This FAQ page covers commonly asked questions related to PEDs. This is written in part to educate both physicians and patients about Performance Enhancing Drugs.
By offering monitoring services for performance-enhancing drug (PED) use, our intention is not to endorse or promote the use of these substances. Our primary goal is to reduce the potential harm and health risks associated with PED use in a non-judgmental and supportive manner. Testing does not remove the need for a physical exam or blood pressure monitoring, which is critical if you are on PEDs.
Who
What is harm reduction testing?
Harm reduction is an approach that aims to minimize the negative consequences of using anabolic steroids and performance-enhancing drugs. It provides education, harm reduction testing, and support to address the risks of using these drugs, while respecting individual autonomy. Harm reduction focuses on reducing harm instead of punishment or moral judgment to promote better health outcomes.
Why does TeleTest offer harm reduction testing for users of PEDs?
Harm reduction testing is important for anabolic steroid users because the use of these drugs can have potential negative effects on the body, including changes in hormone levels, liver damage, and cardiovascular problems. Harm reduction testing, such as blood work to check hormone levels and liver function, can help monitor these potential harms and catch any issues early before they become more serious.
Testing for infections such as HIV and hepatitis can be important, as sharing needles and other injection equipment can increase the risk of these infections. By providing harm reduction testing services, we believe we can help users of anabolic steroids to make informed decisions about their health and minimize the risk of long-term harm.
Is a physical examination important while on PEDs?
Yes, a physical examination by a doctor is important when using Performance Enhancing Drugs (PEDs). This examination may include checking blood pressure, and heart rate, and performing an abdominal and cardiovascular examination.
Does TeleTest complete physical examinations for patients?
TeleTest does not currently have physical offices for examination, offer physical examination for patients on PEDs, but you can request a physical exam at any local walk-in clinic.
It's important to have a physical examination periodically, checking your heart, lungs, skin and blood pressure. A doctor may also complete an abdominal exam looking for signs of cirrhosis or liver damage.
I'm not on PEDs. Can I access PED bloodwork?
Currently TeleTest only offers monitoring bloodwork for those on PEDs. We do not offer testing if you are not on on PEDs at the time of your consultation.
Using PEDs
What are Performance Enhancing Drugs (PEDs)?
PEDs are substances that people use to boost their physical appearance, strength, or performance. These drugs come in various forms, such as anabolic steroids, growth hormones, and other compounds.
What are some risks and side effects of using PEDs?
PEDs can cause various health problems, including heart issues, high blood pressure, hormonal imbalances, and mental health concerns. They can also lead to addiction and difficulty stopping their use.
What is Anabolic Steroid-Induced Hypogonadism (ASIH)?
ASIH is a condition that occurs when the body's natural hormone production is disrupted due to long-term use of anabolic steroids and other PEDs. This can lead to low testosterone levels and various health issues.
What is stacking?
Stacking in the context of AAS (anabolic-androgenic steroids) use refers to the practice of combining two or more different types of steroids or other performance-enhancing substances during a single cycle. Users stack different substances in an attempt to maximize the desired effects, such as muscle growth, while minimizing potential side effects.
What is post-cycling?
Post-cycling, also known as Post Cycle Therapy (PCT), is a period following a cycle of anabolic-androgenic steroid (AAS) use. The primary purpose of PCT is to help the body recover and restore its natural hormone production levels, particularly testosterone, which is often suppressed during AAS use.
During PCT, users typically take medications or supplements that aid in hormonal recovery, such as Selective Estrogen Receptor Modulators (SERMs), Aromatase Inhibitors (AIs), and Human Chorionic Gonadotropin (HCG). These substances can help reduce the likelihood of unwanted side effects and help the body return to its normal hormonal balance.
What are important lab tests based on my PED regimen?
This information was adapted and modified from: Bonnecaze et al
Oral AAS: Injectable AAS Screen + ALT + ALP + Bilirubin
Fat Burning Compounds (i.e. T3): ECG + TSH (+ Injectable AAS screen if on DNP)
HGH and Derivatives: Injectable AAS Screen + Mg + K
hCG: No specific testing unless suspected product impurity, then HGH + Derivative Screen
Site Oil Enhancement: CBC, eGFR, Lipid Profile, Serum Calcium
We consider comprehensive screening if the compound is sourced illicitly, as pharmacologic impurities may render additional health risks to the liver, kidneys and bone marrow.
