Blood Tests Before, During and After Steroid Use: What to Discuss With Your Doctor

Looking strong and feeling well do not reveal everything happening inside your body. Anabolic steroids can affect blood cell counts, cholesterol, hormone production, and organ health before obvious symptoms appear.

Bloodwork helps identify changes that need attention. However, normal results cannot guarantee that steroid use is safe or rule out every complication.

Which tests should you discuss?

The NSW Health monitoring guide includes blood counts, liver and kidney markers, lipids, and reproductive hormones. The appropriate panel depends on your medical history, symptoms, substances used, and previous results.

AssessmentWhat it helps evaluateComplete blood count, including hemoglobin and hematocritIncreased red blood cell concentration and other blood abnormalitiesLiver panelMarkers such as ALT, AST, ALP, and bilirubin that can indicate liver or bile duct problemsKidney assessmentCreatinine, estimated kidney filtration rate, urea, and electrolytesLipid profileHDL, LDL, total cholesterol, and triglyceridesHormone assessmentTestosterone, estradiol, LH, FSH, and sometimes SHBG, depending on the clinical questionBlood pressureCardiovascular risk that a blood panel alone cannot assess

Additional testing may be appropriate. For example, urine albumin testing can help assess kidney damage, while cystatin C may clarify kidney function when creatinine is difficult to interpret in someone with substantial muscle mass. These tests should be selected with your clinician. Learn about kidney health tests.

When should testing happen?

A baseline assessment provides something to compare later results against. Monitoring should continue during use and after stopping, with timing determined by the substances involved, symptoms, and any abnormalities.

Waiting until the end can delay detection of a problem. NSW Health recommends regular follow-up, examination, and investigations during and after anabolic steroid use.

After stopping, hormone tests may help assess recovery. Testosterone results need context, including LH and FSH, the time since the last dose, and any medicines taken afterward. Completing a self-directed post-cycle therapy regimen does not establish that natural hormone production has recovered.

Bloodwork needs careful interpretation

Hard training can elevate some markers commonly associated with liver injury. High muscle mass can also affect creatinine and estimates of kidney function. Tell your clinician about recent training, creatine supplements, medications, and steroid use rather than assuming an abnormal result is harmless.

The clinical guideline on blood testing in anabolic steroid users discusses these interpretation problems and follow-up of abnormal results.

Do you need an echocardiogram?

An echocardiogram examines the heart’s structure and pumping function. It is not a blood test, and there is no universal schedule requiring one after the first cycle and then every year or two.

The American College of Cardiology’s expert approach includes echocardiography in cardiovascular evaluation of steroid users. Your clinician should determine the appropriate assessment and follow-up from your exposure history, symptoms, examination, and findings.

Previous normal results are not permission to skip monitoring

Having tolerated earlier cycles, Clomid, tamoxifen, or an aromatase inhibitor does not establish that future use will be free of complications. Liver and kidney testing should follow clinical need, rather than being dismissed after a few apparently uneventful cycles.

Bloodwork is most useful when results lead to appropriate medical assessment and action. It should never serve as approval to increase doses or add more compounds.