become apparent. One should give special consideration to what these results may mean for their health decades down the road if this type of steroid cycle is to be repeated many times over many years. If hepatotoxic drugs are being used, a full liver panel will be examined. It is also recommended to examine other general health markers here such as blood, kidney, electrolytes, minerals, and glucose.
Lipids (Standard Full Set)
Liver Panel, if taking hepatotoxic steroid(s)
Electrolytes, Minerals, and Glucose
During the post-cycle testing phase it is common to once again look first at the male steroid hormones. The hope here is to obtain values that closely mirror your pretreatment levels. Note that there will always be some variation based on the time of the day, and even in the day-to-day results. An exact match is probably not feasible. It is also considered a good idea to look at pituitary LH and FSH, because if testosterone levels come back low it will give you and your physician a better understanding of the cause. High LH/FSH and low testosterone (primary hypogonadism) may simply indicate that your testicles have not yet fully restored their mass. Alternately, low LH/FSH can indicate secondary hypogonadism, which is often cause to initiate corrective therapy with an endocrinologist. A run of other general markers of health are also usually conducted here including lipids, liver, blood, kidney, electrolytes, minerals, glucose, and prostate.
Hormone (Steroid, LH/FSH)
Lipids (Standard Full Set)
Liver Panel, if taking hepatotoxic steroid(s)
Electrolytes, Minerals, and Glucose
Blood Tests by Category
This set of testing should look at both total and free testosterone. The former measure is most commonly used by physicians to identify the androgen level and determine if there is a need for therapy. The latter measure actually represents the fraction of bioavailable (immediately active) testosterone in the body, and is consequently regarded as more important for assessing the present state of androgenicity. Estradiol is the principle active form of estrogen in the body, and has roles both in potential side effects (gynecomastia, water/fat retention) and hormone balance. This is the estrogen marker most often recommended during hormone profiling.
Luteinizing hormone (LH) and follicle stimulating hormone (FSH) are responsible for stimulating testosterone production and spermatogenesis in the testes. These measures are most relevant when evaluating the cause and potential treatment options for hypogonadism, not the short-term health impact of anabolic-steroid use. The short-term suppression of LH/FSH is expected with anabolic/androgenic steroid administration.
It is regarded as important to get a baseline measure of thyroid activity, usually once per year. Follow up tests during and after steroid use may be an expense some view as unnecessary. Anabolic/androgenic steroid use is unlikely to permanently affect thyroid function, but may slightly elevate thyroid levels during therapy. A misdiagnosis of hyperthyroidism (overactive thyroid) is sometimes made in light of these elevated numbers. The effect of anabolic/androgenic steroid use on thyroid levels should be taken into account before treatment for hyperthyroid is ordered.
Anabolic/androgenic steroids can have strong adverse effects on lipids. The abuse of anabolic/androgenic steroids (particularly long-term abuse) can, likewise, increase the risk for developing cardiovascular disease as assessed by these variables. Mitigating these risks with the careful examination of the lipid profile is regarded as one of the most fundamental of all steroid-related blood tests. While far from comprehensive with regard to assessing total heart disease risk, a full panel examining the variables below (and comparing them to your baseline values) can provide a good snapshot of the cardiovascular impact of anabolic/androgenic steroid use. It is important to measure your blood lipids only after 12 hours of fasting, as food intake can skew the outcome of some measures (particularly triglycerides).
Standard Full Set:
This is a standard full lipid panel examination. Ideally, all values should be kept within the normal ranges at all times during steroid therapy. Note that the LDL/HDL ratio is regarded as the most important measure of the serum lipid tests, as it reflects the ongoing balance between plaque deposition (LDL) and removal (HDL) in the arteries. The LDL/HDL ratio is used to more closely assess heart disease risk in individuals that have elevated LDL or total cholesterol levels.
C-reactive protein and homocysteine are two additional markers that are important to examining cardiovascular health. C-reactive protein is a key indicator of inflammation in the body, and homocysteine is involved in blood clotting and LDL cholesterol oxidation. It is also advisable to include these two variables in your cardiovascular testing schedule.
