What laboratory tests should be ordered for a patient suspected of using trenbolone?

Laboratory Testing for Suspected Trenbolone Use

For a patient suspected of using trenbolone, order urine testing with liquid chromatography-tandem mass spectrometry (LC-MS/MS) targeting trenbolone metabolites, along with baseline cardiovascular and metabolic screening labs given the serious cardiac risks associated with anabolic steroid abuse.

Primary Diagnostic Testing

Urine-Based Trenbolone Detection

• Urine is the specimen of choice for detecting trenbolone use, as metabolites are primarily excreted renally with 54% of administered dose appearing in urine within 26 hours and 63% within 72 hours 1
• LC-MS/MS is the gold standard analytical method for trenbolone detection, with limits of detection ranging from 0.3-3 ng/mL 2
• Target the following key metabolites in urine:
  • 17α-trenbolone and 17β-trenbolone (primary metabolites found predominantly as glucuronide conjugates) 1
  • Epitrenbolone and epitrenbolone glucuronide 3
  • Trenbolone glucuronide 3
  • Trendione (oxidized metabolite) 1
  • Trenbolone-diol and trenbolone-diketone derivatives (detected as glucuronic acid and sulfo-conjugates with detection windows of 5-6 days) 3

Sample Processing Requirements

• Request enzymatic hydrolysis to detect glucuronide-conjugated metabolites, which represent 54% of urinary excretion 1
• Include analysis of unconjugated, glucuronic acid-conjugated, sulfo-conjugated, and alkaline-labile conjugated steroid metabolites for comprehensive detection 3
• At least 20 different trenbolone metabolites have been identified, including potential cysteine-conjugates 3

Essential Cardiovascular and Metabolic Screening

Cardiac Assessment (Critical Priority)

Given that repetitive trenbolone misuse causes advanced heart failure and cardiomegaly 4:

• 12-lead electrocardiogram to evaluate for cardiac abnormalities, arrhythmias, and structural changes 5
• Cardiac biomarkers: Troponin levels to assess for myocardial injury 5
• Echocardiography should be strongly considered given the association with cardiomegaly and heart failure in chronic users 4
• Blood pressure measurement (3 successive measurements 10 minutes apart) 5

Comprehensive Metabolic Panel

• Serum electrolytes (sodium, potassium) 6, 7
• Serum calcium and magnesium 6
• Liver function tests (AST, ALT, alkaline phosphatase) to assess hepatotoxicity 5, 6
• Serum creatinine with eGFR to evaluate renal function 6, 7
• Blood urea nitrogen 6
• Fasting glucose or HbA1c to screen for metabolic dysfunction 6, 7

Lipid and Hematologic Assessment

• Fasting lipid profile including LDL cholesterol, as anabolic steroids adversely affect lipid metabolism 6, 7
• Complete blood count with differential to detect polycythemia (common with anabolic steroid use) and other hematologic abnormalities 6, 7

Endocrine Evaluation

• Total testosterone level (morning sample preferred) to assess for suppression of endogenous testosterone production 5
• Luteinizing hormone (LH) if testosterone is low, as trenbolone has potent antigonadotropic effects 8
• Thyroid-stimulating hormone (TSH) as part of comprehensive endocrine screening 6

Additional Screening

• Urinalysis to detect proteinuria and assess renal function 6, 7
• Coagulation studies (PT/INR, aPTT) if bleeding history or abnormal findings suggest coagulopathy 5

Alternative Specimen Testing

Hair Analysis for Chronic Use Documentation

• Hair testing can document repetitive exposure with trenbolone concentrations measured in pg/mg 4
• Hair analysis provides a longer detection window compared to urine and can establish patterns of chronic use 4
• Concentrations of 9 pg/mg in hair have been documented in chronic users 4

Blood Testing (Limited Utility)

• Blood concentrations are significantly lower than urine (femoral blood: 3.9 ng/mL, cardiac blood: 3.2 ng/mL) 4
• Blood testing is less sensitive than urine for detecting trenbolone use 4
• Consider blood testing only when urine is unavailable or for acute intoxication assessment 4

Critical Clinical Considerations

Detection Window Limitations

• Main metabolites (trenbolone-diol and trenbolone-diketone derivatives) have detection windows of only 5-6 days 3
• Timing of sample collection is crucial—samples should be obtained as soon as possible after suspected use 3
• Glucuronide conjugates provide the longest detection window 1

Androgenic and Metabolic Effects

• Trenbolone has three times the androgenic potency of testosterone propionate with an anabolic/androgenic dissociation index of only 2-3 8
• The compound exhibits potent antigonadotropic activity exceeding testosterone by a factor of 3, causing suppression of spermatogenesis and gonadal function 8
• Virilization symptoms may be present in users, warranting physical examination for acanthosis nigricans, hirsutism, and other androgenic effects 5

Cardiovascular Risk Stratification

• Heart failure is a documented consequence of repetitive trenbolone misuse, with autopsy findings showing cardiomegaly, visceral congestion, and pulmonary edema 4
• Patients with suspected chronic use require comprehensive cardiovascular evaluation beyond basic screening 4
• Consider stress testing or advanced cardiac imaging if baseline ECG or biomarkers are abnormal 5