Tests
1st tests to order
urine toxicology testing
Test
In professional athletes, World Anti-Doping Agency compliant testing of urinary and serum testosterone, dihydrotestosterone, epitestosterone, and their precursors is undertaken at baseline (before the athlete's first competition that has antidoping regulations) and is followed longitudinally.[1]
Exogenous androgens other than testosterone can be detected by gas chromatography with mass spectrometry.
Oral androgens can be detected for 1 month after administration.
Androgens administered by injection may be detectable for 6 to 8 months, and perhaps up to 12 months, post-administration.[48]
Result
positive for exogenous androgens (except testosterone)
testosterone to epitestosterone ratio
Test
In professional athletes, World Anti-Doping Agency compliant testing of urinary and serum testosterone, dihydrotestosterone, epitestosterone, and their precursors is undertaken at baseline (before the athlete's first competition that has antidoping regulations) and is followed longitudinally.[1]
Urinary ratio of testosterone glucuronide to epitestosterone glucuronide is ordered because gas chromatography with mass spectrometry cannot distinguish between endogenous and exogenous testosterone.
Normally the ratio is 1 to 3:1. The World Anti-Doping Agency considers a ratio >4:1 to be positive for "doping" (use of performance-enhancing drugs). Patients taking exogenous testosterone have higher ratios (>6:1).
Result
>6:1 in patients taking exogenous testosterone
serum testosterone, LH, and FSH
Test
There is no practical diagnostic test to detect anabolic-androgenic steroid (AAS) use in the general population.[1] Because AASs suppress circulating gonadotropin concentrations, the most useful of the commonly available tests are measurement of serum testosterone, FSH, and LH concentrations.[1]
AASs inhibit production and release of LH and FSH.
Result
all decreased (if using non-testosterone androgens); high testosterone with decreased FSH and LH (if using testosterone, testosterone precursors, or drugs that increase endogenous testosterone production)
CBC
serum glucose
Test
Should be ordered in all patients with suspected anabolic-androgenic steroid (AAS) use disorder.
AASs tend to increase serum glucose when taken in supratherapeutic doses.
Result
elevated
serum electrolytes
Test
Should be ordered in all patients with suspected anabolic-androgenic steroid (AAS) use disorder (especially athletes who use diuretics).
AASs cause sodium and water retention.
Hypernatremia increases rate of potassium and hydrogen ion excretion.
Metabolic derangements may occur (alkalosis and compensatory respiratory acidosis).
These values are likely to be normal in most athletes.
Result
normal or deranged
lipid panel
Test
Should be ordered in all patients with suspected anabolic-androgenic steroid (AAS) use disorder.
AASs are associated with reduction in serum high-density lipoprotein (HDL) cholesterol concentrations and an increase in low-density lipoprotein (LDL) cholesterol.[6]
These effects are particularly observed with orally active AASs and are less prominent with injectable AASs.
Result
low HDL, raised LDL
LFTs
Test
Should be ordered in all patients with suspected anabolic-androgenic steroid (AAS) use disorder.
AST or ALT may be elevated indicating liver damage (rare) or breakdown of skeletal muscle (common).[6]
Gamma-GT is unique to the liver; therefore, elevated gamma-GT in an AAS user should raise a genuine concern of liver damage. It is reported to be the most distinctive enzyme for the detection of hepatic dysfunction in exercising patients.[49]
Result
elevated
creatine kinase
hepatitis serology
Emerging tests
nuclear medicine cardiovascular imaging
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