The Complete Pre-Cycle Bloodwork Checklist

Starting a cycle without a complete blood work baseline is like navigating without a map. You need to know where you are before you can measure where you are going, and more importantly, you need to be able to recognize danger signals when they appear.

Below is the complete pre-cycle blood work checklist. This is not a suggestion, it is a minimum safety requirement.

1. Kidney Markers

Exogenous androgens put real strain on the kidneys, and it happens through a few different routes at once. Increased muscle mass means more metabolic waste to filter, elevated blood pressure adds mechanical stress to the filtration units, and the compounds themselves have direct metabolic effects on renal tissue. That's why getting a kidney baseline before you start a cycle isn't optional, it's the reference point that tells you where you're starting from and lets you spot trouble early if something shifts mid-cycle.

Your eGFR is calculated from serum creatinine, age, and sex. In athletes, creatinine is often elevated from muscle mass alone, which can falsely lower eGFR. That is why cystatin C is so valuable: it is not affected by muscle, so a cystatin-based eGFR gives a truer picture. If your creatinine-based eGFR is below 90 but cystatin-based is above 90, your kidneys are likely fine. If both are low, you have a real problem. Also, high protein intake and creatine supplementation can raise creatinine. If you are using creatine, stop it for 2 weeks before testing. A baseline UACR above 30 mg/g indicates early kidney stress; if you see that, address blood pressure and hydration before starting anything.

• eGFR (estimated glomerular filtration rate): Your baseline kidney function. Above 90 mL/min/1.73m² is ideal. Monitor for drops > 10% during cycle.
• Serum creatinine: Expected to be slightly elevated in athletes due to muscle mass. Use with Cystatin C for a more accurate picture.
• Cystatin C: Optional but highly recommended. Not affected by muscle mass, so it gives a truer eGFR in athletes. The difference between creatinine-based and cystatin-based eGFR can reveal how much of your creatinine elevation is muscle vs. kidney stress.
• Your BUN (blood urea nitrogen) is a baseline for protein metabolism and hydration status.
• The urine albumin-to-creatinine ratio (UACR) is optional but valuable for detecting early kidney damage before eGFR drops.

2. Liver Markers

Oral androgens hit the liver harder than most other compounds. If you're planning to run them, a baseline liver panel before you start isn't just a nice idea, it's critical.

Oral androgens like anadrol, superdrol, and methyltestosterone are notorious for liver toxicity. They are 17-alpha-alkylated to survive first-pass metabolism, which puts direct stress on hepatocytes. If your baseline ALT is already above 40 U/L, consider delaying your cycle until it normalizes. GGT is the key differentiator: if GGT is normal and AST/ALT are elevated, it is likely from training, not liver. But if GGT is also elevated, you have hepatic stress. Also, check bilirubin: if total bilirubin is high but direct is normal, you may have Gilbert's syndrome, which is benign. If direct bilirubin is high, that suggests biliary obstruction or liver disease. Always get a full panel including GGT and bilirubin before using orals.

• AST (aspartate aminotransferase): Found in both liver and muscle. Elevated in athletes from training alone. Context matters.
• ALT (alanine aminotransferase): More liver-specific than AST. A better indicator of hepatic stress.
• GGT (gamma-glutamyl transferase): Highly liver-specific. If GGT is normal, elevated AST/ALT are likely from muscle, not liver.
• ALP (alkaline phosphatase): Biliary marker. Can be elevated during periods of bone remodeling or liver stress.
• Total and direct bilirubin: Elevated bilirubin indicates impaired liver clearance or Gilbert's syndrome (benign).

3. Cardiovascular Markers

AAS are known to hammer your lipid profile. If you don't have a baseline on record, you're flying blind when it comes to judging how much damage they're actually doing. Get that bloodwork done before you start, so you have something real to compare against.

HDL is the first thing to drop on cycle. A baseline above 40 mg/dL gives you room, but if you start at 30, you will be in single digits within weeks. ApoB is a better marker than LDL because it counts every atherogenic particle. If your ApoB is above 100 mg/dL at baseline, you are already at risk. On cycle, especially with orals like winstrol or anavar, ApoB can spike. If you have a family history of heart disease or high Lp(a), you need to be aggressive. Consider adding ezetimibe or a statin if lipids go sideways, but only after discussing with a licensed medical professional. Track your lipids at mid-cycle, not just at the end, so you can intervene early.

• Total cholesterol: Less important on its own, but provides context.
• HDL cholesterol: The marker most impacted by AAS. A baseline above 40 mg/dL (1.0 mmol/L) gives you more room to drop before reaching dangerous territory.
• LDL cholesterol: Usually rises on cycle. Baseline helps quantify the increase.
• Triglycerides: Can rise on cycle, especially with orals. Fasted measurement is essential.
• ApoB (apolipoprotein B): The single best predictor of atherosclerotic risk. Every particle that can cause plaque contains one ApoB molecule. If you only get one advanced lipid test, make it this one.
• Lipoprotein(a) (Lp(a)): Optional but valuable one-time measurement. Lp(a) is genetically determined and does not change much, but high Lp(a) means you need to be more aggressive about managing LDL and ApoB.

4. Hematology

Androgens stimulate erythropoietin (EPO) production, which increases red blood cell mass. That's one of the most consistent and dose-dependent effects you'll see with AAS use.

