Performance and Enhancing Drugs (PEDs)#

• Harm-reduction laboratory monitoring - bloodwork to track the health effects of PED use on your hormones, blood cells, kidney function, liver function, lipids, and cardiovascular markers.
• Echocardiogram requisitions when clinically appropriate.
• Infectious-disease screening (HIV, hepatitis B, hepatitis C) when there's an injection-equipment-sharing history or risk.
• Education and counselling about test results, what abnormal values mean, and what to do next.
• A non-judgmental, confidential environment in which to share what you're using so the right tests can be ordered.

• TeleTest does not prescribe PEDs of any kind - no anabolic-androgenic steroids, no growth hormone or growth-hormone peptides, no SARMs, no thermogenic compounds.
• TeleTest does not prescribe post-cycle therapy (PCT) - no SERMs, aromatase inhibitors, or HCG protocols tailored to a PED cycle.
• TeleTest does not prescribe beta-blockers or other supportive medication for managing PED-related effects.
• TeleTest does not provide PED dosing advice, cycle planning, or stack recommendations.
• TeleTest does not perform in-person physical exams - which are an important part of safe PED use and need to be obtained from a walk-in clinic, family doctor, or specialist.

If you are seeking prescriptions related to PED use, that conversation belongs with an endocrinologist or another in-person specialist.

Harm reduction is an approach to substance use that focuses on reducing harm without requiring abstinence. It assumes the patient is making their own decisions about their body and supports them with information, monitoring, and safer-use guidance so they can recognise and address adverse health effects early.

In the PED context, that means bloodwork to detect changes in hormones, blood cells, liver markers, kidney function, lipids, and cardiovascular health. Detecting these changes early lets a user adjust dose, take a break, or stop a particular compound before more serious damage develops.

PED use is associated with real, documented health risks - cardiac changes, liver injury, hormonal axis suppression, mood and dependency issues, infection risk from injection equipment. Many users do not feel comfortable discussing their use with a family doctor or walk-in clinician, which leaves them without monitoring.

Our goal is to make evidence-based monitoring accessible in a confidential, non-judgmental setting so users can make informed decisions. Offering monitoring is not an endorsement or promotion of PED use.

The PED harm-reduction panel is specifically for current users. If you're not currently using PEDs and want a general hormone or men's health check, the standard men's health or hormone panels are a better fit. The PED panel orders tests in a configuration that's tailored to active use and may include tests that wouldn't be appropriate or insured outside of that context.

PEDs can produce changes that a blood test cannot detect on its own - particularly:

• Blood pressure - elevated blood pressure is common with several PED classes and is one of the strongest predictors of cardiovascular risk. You need a blood-pressure measurement. Home cuffs are useful; pharmacy or walk-in clinic measurements are also fine.
• Cardiovascular exam - heart rate, heart rhythm, signs of fluid retention. Several PED classes are associated with left ventricular hypertrophy (LVH) and increased risk of sudden cardiac death.
• Abdominal exam - signs of liver enlargement or other abdominal abnormalities. Particularly relevant for oral anabolic steroids, which carry hepatic (liver) risk.
• Skin exam - signs of androgenic side effects, injection-site issues, or skin infections.

TeleTest does not have physical offices and does not perform physical exams. Use a walk-in clinic, your family doctor, or another local provider to get a physical exam at least once a year, plus a blood-pressure measurement at intervals.

No. TeleTest is virtual-only. We can issue requisitions for laboratory testing and certain imaging studies (e.g., echocardiograms), which you complete at the appropriate facility in person.

• Cardiovascular - high blood pressure, left ventricular hypertrophy, premature atherosclerosis, increased risk of sudden cardiac death. Risks rise with dose, duration, and concurrent stimulant use.
• Hepatic (liver) - liver injury, cholestasis, rarely liver tumours. Highest risk with oral anabolic-androgenic steroids; lower with injectable forms.
• Hormonal axis suppression - the body's own testosterone production shuts down on anabolic-androgenic steroid use. Recovery after stopping is variable and may take months to years; in some users, recovery is incomplete (a condition called Anabolic Steroid-Induced Hypogonadism, ASIH).
• Infertility - reduced or absent sperm production while on anabolic-androgenic steroids. Often reversible after stopping but not guaranteed.
• Testicular atrophy - shrinkage from prolonged suppression.
• Gynecomastia - breast tissue development in males, from conversion of androgens to estrogen.
• Polycythemia - elevated red-blood-cell count, increasing blood-clot and stroke risk.
• Mood and behavioural - irritability, aggression, depression, anxiety, sleep disturbance. Some users develop dependency or withdrawal symptoms.
• Skin and hair - acne, oily skin, accelerated hair loss in genetically predisposed users.
• Injection-related - localised infections, abscesses, transmission of blood-borne infections (HIV, hepatitis) from shared or unsterile equipment.
• For SARMs and unregulated compounds - product purity is a major issue. Many products marketed as one substance test as containing different or contaminated compounds. Long-term safety data is limited.
• For thermogenic compounds (e.g., DNP) - dangerous body-temperature elevation, cardiac arrhythmia, deaths.

