Health checks for AAS users
Clinical tests provide information to assess and diagnose a patient's health.
Prospective anabolic steroid users should undergo a specific medical evaluation of their overall health status and identify possible medical conditions that may put them at risk before beginning an Anabolic Androgenic Steroid (AAS) cycle.
You may be affected by conditions that have no obvious symptoms and can only be detected through clinical diagnostic testing. (1)
Entering a cycle cycle will put stress on vital organs such as the heart, liver, and kidneys.
Side effects and possible tissue damage can vary depending on many parameters, including age, time of steroid abuse, AAS/PED dosage, type of AAS, pharmaceutical form, number of other AAS used simultaneously or consecutively (stacking), lifestyle, proper nutrition and supplements, medical precautions, presence of underlying congenital abnormalities, family history (genetic predisposition), etc. [2]
Hyperlipidemia, transaminemia , polycythemia, and anemia are among the most common distortions.
On the other hand, during the course of a cycle, the situation may worsen further, forcing the user to discontinue the cycle.
After the PCT at the end of the cycle, AAS users are obliged to undergo certain clinical tests (biochemical and hormonal) to monitor their health status and possible unwanted effects. [2,3,4,5]
Clinical Tests Before and After a Steroid Cycle
Clinical tests should be performed before or after a cycle, not during a cycle, unless there are serious medical reasons.
Evaluations include
blood/urine tests (blood/urine tests)
- Hematologic profile (complete blood count CBC, including differential):
Hematocrit (Hct), hemoglobin (Hgb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), percentage and absolute differential counts, platelet count, red blood cell count, white blood cell count, iron (Fe), ferritin (Fer), folate (Folate) cyanocobalamin (B12)
- Renal profile:
Urea (min), creatinine (creat), 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 (LPA), apolipoprotein A (Apo A), and 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, glycosylated hemoglobin (HbA1c), total protein, albumin (ALB), globulins, 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 a variety of tissues (skeletal, heart muscle). The test is not specific for the type of enzyme that is elevated; the lab can distinguish between different components of this enzyme. For example, the fraction from skeletal muscle is called CK-MM and the fraction from cardiac muscle is designated CK-MB.
- Coagulation tests:
INR, activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB).
- Hormonal profile (HPTA, spermatogenesis, libido, and fertility assessment):
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 during the morning hours, as levels are highest. [6,7]
- Thyroid profile:
Thyroid stimulating hormone (TSH), thyroxine (T4), free T4 (FT4), and triiodothyronine (T3).
Free T3 (FT3), Anti-T3 (ANTI-TPΟ), Anti-TG (ANTI TG), Thyroid U/S.
Thyroid metabolism is detected, reflecting all scenarios of thyroid metabolism, adequate thyroid function, thyroid size, or possible nodules.
- Tumor markers
Carcinoembryonic antigen (CEA)
CA 19/9
Alpha-fetoprotein (AFP)
Prostate-specific antigen (PSA) and free PSA.
A variety of tumor markers have been characterized and used in the clinic.
Some are associated with only one type of cancer, while other tumor markers are associated with more than one type of cancer.
Tumor markers are reflected in specific tissues such as lungs, testes, colon, prostate, and internal organs.
Tumor markers (CEA, AFP, PSA, CA 19-9) are reliable for the assessment of certain diseases as well as in cases of specific inflammation.
However, somatropin, somatomedin C, transforming growth factor, follistatin, and GHRH peptides are useful for those who want to use growth factors (HGH, IGF1, FST, MGF peptides), since they are responsible for cell growth, causing proliferation, tissue growth, and ultimately carcinogenesis of cancer.
There are some limitations to the use of tumor markers.
Sometimes non-cancerous conditions can cause increased levels of certain tumor markers.
Also, not everyone who has a certain type of cancer has high levels of the tumor markers associated with that cancer.
Also, tumor marker levels have not been identified for every type of cancer.
Tumor markers are used to detect, diagnose, and manage some types of cancer, such as inflammatory diseases (cancer is the result of chronic inflammation), and while high levels of tumor markers may suggest the presence of cancer, this alone is not enough to diagnose cancer.
Therefore, tumor marker measurements are usually combined with other tests such as biopsies, CT, etc. [8]
All of these clinical tests should be performed after a 12-hour fast with adequate hydration.
Cholesterol flakes and triglyceride monitoring require a clean diet the day before to properly measure the results.
cardiovascular assessment (cardiovascular assessment)
A typical cardiovascular screening includes the following
- Check your blood pressure
- Take a chest cavity frontal x-ray to see the shape of the heart (frontal image) and assess the cardiothoracic index.
- Electrocardiogram (ECG): Checks for recent or previous acute myocardial infarction (AMI), arrhythmias (ventricular or atrial), and left ventricular hypertrophy (LVH).
- Echocardiogram (Triplex U/S), which can show all ventricles, the size and function of the valves (estimated ejection fraction), and the presence of structural abnormalities in the myocardium. In addition, the morphology and function of the ascending aorta and aortic arch are described and tested.
Cardiovascular abnormalities such as hypertrophic cardiomyopathy, right ventricular cardiomyopathy (cardiomyopathy), and congenital coronary artery malformations are usually asymptomatic until a fatal arrhythmia occurs, but in some cases can be detected with careful cardiovascular testing. [9]
- If necessary, a 24-hour Holter monitoring (heart rate, rhythm, blood pressure), stress test/ultrasound (U/S), or coronary magnetic resonance imaging (CMR), also known as cardiac MRI, may be performed.