Hematocrit rises because androgens stimulate EPO, and a baseline above 45% means less headroom before reaching the range where blood viscosity becomes a genuine concern. But a raised hematocrit by itself isn't the whole risk picture — it becomes a real clotting concern specifically alongside an elevated platelet count and reduced physical activity, and separately it can push blood pressure up, which is the mechanism that actually damages arteries and kidneys over time. That's why a hematocrit above 54% is worth bringing to a licensed medical professional alongside your platelet count, blood pressure, and training level, rather than treating the percentage alone as the trigger for donating or adjusting dose. If donation does end up being used, ferritin needs to be checked first — donating with ferritin below 30 ng/mL can push you into iron deficiency, which causes its own fatigue and poor recovery. A baseline ferritin comfortably above the low end of normal gives you more room before that becomes a concern.

• Hemoglobin (Hgb): Baseline for oxygen-carrying capacity.
• Hematocrit (Hct): The percentage of blood volume occupied by red blood cells. A baseline above 45% means less headroom before it's worth a closer look — read alongside platelets, blood pressure, and activity level rather than on its own.
• Red blood cell count (RBC): Tracks with hematocrit.
• Platelets: AAS can increase platelet reactivity. Very high platelets combined with high hematocrit increases thrombotic risk.
• Get a white blood cell count (WBC) with differential to establish your baseline immune function.
• Your ferritin and iron panel matters a lot if you plan to donate blood to manage hematocrit. Donating when ferritin is low can push you straight into iron deficiency.

5. Hormones

Knowing your natural hormonal baseline is key to gauging how well, and how quickly, you bounce back after a cycle.

Your LH and FSH are the master switches for natural testosterone production. If your baseline LH is below 2 mIU/mL, you may have secondary hypogonadism, and recovery after cycle could be slow. That is a red flag to address before starting. Also, if you are planning to use 19-nors like nandrolone or trenbolone, get a baseline prolactin. These compounds can elevate prolactin, leading to libido loss and gyno. A baseline prolactin above 15 ng/mL warrants investigation. Post-cycle, LH recovery is the first sign your HPTA is waking up. If LH does not rise within 4-6 weeks after PCT, you may need further intervention. Knowing your natural levels helps you set realistic expectations for recovery.

• Total testosterone (TT): Your natural production level. Critical for calculating suppression and recovery.
• Free testosterone: Provides context for SHBG and bioavailable T.
• SHBG: Your natural SHBG level. Already discussed in detail in a dedicated article.
• Estradiol (E2): Your natural E2 level and aromatization baseline.
• LH (luteinizing hormone): Ideally 4-10 mIU/mL in a healthy natural male. This is your body's signal to produce testosterone. Post-cycle, LH recovery is the key indicator that your HPTA is waking up.
• FSH (follicle-stimulating hormone): Supports spermatogenesis. Important for fertility considerations.
• Prolactin: Especially important if using 19-nor compounds (trenbolone, nandrolone), which can elevate prolactin.

6. Thyroid

AAS can suppress thyroid-binding globulin (TBG) and affect thyroid hormone levels. A pre-cycle thyroid baseline helps distinguish AAS effects from actual thyroid disease.

• TSH (thyroid-stimulating hormone): The primary screening test for thyroid function. Aim for 0.5-2.5 mIU/L.
• Free T4: Confirms thyroid hormone production.
• Free T3: The active thyroid hormone. Optional but valuable if you have symptoms of hypothyroidism.

7. Metabolic Markers

Insulin resistance can develop or worsen on cycle, especially with certain compounds and bulking diets.

Insulin resistance can sneak up on you, especially with bulking diets and compounds like anadrol or trenbolone. A fasting insulin above 10 µIU/mL with normal glucose indicates early insulin resistance. HOMA-IR above 2.0 is a warning sign. If your baseline HbA1c is above 5.6%, you are already prediabetic. Starting a cycle in that state will only worsen it. Consider using metformin or berberine if you are insulin resistant, but only after discussing with a licensed medical professional. Also, orals like anavar can impair glucose tolerance. If you are planning a lean bulk, keep carbs moderate and prioritize cardio. A baseline fasting glucose above 100 mg/dL means you need to fix your diet before adding AAS.

• Fasting glucose: Baseline blood sugar. Above 100 mg/dL (5.6 mmol/L) warrants further investigation.
• HbA1c (hemoglobin A1c): 3-month average of blood sugar. Below 5.4% is optimal; 5.4-5.6% is acceptable; above 5.7% is prediabetic.
• Fasting insulin: Optional but very valuable. High fasting insulin with normal glucose indicates insulin resistance years before glucose rises.
• HOMA-IR: Calculated from fasting glucose and insulin. A score above 2.0 suggests insulin resistance.

8. Vital Signs and Subjective Data

Blood work alone does not tell the full story. Document these before starting:

• Blood pressure: Measure at rest, seated, after 5 minutes of quiet sitting. Take 3 readings and average them. Systolic above 130 or diastolic above 80 needs attention before cycle.
• Resting heart rate: Baseline cardiovascular fitness.
• Body weight: Weigh at the same time of day, same conditions.
• Body fat estimate: Useful context for interpreting blood markers.
• Baseline symptoms: Document any existing joint pain, sleep quality issues, mood patterns, or libido levels so you can track changes.

Sample Pre-Cycle Panel (Recommended)

If you can only afford one comprehensive panel, request the following from your provider:

• CMP (comprehensive metabolic panel): includes eGFR, creatinine, BUN, glucose, AST, ALT, ALP, bilirubin
• Lipid panel: total cholesterol, HDL, LDL, triglycerides
• ApoB (add-on)
• CBC with differential
• Total and free testosterone
• Estradiol (sensitive, LC/MS-MS)
• SHBG
• TSH
• HbA1c