ASIH is suppression of the body's natural testosterone production caused by long-term anabolic-androgenic steroid (AAS) use. The pituitary detects high circulating androgen levels from the exogenous source and stops sending signals (LH and FSH) to the testes. Over time, this shuts down endogenous production.

After stopping AAS, recovery of the body's own production is variable:

• Many users recover over months.
• Some users take a year or more.
• A subset have incomplete recovery and end up with persistently low testosterone, low LH/FSH, infertility, and ongoing symptoms.

ASIH is not always reversible. Anyone considering AAS should understand this risk going in.

Stacking is the practice of using multiple PEDs at the same time during a cycle - typically combining different anabolic-androgenic steroids, sometimes with growth hormone, SARMs, or supportive compounds. Users describe stacking as a way to maximise effect or address side effects of one compound with another.

From a harm-reduction monitoring standpoint, stacking complicates everything: more compounds means more potential side effects, more interactions, more difficulty attributing changes to a specific drug, and higher overall load on the cardiovascular and hepatic systems. Tell your TeleTest clinician about everything you're using so the right monitoring is ordered.

PCT is the use of medications after a cycle of anabolic-androgenic steroids to support recovery of the body's own hormone production. Typical PCT medications include selective estrogen receptor modulators (SERMs), aromatase inhibitors, and human chorionic gonadotropin (HCG).

TeleTest does not prescribe PCT medications or advise on PCT protocols, dosing, or duration. PCT is an off-label, unregulated area of practice with limited high-quality evidence; if you want medical guidance on PCT, you'll need an endocrinologist.

What TeleTest can do is monitor your hormones, blood counts, and lipid panel through and after a cycle, so you have objective data on your recovery.

Core monitoring:

• CBC (complete blood count) - looking for elevated hematocrit (polycythemia).
• eGFR (kidney function) - assess renal status.
• Lipid profile - AAS often lower HDL and raise LDL.
• Total testosterone - to confirm what your body is exposed to.
• PSA if age-appropriate.
• ECG - to screen for cardiac changes.

Everything from the injectable AAS panel, plus:

• ALT (liver enzyme) - main marker of hepatic injury.
• ALP (alkaline phosphatase).
• Bilirubin - cholestasis marker.

AST is no longer routinely ordered as a marker of liver damage - ALT is sufficient to screen for intrahepatic injury.

Oral AAS are more hepatotoxic than injectables and need closer liver monitoring.

For users on stimulant-based fat burners (caffeine-based products, certain prescription stimulants) and especially for DNP (2,4-dinitrophenol) users:

• ECG - looking for arrhythmia.
• TSH - to screen for thyroid effect.
• Injectable AAS screen if also on DNP (because of the systemic risk profile).
• Blood pressure measurement.

DNP carries serious risk including death from hyperthermia and arrhythmia. If you are using it, more frequent monitoring is appropriate.

Recommended monitoring:

• Everything from the injectable AAS panel.
• Magnesium and potassium levels.
• Fasting blood glucose / HbA1c - growth hormone affects glucose metabolism and can contribute to insulin resistance.

No specific testing required unless there's suspected product impurity. If you suspect the product also contains other compounds, the appropriate testing depends on what those compounds might be - usually similar to the growth hormone panel.

Recommended monitoring:

• CBC.
• eGFR.
• Lipid profile.
• Serum calcium.

Site enhancement carries injection-site complications (infection, abscess, sterile inflammation), which require in-person assessment if symptoms develop.

SARMs are a newer class of compounds, sold mostly online and marketed as having a better safety profile than AAS. The reality is more complicated:

• Long-term safety data is very limited. None are approved by Health Canada or the FDA for human use.
• Studies have shown suppression of HDL cholesterol and elevations in liver enzymes.
• Product purity is a major issue. Multiple studies have found that products sold as "SARMs" contain alkylated anabolic steroids, contaminants, or different compounds entirely.

Monitoring is similar to oral AAS - liver enzymes, lipids, hormones - because of the overlap in risks and the purity uncertainty.

If you've ever shared or used non-sterile injection equipment, screening for HIV, hepatitis B, and hepatitis C is appropriate. The clinician orders this when there's a relevant history; it's not part of every requisition by default.

Most users benefit from bloodwork every 8-12 weeks when no symptoms are present. If you develop new symptoms, start a new compound, or change your protocol meaningfully, it's reasonable to test sooner.

Tests are covered by provincial health plans when they're considered medically necessary for diagnosing or monitoring a recognised condition. Several common requests are not covered:

• Free testosterone is generally not a recommended monitoring parameter for users of hormone-altering substances - total testosterone is the standard. Some labs report a calculated free testosterone alongside total.
• Estradiol is usually not covered for routine PED monitoring. It may be insured if symptoms suggest estrogen excess (new breast tenderness or swelling, gynecomastia) - in those cases the test helps guide management.
• PSA is not insured purely as a screening test in PED users without urinary symptoms or other risk factors.
• LH and FSH are insured when investigating an untreated low-testosterone state to determine whether the cause is at the pituitary or the testes. In someone currently using exogenous androgens, LH and FSH are predictably suppressed and don't add diagnostic information - so they aren't insured in that context.
• Vitamin D, folate (B9) and a few others are uninsured even when medically indicated, by provincial policy.

