Risk reduction and biological monitoring
A blood test before, during, and after a steroid cycle allows doctors to monitor the changes caused by exposure and their evolution after cessation. The comparison is based on baseline results, laboratory intervals, and the conditions of each sample collection.
The monitoring process involves three steps: establishing an initial assessment, monitoring relevant parameters during exposure, and then evaluating their evolution and hormonal recovery after cessation. The schedule takes into account the products used, symptoms, and any pre-existing abnormalities.PreparationInitial assessmentRead the markersDuring the treatmentAfter the treatmentCommon mistakesBefore the sample
How to prepare for a blood test in bodybuilding
Maintain consistent conditions for each sample collection: timing, usual hydration, sleep, and time elapsed since the last session. Report any medications, supplements, and substances used, along with their last dates of use. Follow the laboratory’s instructions regarding alcohol and previous meals.
Fasting during exams
When fasting is required, it generally lasts 8 to 12 hours, with only water consumed. Fasting blood glucose levels necessitate this. For lipids, the specific requirements depend on the prescription and the individual situation, particularly the triglyceride level. Confirm the laboratory’s instructions.
A reproducible schedule
Morning blood sampling is particularly important for assessing natural testosterone production. If you are undergoing treatment or active exposure, also note the time elapsed since your last dose or injection. Keep this information with your report.
Intense training: allow sufficient time for recovery.
An intense weight training session increases CK and certain transaminases through muscle exertion. In the study by Pettersson and colleagues, AST and ALT levels remained elevated for at least seven days after a weightlifting session. A rest period of 24 to 48 hours therefore sometimes allows this effect to persist.
For a scheduled assessment, agree on a rest period with the referring physician, especially after an unusual or very strenuous session. In the presence of concerning symptoms or a significant abnormality, a medical evaluation remains the priority, even if the preparation conditions are imperfect.The starting point
What tests should be done before starting a course of steroids?
The initial assessment documents the health status prior to exposure. Personal values are used to measure changes; clinical thresholds and reference ranges remain essential for interpreting their significance. Any pre-existing abnormality requires evaluation before any further exposure.
The table distinguishes between major categories of tests and additional tests tailored to a specific question. The prescribing physician selects the analyses based on the patient’s history, symptoms, and the substances involved.
| Domain | Initial examinations to be discussed | Additional information depending on the context |
|---|---|---|
| Hematology | Complete blood count (CBC), including hemoglobin, hematocrit and red blood cell count. | Ferritin, iron status, vitamin B12 or folates to investigate an abnormality in the blood count. |
| Lipids | Total cholesterol, HDL, LDL, triglycerides and non-HDL cholesterol. | ApoB to specify the atherogenic particle load; Lp(a) to complete the cardiovascular risk assessment. |
| Liver | ALT, AST, with GGT, bilirubin and alkaline phosphatases according to the prescribed test. | Albumin depending on the context; CK if a muscular origin of the transaminases is considered. |
| Kidneys | Creatinine, estimated glomerular filtration rate (eGFR), urea and electrolytes. | Cystatin C if the creatinine estimate is difficult to interpret; albuminuria according to renal risk. |
| Metabolism | Blood glucose levels according to risk and products used. | HbA1c in case of risk of diabetes or exposure to growth hormone. |
| Hormones | In men, total morning testosterone, LH and FSH when the objective includes a hormonal reference state. | SHBG and free testosterone calculated according to the result; estradiol and prolactin according to the symptoms and the clinical question. |
Blood pressure measurement completes this assessment. Other tests are performed for specific indications: TSH and free T4 for the thyroid, PSA depending on age and prostate status, and IGF-1 in cases of growth hormone exposure. A fasting insulin test is performed to answer a specific clinical question rather than as a routine procedure.Interpretation
What the main blood markers show
Hematocrit and hemoglobin
Hematocrit corresponds to the proportion of blood volume occupied by red blood cells. Androgens stimulate their production. An increase is observed in relation to hemoglobin, red blood cell count, hydration, and previous values.
Dehydration concentrates the blood and increases the measured value. A persistent increase under normal hydration conditions warrants medical evaluation, including investigation of other factors influencing red blood cell production.
HDL, LDL, non-HDL and ApoB
Anabolic steroids alter the lipid profile, often with a decrease in HDL and an increase in LDL. Some oral products cause marked changes. Non-HDL cholesterol is calculated by subtracting HDL from total cholesterol; ApoB indicates the number of atherogenic particles.
Cardiovascular screening combines these results with blood pressure, smoking, blood glucose, and family history. For monitoring, compare each marker in the relevant direction: a decrease in HDL and an increase in LDL represent two distinct adverse trends.
ALT, AST, GGT and bilirubin
ALT and AST levels increase in cases of liver damage, but also after intense muscular exertion. CK, GGT, bilirubin, alkaline phosphatase, and the date of the last workout help to interpret the observed profile.
Elevated CK levels after exercise suggest a muscular contribution. All results and their evolution are necessary to investigate for concomitant liver involvement. Jaundice, dark urine, or significant pain warrants prompt evaluation.
