Individuals planning to use anabolic-androgenic steroids should undergo a health assessment before initiating an AAS cycle to check their overall status and identify any medical conditions that could pose a risk.
Some diseases can only be detected through clinical diagnostic tests, as they may not present any obvious symptoms.
An AAS cycle can place stress on vital organs such as the heart, liver, and kidneys.
The likelihood of side effects and tissue damage varies depending on a range of factors, including age, duration of steroid abuse, AAS/PED dosage, type of AAS, drug formulation, concurrently or sequentially used AAS (stacking), lifestyle, nutrition and supplementation, adherence to medical preventive protocols, the presence of congenital abnormalities, and family medical history.
Hyperlipidemia, transaminasemia, erythrocytosis, and anemia are common health abnormalities.
These conditions may worsen as the cycle progresses, potentially requiring the discontinuation of the cycle.
After completing a cycle and PCT, AAS users should undergo biochemical and hormonal clinical tests to monitor their health status and check for any adverse effects.
Clinical Tests Before and After a Steroid Cycle
Unless there is a compelling medical reason, clinical tests should be conducted before or after a cycle, not during it.
Blood/Urine Tests
Hematology Profile (Complete Blood Count with Differential):
Hematocrit (Hct), Hemoglobin (Hgb), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW), Percentage and Absolute Differential Count, Platelet Count, Red Blood Cell Count, White Blood Cell Count, Iron (Fe), Ferritin (Fer), Folic Acid (Folate), Cyanocobalamin (B12).
Kidney Profile:
Urea (BUN), Creatinine (Crea), Uric Acid (UA), Glomerular Filtration Rate (GFR), 24-hour Creatinine Urine Clearance, and Urinalysis.
Lipid Profile:
Total Cholesterol (CHOL), High-Density Lipoprotein (HDL) Cholesterol, Low-Density Lipoprotein (LDL) Cholesterol, Triglycerides (Trig), Homocysteine (Hcy), Lipoprotein (a) [Lp(a)], Apolipoprotein A (Apo A), Apolipoprotein B (Apo B).
Liver Profile:
Alanine Aminotransferase (SGPT/ALT), Aspartate Aminotransferase (SGOT/AST), Gamma-Glutamyl Transferase (γGT), Alkaline Phosphatase (ALP), Bilirubin (BIL), Lactate Dehydrogenase (LDH).
Metabolic Profile:
Glucose, Glycated Hemoglobin (HbA1c), Total Protein, Albumin (ALB), Globulin, A:G Ratio, Sodium (Na), Potassium (K), Calcium (Ca), Magnesium (Mg), Phosphorus (P), Chloride (Cl).
Creatine Phosphokinase (CPK), CK-MM, CK-MB:
CPK is expressed in various tissues (skeletal, cardiac muscle).
This test is not specific about the type of elevated enzyme.
Laboratories can differentiate the various components of this enzyme.
For example, the fraction originating from skeletal muscle is designated as CK-MM, and the fraction from cardiac muscle is designated as CK-MB.
Coagulation Tests:
International Normalized Ratio (INR), Activated Partial Thromboplastin Time (aPTT), Prothrombin Time (PT), Thrombin Time (TT), Fibrinogen (FIB).
Hormone Profile (Evaluation of HPTA, Spermatogenesis, Libido, and Fertility):
Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Total Testosterone (TT), Free Testosterone (FT), Beta-Estradiol (E2), Prolactin (PRL), Sex Hormone-Binding Globulin (SHBG).
Measurements should be taken in the morning, as levels are highest at this time.
Thyroid Profile:
Thyroid-Stimulating Hormone (TSH), Thyroxine (T4), Free T4 (FT4), Triiodothyronine (T3).
Free T3 (FT3), Anti-Thyroid Peroxidase Antibodies (Anti-TPO), Anti-Thyroglobulin Antibodies (Anti-TG), Thyroid U/S (Ultrasound).
This profile evaluates the thyroid’s metabolic activity, proper function, size, and identifies any potential nodules.
Tumor Markers
Carcinoembryonic Antigen (CEA)
CA 19-9
Alpha-Fetoprotein (AFP)
Prostate-Specific Antigen (PSA) and free PSA.
Various tumor markers are used in clinical practice.
Some markers are associated with only one type of cancer, while others are linked to two or more types.
Tumor markers reflect conditions in specific tissues such as the lungs, testes, colon, prostate, and visceral organs.
Tumor markers like CEA, AFP, PSA, and CA 19-9 can be reliable for evaluating specific inflammations or diseases.
However, this is crucial for individuals using growth factors, as somatropin, somatomedin C (IGF-1), mechano growth factor, follistatin, and GHRH peptides are responsible for cell growth and can influence tissue growth and carcinogenesis.