Apolipoprotein ratio testing is also recommended. Although not commonly used in general medical practice, apolipoprotein testing is increasingly regarded as a more accurate predictor of cardiovascular disease risk than cholesterol testing. Apolipoprotein B (apoB) is found in all LDL particles, and is responsible for attaching these lipoproteins to the artery walls. Apolipoprotein A-I (apoA-I) is found mainly in HDL particles, and is responsible for initiating beneficial reverse cholesterol transport. ApoA-I enables the HDL particles to pull cholesterol from the artery walls and transport them back to the liver. The ratio of apoB to apoA-I, therefore, appears to reflect a much truer measure of the balance of potentially atherogenic and antiatherogenic particles in the blood. A ratio above .9 is generally regarded as indicative of increased cardiovascular disease risk. Lower ratios reflect reduced cardiovascular disease risk assessments.
A full liver panel is important to assessing hepatic strain. The two markers of liver stress most commonly elevated in abusers of anabolic/androgenic steroids are the enzymes alanine amino-transferase (ALT) and aspartate amino-transferase (AST). ALT and AST are necessary to amino acid metabolism in the liver, and will leak into the bloodstream as the liver becomes inflamed or damaged. These two enzymes are generally regarded as important indicators of early steroid-induced liver toxicity. There have been cases in which substantial liver damage has occurred without substantial elevations in ALT and AST, however, so a more detailed examination of liver enzyme values is always advised.
Alkaline phosphatase (ALP) and gamma-glutamyltranspeptidase (GGT) are known as cholestatic liver enzymes, which mean they diminish or stop the flow of bile (a greenish fluid that aids digestion and is produced in the liver). ALP and GGT are important markers of liver health during steroid use, and should be included in regular blood testing. Elevations in ALP and GGT can indicate bile duct obstruction (intrahepatic cholestasis), which refers to a condition where the liver can no longer properly transport and metabolize bile. Intrahepatic cholestasis is a potentially very serious manifestation of steroid-induced liver toxicity, so elevations in ALP and GGT should not be disregarded.
Mild elevations in ALT and AST may be caused by muscle damage (exercise) and not steroid-induced liver toxicity. A comparison to baseline levels will be important in determining the cause. If the only factor that has changed is the addition of a hepatotoxic anabolic steroid (training is otherwise steady), the drug is likely to blame. It is important to remember that ALP and GGT are not always elevated with early liver strain. Therefore, the elevation of any hepatic markers above the reference range (even if only ALT and AST) can indicate liver toxicity, and should be cause to discontinue the offending steroids and reassess indicate liver toxicity, and should be cause to discontinue the offending steroids and reassess risk.
The creatine kinase (CK) enzyme is used as a marker of muscle breakdown, kidney damage, and heart damage. High levels usually indicate heart attack or other organ trauma. This enzyme can also become elevated with exercise that breaks down muscle tissue, especially intense endurance or resistance training. Elevated CK levels caused by high intensity training are often mistaken for organ damage. It is important to further examine other markers of kidney and heart heath before such a determination is made. Note that creatine kinase levels may also be useful in determining if liver strain or heavy training is the cause of mild elevations in liver enzymes ALT and AST. Slight increases in ALT and AST caused by muscle damage will usually coincide with elevated CK and normal ALP and GGT levels.
A full blood count is one of the most commonly run blood tests, and can give you a good snapshot of overall health in many regards. A full blood cell test will give you a measure of white cell count (responsible for fighting infection), platelet count (vital to blood clotting and healing), and red blood cell count (responsible for carrying oxygen). Red and white cell counts will be further subdivided into various individual measurements, often referred to as a differential cell count. Hemoglobin is the specific carrier of gases in red cells, and hematocrit is a measure of the percentage of red blood cells in the total blood volume. Due to their effects on erythropoiesis, anabolic steroids tend to increase red blood cell count, hematocrit, and hemoglobin concentrations. While this may increase oxygen-carrying (aerobic) capacity, as the concentration of red blood cells increases so does the thickness of the blood. Elevated hematocrit can increase the risk of heart attack or stroke.
