Ceruloplasmin
Other marker
Ceruloplasmin
The main copper-carrying protein in blood, holding roughly 90% of circulating copper and also acting as a ferroxidase in iron metabolism. It is measured chiefly to help diagnose Wilson's disease (copper overload) and to assess copper status, and it behaves as an acute-phase reactant.
PED Notes
Not a routine PED marker, but it interacts with two things athletes care about. It is an acute-phase reactant, so it rises with inflammation and can also be elevated by high oestrogen states, which matters for AAS users running aromatising compounds or those with elevated oestradiol. It also links copper and iron handling, relevant to enhanced athletes who supplement iron heavily or run copper peptides. A low ceruloplasmin in a young person with liver or neurological symptoms should prompt evaluation for Wilson's disease.
When high
When high (>35 mg/dL):
- Most often reflects inflammation (acute-phase response), pregnancy, or oestrogen exposure (including high-oestradiol states on aromatising AAS or oestrogen therapy); interpret alongside CRP and oestradiol
- Rarely indicates copper overload from excessive supplementation
- Action: address the underlying inflammatory driver or review oestrogen management; an isolated mild elevation with a clear inflammatory or hormonal cause is not concerning
When low
When low (<20 mg/dL):
- The classic concern is Wilson's disease (hereditary copper overload), especially in a younger person with unexplained liver disease, tremor, or neuropsychiatric changes; low ceruloplasmin with high urinary copper and characteristic eye findings warrants urgent hepatology/neurology referral
- Other causes include true copper deficiency (excess zinc supplementation is a common and under-recognised cause, since high zinc blocks copper absorption), malabsorption, and severe protein loss
If copper deficiency is confirmed:
- Reduce excessive zinc intake (a frequent culprit in supplement-heavy athletes) and supplement copper -- 2-4mg/day of copper (as gluconate or bisglycinate) under guidance, rechecking copper and ceruloplasmin
- Do not self-treat suspected Wilson's disease; it requires specialist chelation therapy
History Chart
Reading History
Frequently Asked Questions
Reference Ranges
Standard Range