Essential Bloodwork for Bodybuilders Using Steroids and PEDs

I use Ulta Labs for all my bloodwork. They are cheap and available in most states. 

RECOMMEND TESTS

• BASELINE HEALTH: 

  • INCLUDES: CBC, CMP, A1C, Liver, Electrolytes, TSH, Ferritin, Lipids, GGT

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• ADVANCED HEALTH (BEST): 

  • INCLUDES BASELINE Plus; Full Thyroid, Vitamin D, CRP, SHBG, Urinalysis

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• RECOMMENDED EXTRAS: 

• Ultra-Sensitive Estradiol:

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  • Cystatin C Kidney Test: 

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  • Apo-B

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• OPTIONAL EXTRAS

  • Testosterone (Free & Total)

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  • IGF-1

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Daily At-Home Monitoring

Why: Daily tracking lets you catch problems (BP, glucose) long before they show up as organ damage on labs or imaging. For PED users who push food, bodyweight, and drugs, this is your earliest warning system.

• Blood Pressure – daily

  • Check once a day, seated, relaxed 5+ minutes, same arm, same time.

  • Log it (notes app / sheet). Look for sustained elevations, not one-off spikes.

  • Resting Heart Rate

• Fasting Glucose – daily

  • Fingerstick every morning before food/caffeine.

  • You care about trends over weeks (e.g., 85 → 95 → 105 → 110), not a single hit. We monitor this to look for the effects of insulin resistance from pushing food and HGH use. 

  • If you want more detailed monitoring, you can consider a CGM

Baseline Labwork 

Comprehensive Metabolic Panel (CMP) + Urinalysis

Why: Together, they tell you how your kidneys, liver, fluids, and electrolytes are handling high food intake, PEDs, dehydration, and heavy training. Urine can show early kidney damage before eGFR drops. 

Kidney Profile (blood)

• BUN (Urea Nitrogen) – protein metabolism + perfusion/hydration.

• Creatinine, Serum – more specific kidney filtration marker (may run “high-ish” in very muscular lifters; trends matter).

• BUN / Creatinine Ratio – helps separate dehydration/low kidney perfusion from other issues

• eGFR (Estimated GFR) – overall filtering capacity of the kidneys.

• Cystatin-C: The most accurate blood panel we have to assess kidney function in bodybuilders.

Urinalysis (urine)

• Basic urinalysis: looks for protein, blood, glucose, ketones for signs of early kidney damage (albumin/protein leaking into urine) before eGFR drops.

Liver Panel (part of CMP)

Why: Oral steroids, high-dose injectables, alcohol, and supplements can all injure the liver and bile ducts. The liver panel is your stress gauge for that system.

• Total Protein – with albumin, reflects nutrition and liver function.

• Albumin – major blood protein; chronically low can signal liver disease, inflammation, or poor nutrition.

• Globulin, Total – immune-related proteins, including antibodies.

• Albumin / Globulin Ratio – overall pattern of albumin vs. globulins, shifts with chronic disease/inflammation.

• Bilirubin, Total – high levels signal liver dysfunction or bile obstruction; very high = jaundice.

• Alkaline Phosphatase (ALP) – from liver and bone; up with bile duct issues or bone turnover.

• AST (SGOT) – enzyme in liver, muscle, heart; up with liver injury or heavy muscle damage.
  ALT (SGPT) – more liver-specific; persistent elevation is a red flag for hepatotoxicity (e.g., strong orals).

• GGT – very useful to confirm liver/bile duct stress, especially when AST/ALT are borderline. ALT/AST can be falsely elevated due to exercise. 

Lipid Panel + ApoB

Why: AAS users often get awful lipids. Some of this is diet. Some of it is PED choices. Some of it is genetics. Crushed HDL, elevated LDL combined with high blood pressure drives atherosclerosis. ApoB tells you the number of atherogenic particles, which may predict risk better than LDL alone. 

• Total Cholesterol

• Triglycerides: Often skewed when there is insulin resistance or poor diet. 

