This review article underlines the detection-oriented derivatization of neutral steroids in liquid chromatography-mass spectrometry (LC-MS). Steroids have strong biological activity at very low concentrations in target tissues and, therefore, the analysis of steroids in body fluids or tissues is necessary to elucidate the nature of the many endocrine disease processes and thus be useful for diagnosis and treatment. LC-MS has recently been used for steroid analysis because of its specificity and versatility, but the ionization efficiencies of most steroids are relatively low for the different ionization methods. Derivatization enhances the ionization efficiencies of steroids, leading to high sensitivity and specific detection. For electrospray ionization MS the introduction of permanently charged moieties or easily ionizable moieties effectively increases the sensitivity of detection of steroids. The introduction of moieties with proton affinity or electron affinity enhances the analyte signals in positive and negative atmospheric pressure chemical ionization MS, respectively.