The Importance of Blood Work for AAS/PED Users

Before the onset of steroids or performance-enhancing drug cycle, the candidate should undergo specific blood tests. These tests will help evaluate his or her general health condition. Using a steroid cycle will likely stress some of their vital organs. Of course, side effects and possible tissue damage are dependent on various parameters, such as age, time of use, a dosage of PEDs, a combination of them, lifestyle, proper nutrition, proper supplementation, and family history. After the end of a cycle, when Post Cycle Therapy is through, the user should once again undergo specific blood tests. These labs are crucial in order to evaluate the kind of distortions that took place in different organs.

Laboratory values such as hematocrit, liver enzymes, cholesterol, lipoproteins, and renal indexes are quite important in order to clarify if one’s health was compromised while on cycle. Other factors such as tumor markers could possibly reveal any kind of chronic inflammation that could turn into mutation and oncogenesis. Cancer is the result of a chronic inflammatory disease. Hormonal levels within the thyroid gland and gonads show how the HPTA (hypothalamic-pituitary-gonadal axis) works and if BMR (Basal Metabolic Rate) is affected as well.

We usually measure biochemical and hormonal exams before and after, rather during a cycle- unless a serious medical reason exists. These recommended examinations are below, along with their purpose:

• Hematocrit, Hemoglobin, Platelets, Iron, Ferritin and Cyanocobalamine: Polycythemia and anemia are possible to be diagnosed.
• Urea, Creatinine, Uric acid, 24h creatinine urine clearance and urinalysis: Acute renal failure, glomerulosclerosis, and tubular necrosis are possible to be detected.
• Glucose, Τriglycerides, Total Cholesterol, HDL, LDL: Coronary Heart Disease, dyslipidemia or atherosclerosis-atheromatous of arteries, diabetes mellitus type 2 and metabolic syndrome are highly possible to get diagnosed.
• SGOT/AST, SGPT/ALT, γGT, ALP, Bilirubin, LDH: Pharmaceutical hepatitis, cholestasis, cirrhosis are possible causes of liver disease.
• CPK, CK-MB: Excessive over-training leads to severe inflammation in muscle fibers, causing rhabdomyolysis and CPK elevation along with the elevation of SGOT/AST, SGPT/ALT. CPK is also present in cardiac muscle. The laboratory is able to distinguish between the different components of this enzyme. For example, the fraction coming from skeletal muscle is referred to as CK-MM and the one from heart muscle is designated as CK-MB. So the elevation of CK-MB from the cardiac tissue damage could reveal acute myocardial infarction.
• Sodium, Potassium, Calcium, Magnesium, Phosphorus, Chloride: Dehydration, muscle spasms, hypovolemia, renal damage are the result of electrolyte imbalance.
• INR, APTT, PT, FIB: AAS affect hemostatic mechanisms since those factors are synthesized within the liver parenchyma.
• FSH, LH, TT, FT, E2, PRL, SHBG: HPTA, spermatogenesis, endogenous testosterone production, and estrogens are evaluated, which reflect on libido and fertility.
• TSH, T3, T4, FT3, FT4, ANTI-TPΟ, ANTI TG, U/S of the thyroid gland: The thyroid gland’s metabolism reflects on BMR, proper thyroidal function, size of the gland or any scenario of possible nodulation is detected. In order to evaluate proper thyroid and gonadal function, measurements of the free-active forms of testosterone and thyroxin, triiodothyronine, shall be counted as well. TT, FT, LH, FSH, PRL, E2 are necessary for the evaluation of HPTA, during am hours, since they are on their peak levels.
• CEA, CA 19/9, AFP, PSA, and FREE PSA: These are tumor markers that reflect on specific tissues, such as lungs, testicles, large intestine, prostatic gland, visceral organs. Tumor markers (CEA, AFP, PSA, CA 19-9) are reliable in case of particular inflammation, but also for the evaluation of the specific disease. However they are valuable for those who wish to use growth factors (HGH-IGF1, MGF peptides), since somatropin, somatomedin C, Mechanic Growth Factor, and GHRH peptides are responsible for cellular growth, that leads to tissues growth and eventually to oncogenesis of cancer.

All of these blood measurements should be counted after 12 hours of fasting, with proper hydration. Cholesterol fragments and triglycerides calculation require a lean diet the day before, in order for the results to be properly measured.

A typical cardiovascular check-up should be performed annually and includes: 

A frontal X-ray of the thoracic cavity could show an enlarged myocardium and possible Left Ventricular Hypertrophy.

U/S of the myocardium, ECG, 24 hrs Holter, stress test/echo cardiac muscle hypertrophy (LVH),  myocardial fibrosis, angina/ ischemia, coronary heart disease,  arrhythmia, the function of heart valves can be identified

If necessary, coronary magnetic resonance imaging (CMR), known as cardiac MRI, should be performed.

Imaging studies (U/S, C/T) of the abdominal cavity could reveal hepatic/bile tumors, either adenoma or hepatocellular carcinoma.

In case some of the following values are elevated, potential causes could be:

• Hematocrit: AAS, smoking, dehydration (falsely elevated due to an increase in plasma concentration)
• Urea: Positive nitrogen balance, dehydration
• Creatinine: rhabdomyolysis (CPK>500), creatine loading phase, high consumption of red meat, increased BMI, NSAID’s abuse
• SGOT (AST), SGPT (ALT): Abuse of 17 alkylated AAS (pharmaceutical hepatitis), acetaminophen, rhabdomyolysis, over-training
• γGT, ALP: cholestasis-jaundice, alcoholism, liver cirrhosis
• LDL, Total cholesterol: SFA’s consumption, absence of UFAs (Ω-3,6,9), atherogenesis.
• Τriglycerides: the absence of DHA, EPA (omega 3 PUFA’s)
• INR: AAS abuse
• CPK: rhabdomyolysis, overtraining
• B12: DECREASE equals to megaloblastic anemia (cyanocobalamin deficiency), as a result of either malnutrition or alcoholism
• TSH: hypothyroidism
• T3, T4: hyperthyroidism CEA, AFP, Ca 19-9: Tumors of lungs, testicles (seminoma), large intestine (bowel), visceral organs (liver, bile, pancreas, stomach) PSA/free
• PSA: Benign prostate hypertrophy, prostatitis

References:

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2. Farzad Gheshlaghi, et al. Cardiovascular manifestations of anabolic steroids in association with demographic variables in bodybuilding athletes. J Res Med Sci. 2015 Feb; 20 (2): 165–168.
3. Hargens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports Med. 2004; 34 (8):513-54
4. Hengevoss J, et al. Combined effects of androgen anabolic steroids and physical activity on the hypothalamic-pituitary-gonadal axis. J Steroid Biochem Mol Biol. 2015 Jun; 150:86-96.