When a test isn't insured, the lab will charge you directly. You can decline any uninsured test if you don't want to pay.

Provincial billing is audited - clinicians are required to follow specific rules about when each test is insured. Practice varies between clinicians, and tests that were ordered as insured in the past may not have been technically eligible. TeleTest follows the rules strictly because we are subject to auditing.

This isn't a policy choice we control - it's the framework set by provincial health plans. Within that framework we try to give you the most useful testing for the lowest cost, but we can't override the insurance rules.

These are approximate amounts that the lab charges directly to you. They vary between labs (LifeLabs, Dynacare, Alpha) and can change.

• Estradiol - ~$25
• Free Testosterone - ~$25
• SHBG - ~$30
• PSA - ~$40

TeleTest does not control or profit from these lab fees.

The PED Subscription is a 2-year subscription that covers 6 consultations and follow-ups with the clinician over that period. It's useful if you anticipate needing several bloodwork rounds and consultations over the course of a few cycles.

• The subscription fee covers consultations.
• Test fees marked with $ may still apply at the lab because they're not covered by provincial health plans - the subscription doesn't change which tests are insured.

To activate:

1. Log in to the portal, go to the Men's Health category, and select the Men's Lab Testing panel.
2. Complete the intake and check out. This activates the subscription.
3. For future appointments: log in, go to Billing, find the active subscription, and click Use. Complete an updated intake.

You don't need to contact us first or pay again - the subscription authorises additional consultations.

• Steroid/PED Harm Reduction - covers one consultation and a follow-up if a result is abnormal. Some tests are insured; some are self-pay.
• PED Subscription - covers 6 consultations and follow-ups over 2 years from purchase. Test fees still apply at the lab as appropriate.

If you're going to need only one round, the one-off harm-reduction panel is cheaper. If you anticipate multiple consultations, the subscription is usually a better deal.

Yes. If the clinician determines an echocardiogram is medically appropriate (typically for users with several cycles of exposure, ongoing PED use, or relevant symptoms), the clinician can issue a requisition.

• The echocardiogram itself is typically insured at provincial-plan-covered imaging facilities.
• The TeleTest consultation fee covers the clinical assessment and requisition - it does not cover any fees the imaging centre might charge separately.
• If you choose a private clinic for the echo, confirm with the imaging centre when you book that the echocardiogram will be billed through your provincial plan with no out-of-pocket costs.
• Patients without provincial coverage may pay $500-$600 out of pocket for an echocardiogram.

You can take the requisition to any imaging centre that performs echocardiograms in your area - the suggested locations on the requisition are just suggestions.

Bloodwork timing depends on the specific compound's half-life and dosing schedule. A clinician can discuss what makes sense for your situation during a consultation. In general:

• Mid-cycle bloodwork shows your physiology during typical exposure.
• Trough bloodwork (just before your next dose) shows the lowest exposure.
• If you want to assess your baseline off-cycle, a meaningful washout period is needed; the exact duration depends on what you've been using.

A trough level is the lowest level of a compound in your blood before your next dose. For injectable users, trough levels indicate whether the dose is lasting long enough between injections. If trough is very low relative to peak, the clinician can discuss adjusting frequency.

The tests on your requisition are chosen based on what you reported in your intake - particularly what substances you're using or have used. The Men's Health panel is designed for PED users and includes a broader set of tests. If you reported you are NOT using PEDs, the requisition only includes the tests appropriate for your situation - it does not order PED-specific tests routinely.

Therapeutic phlebotomy (blood removal to lower hematocrit) is sometimes appropriate for users with elevated red-blood-cell counts on cycle. TeleTest does not maintain a list of phlebotomy providers because availability varies by location.

If you identify a clinic or hospital that offers therapeutic phlebotomy and confirms they accept referrals, we can prepare and send the required documentation to support your request.

It means your estradiol level is below the lab's reporting limit for the standard estradiol assay. For most men, an estradiol level below 40 pmol/L is normal and expected.

• The standard assay can't reliably quantify values below 40 pmol/L - so anything from 0 to 39 is reported as "< 40".
• It doesn't tell you the exact number within that range.
• If precision matters for your situation, request the sensitive estradiol assay in your intake; the clinician can add it to the requisition (often with a lab fee).

We order the standard estradiol assay by default. If you need the sensitive estradiol, mention it in your intake. If clinically appropriate, the clinician can add it. Labs may charge an additional fee for the sensitive version.

Both LifeLabs and Dynacare provide reliable total testosterone results. The main difference is free testosterone:

• Dynacare calculates free testosterone using Vermeulen's equation, which remains reliable at high testosterone levels.
• LifeLabs also uses the same calculation but has an upper-limit cutoff; when total testosterone exceeds that range, free testosterone may not be reported.

For PED users with elevated testosterone, Dynacare is more likely to provide complete, interpretable free testosterone results.

Yes - within the limits of what's insured. The clinician will order what's medically indicated for your situation. If you want additional tests beyond what's standard, the clinician can add them as uninsured (self-pay) tests, and you'll pay the lab directly for those.