Additional lab testing (i.e. free testosterone, estradiol) is not essential to the safety monitoring component of PED drug monitoring but can be included as an uninsured lab test (i.e. additional fees at the lab).
Test Frequency
The following section outlines TeleTest Guidelines for harm reduction monitoring. We understand many patients like to track other parameters that are not directly required in harm reduction. These tests can be ordered as uninsured (private-pay) tests.
Important Notes
Testing not required for harm reduction incurs additional lab test fees ($).
Testing more frequently than is medically required by our guidelines incurs additional lab test fees ($).
Lab Assay
Test Frequency
OHIP Insured
Private ($)
Comments
Complete Blood Count (CBC)
Monthly - Quarterly
A
Liver Enzymes (ALT, ALP)
Monthly - Quarterly
A, B
Total Testosterone
Quarterly
A
Creatinine (eGFR)
Quarterly
A, B
Bilirubin
Quarterly
A, B
Potassium
Quarterly
A, B
ECG
Annual
A
Lipid Profile
Annual
A, B
Fasting Blood Glucose
Annual
A, B
HbA1c
Annual
A, B
Serum Calcium
Quarterly
A, B
Estradiol
Not Required
Prolactin
Not Required
Sex Hormone Binding Globulin
Not Required
Free Testosterone
Not Required
Prostate Specific Antigen (PSA)
Not Recommended
Luteinizing hormone (LH)
Not Required
Follicle Stimulating Hormone (FSH)
Not Required
Comments
A = Test Frequency may be increased (OHIP Insured) based on previous abnormal lab test values
B = Only OHIP insured when medically indicated based on PED used
Why is some testing uninsured?
Testing that is medically required to identify disease is OHIP insured.
The Ministry of Health requires that physicians who order a lab test under OHIP insurance have a medical justification to order specific testing. This necessitates:
A clear medical indication for testing
A test frequency that is based on guidelines, or reasonable in the context of current clinical practice
In some instances, regardless of whether a test is required for disease identification or monitoring, OHIP will still not cover the cost of the test. Examples include Folate (B9), Vitamin D, PSA (Prostate Specific Antigen) testing. Under these circumstances, patients pay the lab directly for 'uninsured testing' and still obtain these values.
TeleTest operates within this framework to continue to be able to provide effective, evidence-based harm reduction care.
Example 1:
Free testosterone is not a monograph-indicated monitoring parameter for individuals on TRT. It is therefore an uninsured test.
Total testosterone is a monograph-indicated monitoring parameter. It is therefore an insured test.
Example 2:
Lipid profiles can be ordered on an annual basis as that is a reasonable frequency based on current clinical practices for individuals on PEDs. It is therefore an insured test when screened annually.
Lipid profiles ordered every 30-60 days would not be considered reasonable based on current mainstream accepted clinical practices. Averages in lipid profiles over many years have a bearing on the development of atherosclerosis. Therefore, lipid profile screening every 30 days is not insured.
Can I get my prolactin levels tested, and is this included in the Steroid/PED panel?
Prolactin testing is not included in the Steroid/PED panel, as it is not a routine component of this test. Additionally, prolactin testing is considered a non-insured service and therefore is not covered within the scope of the Steroid/PED panel.
Can the physician provide a prescription for PCT (Post Cycle Therapy) protocol after a Steroid/PED bloodwork test?
Our doctors do not currently issue prescriptions for PCT protocols. Our primary mandate is to provide harm reduction bloodwork to monitor the health effects of Steroid/PED use
Can the doctors provide a consultation on an appropriate PCT protocol based on my PED regimen?
The doctors cannot provide feedback on the appropriate protocol for PCT therapy, including specific drugs, dosages, or durations. The purpose of the PED panel is to monitor individuals using various PEDs and, if abnormal values are detected, to guide on the potential harm caused along with recommendations for follow-up investigations and next steps in the diagnostic process.
I recently received a blood work requisition and noticed that tests previously covered by OHIP, specifically HbA1C and lipid assessments, are now classified as third-party/uninsured. Can the requisition be updated to reflect these as insured tests?
Many of our patients prefer to track parameters more frequently than our guidelines recommend (for example cholesterol testing every 6-8 weeks with previously normal results), and we respect the need for this preference for monitoring. However, when testing is requested based on a preference for monitoring, and doesn’t meet our criteria for medically indicated testing, is it not insured under OHIP (i.e. OHIP won’t cover the cost of this testing).