There are limitations to the use of tumor markers.
Non-cancerous conditions can cause levels of certain markers to increase, and not all cancer patients will have elevated levels of a relevant marker.
Furthermore, not every type of cancer has an identified marker.
Tumor markers are used in the detection, diagnosis, and management of cancer, and their levels can be elevated in inflammatory conditions.
However, they are not sufficient to diagnose cancer on their own and are typically used in conjunction with other tests like biopsies and CT scans.
These clinical tests should be performed after a 12-hour fast, with proper hydration.
A clean diet is required when measuring cholesterol and triglycerides.
Cardiovascular Assessment
Blood Pressure Check
- Chest X-ray to check the shape of the heart and evaluate the cardiothoracic ratio.
- Electrocardiogram (ECG): To identify recent or past acute myocardial infarction (AMI), arrhythmias (ventricular or atrial), and left ventricular hypertrophy (LVH).
- Echocardiogram (Triplex U/S): Describes the size and function of the ventricles and valves (ejection fraction), any structural abnormalities of the myocardium, and the morphology and function of the ascending aorta and aortic arch.
- Cardiovascular abnormalities such as hypertrophic cardiomyopathy, right ventricular cardiomyopathy, and congenital coronary artery anomalies are often asymptomatic but can be detected through thorough examination.
- A 24-hour Holter monitoring, stress test/echocardiogram (U/S), or cardiac MRI (coronary MRI) may be performed if necessary.
- Coronary MRI plays a crucial role in the diagnosis and treatment of cardiovascular diseases and is useful for evaluating myocardial ischemia, cardiomyopathy, myocarditis, vascular diseases, and the side effects of AAS abuse.
Imaging Studies:
- Abdominal Ultrasound (U/S) and Computed Tomography (CT) can detect fatty liver (NAFLD), peliosis hepatis, hepatic/biliary tumors, adenomas, and hepatocellular carcinoma (liver cancer).
- A pelvic MRI may be performed to rule out prostate cancer.
This check-up should be conducted once a year.
Interpreting Test Results
Possible causes for elevated lab values due to AAS abuse
- Hct: AAS abuse, smoking, dehydration (false elevation due to increased plasma concentration), erythrocytosis from living at high altitudes (>2000m).
- Urea: Positive nitrogen balance-anemia, dehydration, renal failure.
- Creatinine: Rhabdomyolysis (CPK>1000), increased creatine intake (>10g/day), excessive red meat consumption, increased muscle mass (BMI>30), NSAID abuse, renal failure, glomerulosclerosis, tubular necrosis, administration of aminoglycoside antibiotics.
- Uric Acid: Increased intake of animal protein, gout.
- SGOT(AST), SGPT(ALT): Abuse of 17-alpha-alkylated oral AAS (drug-induced hepatitis), acetaminophen abuse, rhabdomyolysis, excessive training, alcohol consumption.
- γGT, ALP: Cholestasis-jaundice, alcoholism, liver cirrhosis.
- Total/Conjugated Bilirubin: Jaundice, liver cirrhosis, drug-induced hepatitis, hemolysis.
- LDL, Total Cholesterol: Dyslipidemia, atherosclerosis, consumption of Saturated Fatty Acids (SFA), lack of Essential Fatty Acids (EFA) (Ω-3,6,9).
- Triglycerides: Lack of DHA, EPA (Omega-3 PUFAs).
- Homocysteine: AAS abuse and risk of cardiovascular/cerebrovascular events, low B12, folic acid.
- Ammonia: Liver cirrhosis, severe hepatitis, renal failure, high protein intake.
- Glucose, HbA1c: Type 2 Diabetes, metabolic syndrome, insulin resistance.
- INR: AAS abuse.
- CPK: Rhabdomyolysis, excessive training, cocaine use.
- B12: Decreased levels in megaloblastic anemia (cyanocobalamin deficiency) due to malnutrition or alcoholism.
- TSH: Hypothyroidism.
- T3, T4: Hyperthyroidism.
- CEA, AFP, Ca 19-9: Tumors of the lungs, testes (seminoma), colon, and visceral organs (liver, bile duct, pancreas, stomach).
- PSA/free PSA: Benign Prostatic Hyperplasia (BPH), prostatitis.
Clinical testing is crucial for athletes who abuse AAS, and physicians must provide accurate information and conduct monitoring.
Every physician has a duty to guide their patient on how to maintain their health.
The evaluation is vital for understanding health status and risks before a cycle begins, for assessing the direct impact of use, and for evaluating any distortion or recovery of health.
Laboratory data cannot replace a good physical examination and medical history; clinicians must treat the patient as a whole, not just the results.