This panel of tests looks at three primary waste products filtered and excreted through the kidneys, urea, uric acid, and creatinine. Problems here can indicate serious underlying problems with kidney function. Note that Blood Urea Nitrogen (BUN) is often elevated with excess protein consumption, and is used by many physicians as an indicator that too much protein is being consumed for optimal metabolism. The high consumption of meat or creatine supplementation can also elevate creatinine levels, diminishing the value of blood creatinine testing as a marker of kidney health. Electrolyte, mineral, and fasting glucose testing is important to further assessing kidney health, and is advised in addition to the above kidney markers. A quick urine screen for pH, specific gravity, and the presence of sugar, blood, and ketones is also available at most physicians’ offices, and is generally advised alongside blood work when possible.
Electrolytes, Minerals, and Glucose
Electrolyte levels are examined to help detect problems with the fluid and electrolyte balance. Abnormal values may reflect something as small as sodium or potassium deficiency, or a more serious condition such as kidney disease. A variety of other health issues may also become apparent by looking at both electrolyte and mineral levels, giving them somewhat broad prognostic value. Fasting glucose is also examined to determine if the individual may be hypoglycemic (low blood sugar) or hyperglycemic (high blood sugar). Problems with fasting glucose may reflect potentially serious health conditions including metabolic syndrome, diabetes, pancreatic disease, liver disease, kidney failure, or acute stress.
Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland. Its levels can become elevated in cases of benign prostate hypertrophy or prostate cancer. While it remains unknown if elevating the level of androgens in the body with anabolic/androgenic steroids can increase the risk of prostate cancer, it is known that this disease can be progressed by elevated hormone (androgen and estrogen) levels. The PSA test is regarded as an important diagnostic tool for screening individual prostate cancer risk. If PSA levels are elevated, most will advise against using anabolic/androgenic steroids.
Individual Heath Markers Defined
Alanine amino-transferase (ALT): An enzyme produced primarily in the liver but also in other tissues. ALT is involved in amino acid and protein metabolism. Used as a primary marker of hepatic strain. Also called Serum Glutamic Pyruvic Transaminase (SGPT).
Albumin: The main protein that circulates in the blood. Produced in the liver and has antioxidant properties. Transports certain hormones, vitamins, and minerals, and plays a role in water balance. Used as an indicator of liver health. Higher levels are optimal.
Alkaline Phosphatase (ALP): A family of cholestatic enzymes produced mainly in the liver, but also in the intestines, kidneys, and bone. Used as a marker of hepatic strain, often relating to disease of the bile ducts.
Apolipoprotein A-I (apoA-I): A constituent of HDL (good) cholesterol, apoA-I is responsible for initiating beneficial reverse cholesterol transport. This process pulls cholesterol particles from the artery walls and transport them back to the liver. Higher levels are optimal.
Apolipoprotein B (apoB): A constituent of LDL (bad) cholesterol, apoB is responsible for attaching these lipoproteins to artery walls. ApoB is a promoter of fatty plaque deposits in the arteries. Lower levels are optimal.
Aspartate amino-transferase (AST): An enzyme produced primarily in the liver but also in muscle tissue. AST is involved in amino acid and protein metabolism. Used as a marker of hepatic strain, although it is considered less specific than ALT testing. Also called Serum Glutamic-Oxalocetic Transaminase (SGOT).
Basophils: A type of white blood cell. Action not fully understood, but cells are known to carry histamine, heparin, and serotonin. Levels are elevated with allergic reaction and parasitic infection.
Bicarbonate: A measure of carbon dioxide content in the blood, and a common marker of the acid-base balance.
Bilirubin: A waste product made from the breakdown of red blood cells. Excreted into the bile. Regarded as an important indicator of liver health. Elevated levels in the blood indicate liver toxicity.