Coronary MRI is superior to other imaging techniques.
It plays a key role in the evidence-based diagnosis and treatment pathway for cardiovascular disease.
It includes the evaluation of conditions such as myocardial ischemia and , cardiomyopathy, myocarditis, vascular disease (endothelial dysfunction), which are side effects of AAS abuse.
It is the reference standard for the evaluation of cardiac structure and function and is useful in the diagnosis and surgical planning of heart disease. [10]
imaging studies (imaging studies)
Ultrasound (U/S) and computed tomography (C/T) of the abdominal cavity can detect fatty liver (NAFLD), hepatic peliosis, liver/biliary tumors, adenomas, or hepatocellular carcinoma (liver tumors).
If the presence of prostate cancer needs to be ruled out, a pelvic MRI may be performed to complement other imaging techniques.
"This screening should be done once a year."
- Htc: polycythemia due to AAS abuse, smoking, dehydration (false elevation due to increased plasma concentrations), living at high altitude (>2000m)
- Urea: Positive nitrogen balance-anemia, dehydration, renal failure
- Creatinine: Rhabdomyolysis (CPK>1000), increased creatine intake (>10 gr/day), high intake of red meat, increased muscle mass (BMI>30), non-steroidal anti-inflammatory drug (NSAID) abuse, renal failure, glomerular sclerosis, tubular necrosis, aminoglycoside antibiotic use
- Uric acid: Involved in the metabolism of purines, increased intake of animal protein,gout
- SGOT (AST), SGPT (ALT): 17 alkylated per OS AAS abuse (pharmaceutical hepatitis), acetaminophen abuse, rhabdomyolysis, overtraining, alcohol consumption
- yGT, ALP: cholestasis-jaundice, alcoholism, cirrhosis
- Total/conjugated bilirubin: jaundice, cirrhosis, pharmaceutical hepatitis, hemolysis
- LDL, total cholesterol: dyslipidemia, atherosclerosis, consumption of SFAs, absence of EFAs (Ω-3,6,9),
- Triglycerides: DHA, absence of EPA (omega-3 PUFA)
- Homocysteine: AAS abuse and high risk of cardiovascular/cerebrovascular events, low B12, folate
- Ammonia Cirrhosis, severe hepatitis, renal failure, high protein intake
- Glucose, HbA1c: type 2 diabetes, metabolic syndrome, insulin resistance
- INR: AAS abuse
- CPK: Rhabdomyolysis, overtraining, cocaine use
- B12: Decreased levels corresponding to megaloblastic anemia (cyanocobalamin deficiency) due to malnutrition or alcoholism
- TSH: Hypothyroidism
- T3, T4: hyperthyroidism
- CEA, AFP, Ca 19-9: Tumors of the lungs, testes (seminal vesicles), large intestine (bowel), and internal organs (liver, bile, pancreas, stomach)
- PSA/No PSA: Benign prostatic hyperplasia, prostatitis
Clinical testing is very important for athletes who abuse AAS, and doctors should provide accurate information and provide this monitoring.
Each doctor has an obligation to inform their patients how to stay healthy.
Evaluation is important to first determine the user's current health status and risks before starting a cycle, then to assess the direct effects of AAS/PED use, and finally to evaluate any distortion or recovery of the original health status.
However, laboratory data is not a substitute for a good physical examination and patient history, and clinicians should treat the patient, not just the laboratory results.
reference
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Fallon Ke. Br J Sports Med. May 2008; 42(5):334-7
2. Anabolic male hormone steroids
Outpatient Clinic for Users: Overview. Smit DL, de Ronde W. Ness J Med. May 2018; 76(4):167
3.Excessive testosterone use among bodybuilders: an uncommon group of illicit substance users. Westerman ME, Charchenko CM, Ziegelmann MJ, Bailey GC, Nippoldt TB, Trost L. Mayo Clin Proc. 2016;91:175-82
4. Hepatotoxicity associated with illegal use of anabolic androgenic steroids in doping.R. Solimini,
MC Rotolo, et al. Eur Rev Med Pharmacol Sci 2017; 21 (1 supply): 7-16
5. Cardiac and metabolic effects of anabolic-androgenic steroid abuse on lipids, blood pressure, left ventricular dimensions and rhythm. Achar S, Rostamian A, Narayan SM. This is J Cardiol. September 15, 2010; 106(6): 893-901.
6. Adverse health effects of performance-enhancing drugs: Endocrine Society scientific statement. Pope HG Jr., Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Endocr Rev. 2014;35:341-75.
7. Combined effects of androgenic anabolic steroids and physical activity on the hypothalamic-pituitary-gonadal axis. Hengevoss J, et al. J Steroid Biochem Mol Biol. June 2015; 150:86-96.
8. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet <
9.Cardiovascular manifestations of anabolic steroids in relation to demographic variables in bodybuilding athletes. FarzadGheslaghi, et al. J Res Med Sci. February 2015; 20(2): 165–168.
Representation of cardiovascular magnetic resonance in the AHA/ACC guidelines. von Knobelsdorff-Brenkenhoff F, Pilz G, Schulz-Menger J. J Cardiovasc Magn Reson. September 25, 2017 19(1):70.