We’ll still arrange testing, but this just means the lab will charge you for the specific test when you would like to exceed our guideline frequency for testing. We have more about recommended frequency of testing here, and if you wish you can decline any uninsured tests that are not required for harm reduction purposes.
Injectable Anabolic-Androgenic Steroids (AAS)
What are the most common injectable anabolic-androgenic steroids (AAS)?
Injectable anabolic-androgenic steroids (AAS) are synthetic substances similar to the male sex hormone testosterone. They are used to promote muscle growth, improve athletic performance, and enhance physical appearance. Some of the most common injectable AAS include:
Testosterone (various esters such as enanthate, cypionate, and propionate)
Nandrolone Decanoate (Deca-Durabolin)
Trenbolone Acetate
Boldenone Undecylenate (Equipoise)
Methenolone Enanthate (Primobolan Depot)
Drostanolone Propionate (Masteron)
Stanozolol (Winstrol, available in both oral and injectable forms)
Oxandrolone (Anavar)
Methandrostenolone (Dianabol)
Oxymetholone (Anadrol)
These compounds are associated with various side effects and health risks.
What are the most important lab tests for someone using anabolic steroids?
The most important lab tests for an individual on anabolic steroids include a Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC), lipid profile, Prostate-Specific Antigen (PSA, if indicated), and Testosterone levels. Additional testing may be required if AASs are combined with other PEDs.
Why is a Comprehensive Metabolic Panel (CMP) important for someone using anabolic steroids?
A CMP is a group of blood tests that measure your electrolyte balance, kidney function, liver function, and blood sugar levels. Anabolic steroids can cause changes in these parameters, which may lead to complications if not monitored regularly.
Why is a Complete Blood Count (CBC) necessary for anabolic steroid users?
A CBC measures the number of red blood cells, white blood cells, and platelets in your blood. Anabolic steroids can affect the production and function of these cells, which may lead to issues such as anemia, infection, or abnormal clotting.
Why should anabolic steroid users monitor their lipid profile?
Anabolic steroids can negatively affect your lipid profile, leading to an increased risk of heart disease. Monitoring your lipid profile helps detect changes in cholesterol and triglyceride levels, allowing you to take appropriate action to maintain a healthy cardiovascular system.
When should someone using anabolic steroids have their PSA tested?
Prostate-Specific Antigen (PSA) testing is typically recommended for men over the age of 50, or those with a family history of prostate cancer. However, anabolic steroid use may increase the risk of prostate enlargement or cancer. It's important to discuss PSA testing with your healthcare provider, as they will determine the appropriate frequency based on your individual risk factors.
Why is it important to monitor Testosterone levels while using anabolic steroids?
Anabolic steroids can disrupt the hormonal balance in your body, causing a decrease in the natural production of Testosterone. Monitoring these hormone levels can help identify any abnormalities, allowing you to address potential issues such as infertility or other hormonal imbalances.
Why is an ECG important for anabolic steroid users?
An ECG, or electrocardiogram, is a test that measures the electrical activity of your heart. Anabolic steroid use has been linked to an increased risk of heart problems, such as irregular heartbeat or myocardial hypertrophy. Regular ECGs can help detect any changes in your heart function, allowing you to take preventive measures to maintain your cardiovascular health.
Why should anabolic steroid users be screened for hypertension (HTN)?
Hypertension, or high blood pressure, is a potential side effect of anabolic steroid use. Regular blood pressure screenings can help detect any changes in blood pressure, allowing you to take appropriate action to reduce the risk of complications such as heart attack or stroke.
Oral Anabolic-Androgenic Steroids (AAS)
Why are Liver Function Tests important for individuals on oral AAS?
Oral AAS are metabolized in the liver, which can cause strain on the organ and potentially lead to liver damage. Liver Function Tests help monitor the health of your liver by measuring specific enzymes and bilirubin, looking for evidence of damage and dysfunction. We test ALT, ALP and Bilirubin if you are on oral AAS, in addition to other screening for injectable AAS. Current clinical practice informs that AST is no longer routinely ordered as a marker of liver damage, as ALT is sufficient to screen for intrahepatic injury.
Fat Burning Compounds
What are fat burning compounds?
Fat burning compounds, also known as thermogenic agents or fat burners, are substances that claim to help increase metabolism, burn fat, and promote weight loss. They can be found in various forms, such as supplements, medications, or natural products. Some common fat-burning compounds include caffeine, green tea extract, and DNP (2,4-Dinitrophenol), among others.