Blood Urea Nitrogen (BUN): A waste product from the breakdown of proteins, filtered and excreted through the kidneys. Elevated levels may indicate a number of problems including excessive protein intake, kidney damage, dehydration, heart failure, or reduced production of digestive enzymes. Low levels may be indicative of many things including malnutrition or liver damage.
BUN/Creatinine Ratio: The ratio of Blood Urea Nitrogen to Creatinine, used as a marker of kidney and liver health.
C-reactive Protein (CRP): A key marker of inflammation in the body. Elevated levels may indicate increased risk of cardiovascular disease or stroke.
Carbon Dioxide (CO2): Byproduct of respiration, and a common marker of the acid-base balance. See also Bicarbonate.
Calcium: Electrolyte involved in a myriad of body functions including bone metabolism, protein utilization, muscle and nervous system functioning, cardiovascular functioning, blood clotting, and nutrient transport.
Chloride: Electrolyte involved in the regulation of water balance. Elevated levels may indicate a number of things including anemia, dehydration, excess salt consumption, and hyperthyroid. Low levels may indicate heart or kidney failure, severe vomiting, or a number of other health conditions.
Cholesterol, Total: A measerure of all fractions of cholesterol in the blood (LDL, VLDL, and HDL). High total cholesterol is regarded as a risk factor for cardiovascular disease.
Cholesterol, HDL: A measure of the beneficial high-density lipoprotein (HDL) fraction of cholesterol, which helps remove plaque deposits from arteries. High levels are optimal. Low levels may be found in cardiovascular disease.
Cholesterol, LDL: A measure of the low-density lipoprotein (LDL) fraction of cholesterol. This is the primary atherogenic particle, meaning it tends to promote the formation of plaque deposits in the arteries. Low levels are optimal.
Cholesterol, VLDL: A measure of the very low-density lipoprotein (LDL) fraction of cholesterol. VLDL contains the highest amount of triglycerides. Considered an atherogenic (“bad”) cholesterol particle. Lower levels are optimal. C
Cholesterol, LDL/HDL Ratio: A measure of the primary atherogenic particle (LDL) in relation to the primary antiatherogenic particle (HDL). This ratio is generally considered the most important cholesterol test value for assessing cardiovascular disease risk. A low ratio is desirable.
Creatine Kinase: An enzyme found largely in the heart and muscle, and responsible for converting creatine to phosphocreatine. Elevated levels may be linked to a number of things including heart attack, kindey failure, or sever muscle damange.
Creatinine: A waste product of muscle metabolism. Low levels may indicate kidney disease, malnutrition, or liver disease. High levels may indicate a number of things including reduced kidney function or muscle degeneration. Creatine supplementation may also elevate creatinine levels.
Eosinophils: A type of white blood cell. Similar to basophils, eosinophils are used by the body to protect against allergy and parasites. Levels are elevated with infection, and are low with good health.
Estradiol: The principle active form of estrogen. High levels can be associated with water retention, fat buildup, and gynecomastia (men). Also plays a role in prostate hypertrophy. Low levels of estradiol may be associated with increased heart disease risk.
Follicle Stimulating Hormone (FSH): A pituitary hormone involved in reproduction. In men, FSH is mainly responsible for supporting spermatogenesis. In women it supports ovulation.
Gamma-Glutamyl Transpeptidase (GGT): A cholestatic enzyme produced in the bile ducts. GGT is involved in glutathione metabolism and the transport of amino acids and peptides. Used as a marker of hepatic strain.
Globulin: A blood protein similar to albumin. Globulin is responsible for transporting certain hormones, lipids, metals, and antibodies. Levels may be elevated in many conditions including chronic infections, liver disease, arthritis, cancer, or lupus. Lower levels may be found with a number of conditions including suppressed immune system, malnutrition, malabsorption, and liver or kidney disease.