• HDL (“good”): Suppression for oral and DHT based steroids. 

• LDL (“bad”): Partly genetics and partly from high fat diets. PED use further skews it. 

• Total Cholesterol / HDL Ratio – quick risk snapshot.

• Apolipoprotein B (ApoB): The strongest predictor we have of cholesterol risk

Thyroid Panel with TSH

Why: Thyroid hormones influence metabolism, heart rate, energy, and weight regulation. On top of PEDs and stimulants, an abnormal thyroid can quietly amplify strain on the heart and nervous system. Growth hormone and Tren use can affect T4, T3 Uptake, and TSH. 

• Panel includes:

  • TSH

  • T3 Uptake

  • T4

  • Free Thyroxine Index (T7)

CBC with Differential & Platelets

Why: PEDs (especially androgens/EPO-type effects) can thicken the blood and alter immune cells. The CBC measures oxygen-carrying capacity, blood thickness, infection, and clotting potential.

• RBC, Hemoglobin, Hematocrit – erythrocytosis (high HCT) = thicker blood, higher clot risk.

• WBC + Differential – infection, inflammation, immune stress.

• Platelets – too high or too low both raise risk of problems.

Mineral & Bone: Iron, Calcium, Phosphorus

Why: These relate to bone health, muscle contraction, and anemia—all important when you’re training hard and repeatedly dieting/bulking.

• Total Iron

• Calcium

• Phosphorus

Sex Hormones 

Why: You’re literally manipulating this axis. You need to know how hard you’re suppressing yourself and whether your cruise/PCT is actually restoring anything.

• Total & Free Testosterone (OPTIONAL)

• LH, FSH (pituitary signals) (OPTIONAL)

• Estradiol (E2) – sensitive assay

  • Estrogen is the hormone that seems to cause the most problems and is most often skewed in PED users. 

• Prolactin, SHBG, DHEA-S depending on compounds used. Only if needed. 

Cardiovascular Imaging & Tests

Why: PED use + bad lipids + high BP = higher risk of LV hypertrophy, cardiomyopathy, arrhythmias, and early coronary disease. Imaging looks at the actual heart structure and coronary plaque, not just blood surrogates. I can think of many bodybuilders who would have saved their lives with this testing. 

• Echocardiogram – every 2-4 years

  • Assesses LV size/wall thickness, ejection fraction, diastolic function, and valves.

• ECG / EKG – every year

  • Screens for arrhythmias, conduction issues, QT prolongation, etc.

• Coronary Artery Calcium CT (CAC) – every 2-4 years

  • Quantifies calcified plaque burden in coronary arteries.

  • Useful to stratify long-term risk in someone with years of PED use and high lipids.

• Carotid Ultrasound (Neck Arteries) every 2-4 years

  • The scan measures carotid intima–media thickness (cIMT) and looks for plaques in the vessel wall.

  • More thickness and plaque = more atherosclerosis, which correlates with a higher risk of heart attack and stroke, even if your basic labs aren’t horrible.

  • Gives a “real-world” picture of risk beyond labs

• Aortic Ultrasound (Usually Abdominal Aorta) every 2-4 years

  • Screens for abdominal aortic aneurysm (AAA)

    • This would have saved Boston Lloyd's life

Red-Flag Changes

• Hematocrit north of 55

• Hemoglobin north of 18

• RBC North of 6

• Persistent jumps in AST, ALT, north of 80 (outside contest prep) 

• GGT, ALP, and bilirubin are increasing

• Creatinine 1.4 or climbing

• Falling eGFR

• Changes in cystatin C

• New or worsening protein/albumin in urine on urinalysis.

• HDL below 30 outside contest prep, 

• LDL higher than 100 is a cause changes. 150 or above is cause for concern

• ApoB 80 or below is optimal. Over 100 is a problem. 

• Blood pressure consistently over 130/80

• Fasting glucose consistently over 100 and/or A1c 5.7 trending upward over months.

• Estradiol above 60 or below 10

• Low ferritin from GLP1 use or blood donations