What labs would I do for someone with long-term use of anabolic steroids (AAS)?

Laboratory Monitoring for Long-Term Anabolic Steroid Users

For patients with long-term anabolic steroid use, comprehensive laboratory monitoring should include hormone panels, lipid profiles, liver function tests, complete blood count, and cardiac markers to assess for adverse effects on multiple organ systems.

Essential Laboratory Tests

Endocrine Function

• Testosterone (total and free) to assess hypothalamic-pituitary-gonadal (HPG) axis suppression 1
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to evaluate pituitary function 1
• Estradiol levels, as anabolic steroids can be aromatized to estrogens 2
• Thyroid function tests (TSH, free T4) 3
• Morning cortisol to assess adrenal function 3

Metabolic Parameters

• Fasting blood glucose and HbA1c to monitor for steroid-induced hyperglycemia 3
• Random blood glucose measurements (more effective than fasting levels for detecting steroid-induced hyperglycemia) 3
• Lipid profile (total cholesterol, HDL, LDL, triglycerides) as anabolic steroids typically cause dyslipidemia 3

Liver Function

• Comprehensive liver function tests (AST, ALT, GGT, bilirubin, alkaline phosphatase) as anabolic steroids can cause hepatotoxicity 3
• Consider more frequent monitoring if baseline abnormalities exist 3

Cardiovascular Assessment

• Complete blood count with hemoglobin and hematocrit (anabolic steroids can increase erythropoiesis) 3
• Cardiac biomarkers (troponin, BNP) if cardiovascular symptoms are present 3

Renal Function

• Serum creatinine and BUN to assess kidney function 3
• Electrolytes, particularly sodium and potassium 3

Specialized Testing

Bone Health

• Bone mineral density testing via DEXA scan, particularly for patients on prolonged therapy 3
• Vitamin D and calcium levels 3

Psychological Assessment

• Screen for depression and suicidal ideation, as these are common during anabolic steroid withdrawal 4, 5
• Assessment for body image disorders and steroid dependence 5

Monitoring Frequency

• Initial comprehensive baseline assessment 3
• Follow-up testing every 3-6 months during continued use 3
• More frequent monitoring (monthly) during withdrawal period due to risk of hypogonadal symptoms 1
• Extended monitoring for at least 12-24 months after cessation, as hypogonadism can be prolonged 1

Special Considerations

Withdrawal Monitoring

• More intensive monitoring during the withdrawal period for:
  • Persistent hypogonadism (testosterone levels below 200 ng/dl have been observed despite 3-26 months of abstinence) 1
  • Mood disorders including major depressive episodes 5, 1
  • Sexual dysfunction (decreased libido and erectile function) 1

Common Pitfalls to Avoid

• Failing to monitor for psychological symptoms during withdrawal, which can include depression, anxiety, and suicidal ideation 4, 5
• Overlooking the need for extended monitoring after cessation, as hypogonadal symptoms can persist for months to years 1
• Not considering that some patients may require testosterone replacement therapy if natural production does not recover 1
• Neglecting to screen for polypharmacy, as users often take multiple performance-enhancing substances simultaneously 2

By implementing this comprehensive monitoring approach, clinicians can better identify and address the various adverse effects associated with long-term anabolic steroid use, potentially improving morbidity, mortality, and quality of life outcomes for these patients.