What are common side effects of fat burning compounds?
Common side effects of fat burning compounds may include arrhythmia (irregular heartbeats), hypertension (high blood pressure), and hyperthermia (dangerously elevated body temperature), particularly in the case of DNP (2,4-Dinitrophenol). It is crucial to monitor for these side effects and consult with your healthcare provider if you experience any symptoms or concerns.
What tests and screenings should individuals using fat-burning compounds undergo to monitor potential side effects?
To ensure overall health and well-being, individuals using fat-burning compounds should regularly undergo specific tests and screenings for high blood pressure (Hypertension), ECGs and tests for Thyroid-Stimulating Hormone (TSH).
Selective Androgen Receptor Modulators (SARMs)
What are SARMS?
Selective Androgen Receptor Modulators (SARMs) are a relatively new and promising class of non-steroidal compounds that specifically target androgen receptors in the body. They are engineered to mimic the positive effects of anabolic steroids, such as increased muscle mass, strength, and bone density, while minimizing the negative side effects typically associated with steroid use.
SARMs work by selectively binding to androgen receptors in specific tissues, such as muscle and bone, while avoiding other tissues like the liver, prostate, and brain. This selective binding is what differentiates SARMs from traditional anabolic steroids, which have a more generalized effect on the body and can lead to a range of undesirable side effects.
Although SARMs have shown promise in early research and clinical trials, they have not been approved by the FDA for human use. As a result, they are often sold online as "research chemicals" and are not subject to the same rigorous testing and quality control standards as FDA-approved medications.
What are the potential adverse effects of SARMs?
There is a lack of long-term data on the potential adverse effects of SARMs. However, a clinical trial involving a SARM indicated that it could lead to the suppression of good cholesterol (HDL) and abnormal liver function tests. Moreover, a study discovered that not all products sold online as SARMs actually contained these compounds, with a significant number containing alkylated anabolic-androgenic steroids (AAS) instead. This highlights the importance of being cautious when purchasing SARMs, as their quality and content can be questionable.
We do not have any data on the long-term neurocognitive, cancer or teratogenic (inducing birth defects) of these compounds.
Do SARMs affect liver function?
Some studies have reported temporary increases in liver enzyme levels in participants taking SARMs. However, it is not yet clear if SARMs pose a significant risk for liver damage. More research is needed to investigate the relationship between SARMs and liver health.
What are some examples of SARMs?
Some SARMs that have been studied include Enobosarm, GSK2881078, PF-06260414, and LGD-4044. These compounds have shown potential for muscle growth and strength in people with muscle wasting but none have been approved by the FDA or Health Canada.
References
Bonnecaze AK, O'Connor T, Burns CA. Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review. J Gen Intern Med. 2021 Jul;36(7):2055-2064. doi: 10.1007/s11606-021-06751-3. Epub 2021 May 4. PMID: 33948794; PMCID: PMC8298654.
Solimini R, Rotolo MC, Mastrobattista L, Mortali C, Minutillo A, Pichini S, Pacifici R, Palmi I. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmacol Sci. 2017 Mar;21(1 Suppl):7-16. PMID: 28379599.
Harvey, O., Keen, S., Parrish, M. et al. Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access. BMC Public Health 19, 1024 (2019). https://doi.org/10.1186/s12889-019-7288-x
Albano GD, Amico F, Cocimano G, Liberto A, Maglietta F, Esposito M, Rosi GL, Di Nunno N, Salerno M, Montana A. Adverse Effects of Anabolic-Androgenic Steroids: A Literature Review. Healthcare (Basel). 2021 Jan 19;9(1):97. doi: 10.3390/healthcare9010097. PMID: 33477800; PMCID: PMC7832337.
Smit DL, de Ronde W. Outpatient clinic for users of anabolic androgenic steroids: an overview. Neth J Med. 2018 May;76(4):167. PMID: 29845939.
Solomon ZJ, Mirabal JR, Mazur DJ, Kohn TP, Lipshultz LI, Pastuszak AW. Selective Androgen Receptor Modulators: Current Knowledge and Clinical Applications. Sex Med Rev. 2019 Jan;7(1):84-94. doi: 10.1016/j.sxmr.2018.09.006. Epub 2018 Nov 30. PMID: 30503797; PMCID: PMC6326857.