Glucose (fasting): Glucose is the product of carbohydrate metabolism and the primary source of energy for most cells in the body. Fasting glucose levels are elevated in a number of conditions including diabetes, liver disease, metabolic syndrome, pancreatitis, dieting, and stress. Low fasted glucose levels may indicate liver disease, overproduction of insulin, hypothyroidism, or other diseases.
Hematocrit: A measure of the percentage of red cells in the blood. Low levels indicate an anemic condition. High levels may indicate a number of things including dehydration, increased red cell breakdown in the spleen, cardiovascular disease, or respiratory disease. Anabolic steroids may also increase hematocrit.
Hemoglobin: A constituent of red blood cells, and the main carrier of oxygen and carbon dioxide in the blood. Levels may be suppressed with a number of conditions including malnutrition, malabsorption, and anemia. High levels may indicate many things including dehydration, cardiovascular disease, or respiratory disease. Anabolic steroids may also increase hemoglobin levels.
Homocysteine: A compound formed from the metabolism of the amino acid methionine. Involved in blood clotting and LDL cholesterol oxidation. Elevated levels of homocysteine indicate an increased risk of cardiovascular disease and stroke.
Iron: Mineral necessary for many functions including the formation of hemoglobin and certain proteins, and the transport of oxygen. Elevated levels may be caused by many conditions including certain forms of anemia, liver damage, hepatitis, iron poisoning, or vitamin B6 or B12 deficiency. Low levels can indicate a number of things including gastrointestinal blood loss, heavy menstrual bleeding, iron malabsorption, or dietary iron deficiency.
Lactic Acid Dehydrogenase (LDH): An intracellular enzyme found in many tissues including the kidney, heart, skeletal muscle, brain, liver, and lungs. Used as a marker of tissue damage. High levels are found in many conditions including heart attack, anemia, low blood pressure, stroke, liver disease, muscle injury, muscular dystrophy, and pancreatitis.
Luteinizing Hormone (LH): A pituitary hormone responsible for the stimulation of testosterone production in the testes (men). LH primarily supports ovulation in women.
Lymphocytes: A type of white blood cell. Primary role is to fight viral infection. Levels are elevated with active infection. Low levels are associated with suppressed immune system or active bacterial infection (noted by elevated neutrophils).
Mean Corpuscular Volume (MCV): A measure of the size of red blood cells, determined by measuring the volume of a single red blood cell. Useful in determining the cause of anemia. Elevated levels may reflect a number of things including a deficiency of vitamin B6 or folic acid. Low levels may reflect iron deficiency, or other causes.
Mean Corpuscular Hemoglobin (MCH): A measure of the average weight of the hemoglobin in red blood cells. Useful in determining the cause of anemia.
Mean Corpuscular Hemoglobin Concentration (MCHC): A measure of the average concentration of hemoglobin in red blood cells. Useful in evaluating the cause of, and therapy for, anemia. Low levels may indicate blood loss, B6 or iron deficiency, or other causes.
Monocytes: A type of white blood cell. Primary role is to fight severe infection not sufficiently countered by lymphocytes and neutrophils. Levels can be elevated with a number of things including chronic infection and certain cancers. Low levels indicate good health.
Neutrophils: A type of white blood cell, also known as granulocytes. The primary white cell used by the body to fight bacterial infection. Levels are elevated with infection. May be suppressed with compromised immune system or bone marrow.
Phosphorous: An abundant electrolyte involved in a number of body functions including the utilization of carbohydrates, fats, and proteins for cellular maintenance, repair, and growth, the production ATP for the storage of cellular energy, the transport of calcium, the maintenance of osmotic pressure, and the maintenance of heartbeat regularity.
Platelet Count: A measure of the concentration of platelets (also known as thrombocytes) in the blood. Platelets are involved in blood clotting, and protect against excessive bleeding. Elevated levels may be linked with a number of things including dehydration. Low levels are found in suppressed immune system functioning, drug reactions, or deficiencies of vitamin B12 or folic acid, or may have other causes.
