Objectives Olympic athletes are often considered the pinnacle of health and performance. However, routine blood tests may reveal biochemical abnormalities. Understanding these abnormalities is crucial for optimizing athlete health and performance. Design Cross-sectional study. Methods We analyzed blood test results from 2525 Olympic athletes evaluated at the Institute of Sports Medicine and Science over a decade (London 2012-Paris 2024). Athletes were categorized into skill, power, endurance, and mixed sports based on the European Society of Cardiology classification. Blood samples were analyzed for hematological, metabolic, and biochemical markers. Abnormalities were defined according to established clinical thresholds. Statistical comparisons were performed to assess differences by sport category and sex. Results We enrolled 2525 Olympic athletes (mean age 25.7 ± 5.2 years old, 1138 females (45.1 %)). Overall, 62.6 % of athletes presented at least one blood test abnormality. The most common findings included dyslipidemia (20.4 %), hypercortisolemia (15 %), iron deficiency (9.7 %), and glucose intolerance (8.4 %). Female athletes had a higher prevalence of iron deficiency (16.5 % vs. 4.2 %, p < 0.0001) and hypercortisolemia (17.1 % vs. 13.2 %, p = 0.005), while male athletes showed higher rates of dyslipidemia (p = 0.004) and glucose intolerance (p < 0.0001). Skill-based athletes exhibited the highest prevalence of metabolic abnormalities. Conclusions Despite being regarded as models of health, Olympic athletes frequently present biochemical abnormalities. Routine blood screenings are essential for early detection and management of these abnormalities. Future studies are needed to determine the prognostic significance of these findings and their long-term impact on athlete health.
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