In a Case of Death Involving Steroids, Hair Testing is More Informative than Blood or Urine Testing

Abstract

A 59-year old male was found dead at home, with 2 empty vials of an oily preparation attributed to a manufacturer from East Europe. There was no label on the vial. The subject was a former weightlifter, also known as an anabolic steroids abuser. The local prosecutor ordered a body examination, which was unremarkable and allowed collecting femoral blood, urine and scalp hair (6 cm, brown). He was treated for cardiac insufficiency with quinidine. Biological specimens were submitted to standard toxicological analyses including a screening with LC-QToF, but also to a specific LC-MS/MS method for anabolic steroids testing. Ethanol was not found in both blood and urine. Quinidine blood concentration (791 ng/mL) was therapeutic. No drug of abuse was identified. In blood, testosterone was less that 1 ng/mL and no other steroid was identified. In urine, T/E was 1.56 and boldenone showed up at 9 ng/mL. The hair test results, performed on the whole length, demonstrated repetitive steroids abuse, including testosterone (140 pg/mg), testosterone propionate (605 pg/mg) and testosterone decanoate (249 pg/mg), but also boldenone (160 pg/mg), trenbolone (143 pg/mg) and metandienone (60 pg/mg). Given forensic laboratories have limited access to steroid urinary metabolites reference material due to specific regulations (to avoid testing athletes before anti-doping verifications), hair analyses seem to be the best approach to document anabolic agents abuse. Indeed, in hair, the target drug is the parent compound and, in addition, when compared to blood or urine, this matrix has a much larger window of detection. The pathologist concluded to cardiac insufficiency in a context involving repetitive abuse of anabolic drugs. This case indicates that more attention should be paid to anabolic steroids, in a context of sudden cardiac death.

The importance of including anabolic steroids in systematic toxicological analysis: A case study

“…In interpreting the concentrations of anabolic steroids in the post-mortem phase, it is necessary to consider that anabolic steroids have a poor incorporation in hair and that a single dose of 50 mg of some of them (nandrolone undecanoate, nandrolone decanoate, testosterone enanthate, testosterone undecanoate, and testosterone propionate) is undetectable in the hair. 33 Thus, identification of AAS in the hair sample confirms the frequent/chronic use of those substances and contributes to establishing hair analysis as the best approach to document the current/past abuse of anabolic agents. Anatomopathological findings are consistent with this assumption: cardiac hypertrophy and widespread presence of fibroatheromatic plaques in coronary arteries.…”

“…Furthermore, concentrations of other two synthetic steroids, boldenone and nandrolone, compared with the existing literature 28 suggest that the decedent was a regular anabolic steroid abuser. In interpreting the concentrations of anabolic steroids in the post‐mortem phase, it is necessary to consider that anabolic steroids have a poor incorporation in hair and that a single dose of 50 mg of some of them (nandrolone undecanoate, nandrolone decanoate, testosterone enanthate, testosterone undecanoate, and testosterone propionate) is undetectable in the hair 33 …”

Hair analysis as a powerful tool for the identification of anabolic androgenic steroids and other performance and image enhancing drugs in a subject with tissues damages

“…Favretto et al reported a testosterone hair concentration of 18 pg/mg for a testosterone undecanoate user, 13 143 pg/mg. 11,12,36 These values are below our method LOD. Few papers reported hair concentration levels for sildenafil.…”

“…The concentrations measured in head hair were comparable or higher to the ones found by other authors for chronic users. In particular, stanozolol was detected in the hair from 2 up to 881 pg/mg, [27][28][29] methandienone levels in hair ranged from 3 to 206 pg/mg, 11,[29][30][31] and testosterone enanthate from 0.6 up to 18.8 ng/mg. 32 Also, testosterone was in a concentration higher than those reported for endogenous contribution, which ranged from 0.3 to 11.81 pg/mg.…”

“…[3][4][5][6][7] Many are the side effects related to the use of AAS on several organs and systems, including cardiovascular, reproductive, central nervous and musculoskeletal systems as well as renal, skin, and liver. [8][9][10][11][12][13] In…”