Monitoring health markers whilst using Performance-Enhancing Drugs

As a 10-year performance-enhancing drug user and a coach who has dealt with 100s of enhanced clients, I can confidently say that monitoring health markers is absolutely paramount as a performance-enhancing drug (PED) user.

Amongst all the positives that are often highlighted about PED use, particularly in the modern age of social media, it is often forgotten about or a blind eye is turned on to the plethora of negative health consequences that are often accompanied by desirable effects of PEDs.

Some of these negative side effects include but are not limited to:

• High blood pressure
• Changes in lipid metabolism leading to changes in both HDL and non-HDL cholesterol levels
• Negative impacts on sexual function, both a lack of or undesirably high sex drive, erectile dysfunction in males, and changes in size and sensitivity of the clitoris in females.
• Negative impacts on mood
• Impaired kidney function
• Disruption of the Hypothalamus-Pituitary-Gonadal axis leading to both acute and potentially chronic loss of function
• Impaired liver function
• Skewed blood counts including increases in red cell counts, haemoglobin, and haematocrit. White cell markers may also become skewed in an immune response to certain products, particularly those using harsh solvents that cause acute inflammation
• Negative cardiac tissue modelling such as left ventricular hypertrophy and global cardiac myopathy. Negative change in neurotransmitters and general brain chemistry.

Someone who chooses to embark on the performance-enhancing drugs route, whether they intend to or not initially, will typically end up using these compounds for a large portion of their life. Whilst most acute side effects and short-term use of these drugs are fairly innocuous, long-term use presents additional risks that must be monitored closely if one is at all concerned for their longevity. Most health issues PED users run into come from chronic changes in baseline physiology that then lead to pathological issues down the line, often most of which can be mitigated with consistent health marker monitoring and early intervention and lifestyle changes before they ever become a real concern to someone’s health. In the worst-case scenario, with constant health monitoring, you are at least able to find a health issue quickly and remove the pharmacological insults quickly and treat the health issue before it develops into something that may potentially be no longer treatable and greatly improve one’s chance at maintaining good health beyond your years of PED use.

Essential (bare minimum) health markers to watch:

• At least once per week blood pressure check
• Echocardiograms to monitor for changes in structure and function of the heart every 1-2 years
• Organ ultrasounds such as liver and kidney markers, as certain blood markers relating to these can often be skewed in heavily muscled individuals and athletes. Whilst it may be normal for certain blood markers to elevate, it’s always best practice to rule out more sinister causes of blood marker elevations such as ALT, AST, and creatine with imaging. Every 1-2 years
• Urine albumin-creatinine ratio to monitor for excess albumin or creatinine leakage at the kidney, indicating sub-par kidney function. Every 3-6 months
• Full lipid panel including a once-off check of LP(a), a genetically determined lipoprotein which is currently non-modifiable and is an independent risk factor to all other APO-B (all lipoproteins capable of becoming bound to the arterial wall and beginning the process of a calcium deposit forming) containing lipoproteins. On top of this, monitoring APO-B itself and targeting numbers typically below the standard reference range as a counter to the plethora of increased risk factors PEDs bring around increased risk of calcium deposits due to increases in blood pressure, reduction in HDL (very hard to avoid), and massive increases in oxidative stress as a result of both hard training and PED use, androgen use in particular. Every 3-4 months (LP(a) only once).
• Electrolyte, urea, creatinine blood panel and Cystatin C for an EGFR calculation that is not skewed by normal physiological changes in creatinine that occur from intense training and carry large amounts of muscle tissue. Every 3-4 months.
• HbA1c to monitor long-term blood glucose management.
• Full thyroid panel to monitor for changes in thyroid function which can be altered when using certain compounds. Every 3-4 months.
• Full hormone panel to check for hormonal imbalances as a result of exogenous hormone use.You may also want to test oestrogen via liquid chromatography mass spectrometry (LCMS) as certain androgens will falsely test as E2 on a standard assay. Every 3-4 months or anytime adjusting exogenous hormone doses.

Now that you have your results, it’s time to talk to someone who can interpret and monitor them for you as well as give you actionable advice on how to manage your health markers. It is important to not only look at a single health test in isolation but to also compare it to old tests to identify trends and help pick up on things that may become an issue in the future early.

Whilst it will never be safe to use PEDs, there are certainly plenty of measures one can take to mitigate some of the risk involved. I truly hope anyone who is currently or planning to use PEDs can walk away after reading this better equipped at taking the correct steps towards safer use via regular health monitoring.