Test before, during and after. Before: full baseline so later results mean something. During: blood pressure daily, hematocrit and lipids every 2–3 months, liver markers if using orals. After: LH, FSH and testosterone to confirm recovery. Three values drive most decisions: blood pressure, hematocrit, HDL.
- A baseline panel before first use is the most valuable test you will ever run; every later value is compared to it.
- Blood pressure, hematocrit and HDL cholesterol change most reliably with androgen use and account for most cardiovascular risk.
- ALT and AST rise after heavy training as well as with orals; GGT and bilirubin tell muscle from liver.
- Creatinine is inflated by muscle mass; cystatin C is the fair kidney marker for lifters.
- Recovery after stopping is confirmed by LH, FSH and testosterone back at your baseline, tested in the morning.
The timeline
| When | What | Why |
|---|---|---|
| Before first use | Full panel below + home blood pressure for a week + ECG | Your reference point. Without it nothing later can be interpreted |
| Every 2–3 months during use | Blood count, lipids, blood pressure log; liver panel if using orals; estradiol if symptoms | Catch the three big movers before they cause harm |
| 4–6 weeks after the compound has cleared | LH, FSH, total and free testosterone, blood count, lipids | First look at recovery; lipids and hematocrit should be heading back |
| 3–4 months after | Same hormones again | Confirms recovery or diagnoses persistent suppression |
| Long-term users, yearly | Echocardiogram, lipids, kidney panel with cystatin C | Structural heart changes do not show in blood |
The panel
| Marker | What it tells you | Act when |
|---|---|---|
| Blood pressure (home) | Cardiovascular load | Persistently > 140/90 |
| Hematocrit, haemoglobin | Blood thickness | Above lab upper limit |
| HDL, LDL, triglycerides | Heart risk; HDL falls, LDL rises, orals worst | HDL falls sharply or LDL climbs |
| ALT, AST, GGT, bilirubin | Liver; GGT and bilirubin separate liver from muscle | GGT up, bilirubin up, dark urine, itching |
| Total and free testosterone, SHBG | Level and what is actually available | Post-use: not back to baseline |
| LH, FSH | Your own signal; near zero during use | Post-use: still suppressed |
| Estradiol | Estrogen from aromatisation | Too high: water, mood, breast tenderness. Too low: joints, libido, lipids |
| Prolactin | Raised by some compounds | Libido and mood problems |
| Creatinine, cystatin C, eGFR | Kidneys; creatinine is inflated by muscle | Cystatin C out of range |
| Fasting glucose, HbA1c | Insulin sensitivity | Rising trend |
| PSA (men over 40) | Prostate | Rising trend |
Reading the tricky ones
Liver enzymes. ALT and AST come from muscle too. A heavy leg day two days before the draw raises both. Normal GGT and bilirubin with raised ALT/AST after training is muscle. Raised GGT, rising bilirubin, dark urine or itching is liver, and urgent.
Creatinine. Made from muscle. More muscle, higher creatinine, and lifters get flagged for kidney disease they do not have. Ask for cystatin C before anyone draws a conclusion.
Testosterone during use. High, obviously. The number itself is not the point; blood pressure, hematocrit and lipids are. Testing testosterone mid-use mainly confirms the product is real.
The three numbers and what fixes them
- Blood pressure: sodium down, body weight in check, cardio three times a week, sleep. If still high, a physician can treat it; hypertension is not a reason to shrug.
- Hematocrit: hydrate before the test, cardio, and if it is above range a physician may arrange blood donation. Not a home remedy; a medical one.
- HDL: avoid or shorten orals, cardio, fibre, fish oil has modest evidence. HDL usually recovers within weeks of stopping orals.
Recovery is a number
Feeling fine is not recovery. Many people feel fine at half their baseline testosterone. Recovery is LH and FSH back in range and testosterone back at your own pre-use value, in the morning, ideally twice. If not there by the time your physician expects, that is anabolic steroid-induced hypogonadism, it is treatable, and treating it early keeps the muscle. What that treatment looks like.
Bring to the doctor
All results, baseline first, in one file. The blood pressure log. What you use and when. A physician who does not know cannot interpret; one who will not engage should be replaced with sports medicine or endocrinology.
Frequently asked questions
How often should I do bloodwork while using?
A common physician schedule: baseline, then every 2–3 months during use, then 4–6 weeks after the compound has cleared, then again after a few months. More often if a value was out of range.
Which results mean stop and see a doctor now?
Hematocrit above the reference range, ALT/AST several times normal with dark urine or yellow skin, blood pressure persistently above 140/90, or chest pain, breathlessness, severe headache at any time. These do not wait for the next scheduled test.
Do I need to fast?
For lipids and glucose, 8–12 hours. Hormones in the morning, when testosterone peaks. No heavy training for 48 hours before, or liver enzymes and creatinine will mislead.
Can I read my own results?
Learn what each marker means and track trends against your baseline. Interpretation and decisions belong to a physician; reference ranges differ between labs and single values mislead.
Why is hematocrit the big one?
Androgens raise red cell production. Above range, blood thickens and clot, stroke and heart attack risk rise. It is the most common reason physicians pause testosterone.
Sources
- Pope HG et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. 2014.
- Baggish AL et al. Cardiovascular toxicity of illicit anabolic-androgenic steroid use. Circulation, 2017.
- Smit DL et al. Health effects of androgen abuse: a review of the HAARLEM study. 2022.
- Rahnema CD et al. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertility and Sterility, 2014.