Potassium: A key electrolyte necessary for nerve and muscle function, and the transport of nutrients and waste products in and out of cells. Along with sodium it helps maintain the acidbase balance and osmotic pressure. High levels may be caused by a number of things including kidney failure, metabolic or respiratory acidosis, and red blood cell destruction.
Prolactin: A reproductive hormone involved specifically in lactation. Prolactin is sometimes (but not commonly) elevated in steroid abusers, and may be linked to estrogen excess or hormone imbalance. Elevated prolactin may also indicate other issues with the pituitary.
Prostate-specific antigen (PSA): A protein found in prostate cells. Used as a screening for prostate cancer risk. Elevated levels reflect an increased risk of developing prostate cancer. Low levels are desirable, although do not assure against prostate cancer.
Red Blood Cell Count: A measure of the total concentration of red blood cells, responsible for transporting oxygen and carbon dioxide in the body. High red cell counts are seen with a number of conditions including heart disease, dehydration, or pulmonary fibrosis. Low levels may be linked to many things including anemia, bone marrow failure, red blood cell destruction, bleeding, leukemia, and malnutrition.
Red Cell Distribution Width (RDW): A measure of the variation in size between red blood cells. Useful in evaluating the cause of, and therapy for, anemia. Increased values may indicate a number of things including vitamin B12, folic acid, or iron deficiency.
Sodium: An abundant electrolyte necessary for many functions including the maintenance of osmotic pressure, acid-base balance, and nerve impulse activity. Disturbances in the sodium level may be caused by minor things including excessive sweating, vomiting, diarrhea, water intake, or very serious conditions including heart, kidney, or liver disease.
T3 Uptake: This test measures the level of unsaturated thyroxine binding globulin (a carrier of thyroid hormones) in the blood. Increased levels may indicate a number of things including hyperthyroidism (overactive thyroid), liver disease, cancer, and decreased lung function. Low levels may be indicative of hypothyroidism (under active thyroid), excess estrogen levels, pregnancy, or other causes.
Testosterone, Total: The measure of both unbound (active) and bound (inactive) portions of testosterone in the blood.
Testosterone, Free: The measure of free (unbound) testosterone in the blood. This represents the total amount of testosterone immediately available to tissues.
Thyroid-Stimulating Hormone (TSH): A pituitary hormone responsible for stimulating the release of thyroid hormones.
Thyroxine (T4): The more abundant of the two major thyroid hormones (T3 and T4). T4 serves mainly as a reservoir for the more active thyroid hormone (T3), which helps to stabilize and regulate thyroid supply. This is a key marker of the state of thyroid health (low, normal, or overactive).
Thyroxine, Free Index: This measure is a calculation of the amount of unbound (free) T4 in the blood. This is a key marker of the state of thyroid activity (low, normal, or overactive).
Total Protein: A measure of the total serum protein concentration, mainly albumin and globulin. Serum proteins are important to the function and supply of enzymes, hormones, nutrients, and antibodies, and also play a role in maintaining the water and pH balance. Low levels may indicate a number of things including malnutrition, liver disease, malabsorption, diarrhea, or severe burn injury. Elevated levels may indicate infection, liver damage, or other disease.
Triglycerides: The main storage form of fatty acids in the body. May be metabolized and used for energy. Elevated triglyceride levels may contribute to hardening of the arteries (atherosclerosis), and increase the risk of heart disease or stroke. Low levels are optimal.
Urea: (see Blood Urea Nitrogen)
Uric Acid: The waste product of purine metabolism, which is filtered and excreted through the kidneys. Elevated levels may indicate a number of things including gout, infection, kidney damage, and excessive protein intake. Low levels may indicate kidney damage, malnutrition, liver damage, or other causes.
White Blood Cell Count: A measure of the total concentration of white blood cells (also known as leukocytes), responsible for fighting infection and protecting the body from pathogens. A differential measure of white blood cells is usually also taken including neutrophils, eosinophils, basophils, lymphocytes, and monocytes. Levels may be elevated with certain infections or allergic conditions.
Wlliam Llewellyn (2011) - Anabolics