Creatinine, eGFR and cystatin C
Creatinine levels depend on kidney filtration, but also on muscle mass, diet, and certain supplements. Therefore, in a very muscular individual, the eGFR calculated from creatinine requires careful interpretation.
Cystatin C provides a less muscle-mass-dependent estimate. Depending on the situation, a calculation combining creatinine and cystatin C improves accuracy. Albuminuria measurement completes the assessment when renal impairment is suspected.
Testosterone, SHBG, LH and FSH
Total testosterone measures circulating testosterone. The result provides information about this hormone; the activity of other anabolic agents requires separate evaluation. SHBG and, when necessary, calculated free testosterone clarify the interpretation of a total value.
LH and FSH provide information about pituitary signals. Their suppression is expected during androgen exposure. After cessation, their evolution in relation to testosterone and symptoms helps assess the resumption of the hormonal axis.
Estradiol and prolactin
Estradiol plays a role in sexual function and bone health. Its levels should be interpreted in light of exposure to flavored products, the laboratory method used, and symptoms. Water retention, mood swings, and sexual dysfunction have several possible causes.
Prolactin levels are measured when clinically warranted, for example, in cases of certain sexual dysfunctions or breast discharge. Stress during the blood draw and medications can also influence the result. An abnormal result requires interpretation before any treatment decision is made.
Blood glucose and HbA1c
Blood glucose levels describe the glucose level at the time of sampling. HbA1c reflects the average level over the previous two to three months. It therefore provides a different perspective, particularly useful in cases of exposure to growth hormone or in the presence of metabolic risk.Active exposure
Blood tests during a steroid cycle
During exposure, monitoring is carried out to identify any deviations from the initial assessment and any abnormalities requiring intervention. Priority examinations include complete blood count, lipids, liver function, kidney function, and blood pressure, with additional tests depending on the substances involved and symptoms observed.
- Oral products: special attention to lipids and liver function tests, depending on the molecule.
- Androgen exposure: monitoring of hematocrit, hemoglobin and blood pressure.
- Aromatic products: estradiol when its dosage answers a clinical question.
- Growth hormone: blood glucose and HbA1c, with IGF-1 according to the monitoring objective.
The timing depends on the duration of action of the substances, changes in exposure, and previous results. To compare injectable hormone levels, note the time between injection and blood sampling. Any abnormality or symptom warrants early monitoring, regardless of the stability of exposure.After the stop
Assessment after a cycle and after PCT
Post-cessation monitoring has two objectives: to check the evolution of general parameters and to assess autonomous hormone production. These two assessments sometimes follow different schedules.
Recheck the anomalies
Compare the modified parameters to the baseline assessment and to their most unfavorable value during exposure. Monitoring for elevated hematocrit, a degraded lipid profile, or liver abnormalities begins as clinically necessary, either immediately upon cessation or beforehand.
Assess hormonal recovery
In men, morning testosterone, LH, and FSH are the main markers. SHBG, free testosterone, and estradiol complete the assessment depending on the situation. A sperm analysis is added to the monitoring for fertility treatment.
Consider hCG and SERMs
Clomifene and tamoxifen alter hormonal axis signals during their action. hCG stimulates LH receptors in the testicles and increases testosterone production. An assessment performed while these medications are in use provides information on the response during treatment.
To assess self-recovery, the prescriber considers the last dose of each substance, its duration of action, and its active metabolites. Record the discontinuation dates for anabolic steroids, hCG, and SERMs. Long-acting injectable preparations prolong exposure after the last injection.
Low testosterone is confirmed by a new morning test under appropriate conditions, with interpretation of symptoms. Repeated results allow monitoring of the trend. Hormonal recovery and fertility recovery sometimes follow different rhythms.Useful comparisons
Errors that complicate the reading of the balance sheet
Limit monitoring to hormones
Supplement the hormonal assessment with relevant cardiovascular, hepatic, and renal parameters. A satisfactory testosterone result leaves these dimensions to be evaluated separately.
Compare different conditions
Check the timing, the required fasting period, recent training, the time since the last dose, and the units. The same laboratory facilitates monitoring; in case of changes, refer to the reference methods and intervals.
Modify multiple variables without noting them
Keep track of the dates of changes to medications, supplements, diet, and training. This timeline helps interpret results, even when multiple factors have changed simultaneously.
Conclude recovery on a single value
The conclusion is based on symptoms, the evolution of several markers, and the remaining effects of medication. Reassuring results, however, remain a partial snapshot of the patient’s health.
References
- Fasting for a Blood Test. MedlinePlus.
- Muscular Exercise Can Cause Highly Pathological Liver Function Tests in Healthy Men. Pettersson et al., 2008.
- Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. Bhasin et al., 2018.
- Essential blood testing in the patient using androgenic anabolic steroids: a clinical practice guideline for primary care. Gibbons et al., 2024.
- Fasting Is Not Routinely Required for Determination of a Lipid Profile. EAS/EFLM consensus, 2016.
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
- Hemoglobin A1C (HbA1c) Test. MedlinePlus.
- Diagnosis and Management of Anabolic Androgenic Steroid Use. Anawalt, 2019.