title: Sudden or unnatural deaths involving anabolic-androgenic steroids.
abstract: Anabolic-androgenic steroids (AASs) are frequently misused. To determine causes of death, characteristics, toxicology, and pathology of AAS positive cases, all cases (n = 24) presenting to the New South Wales Department of Forensic Medicine (1995-2012) were retrieved. All were male, and the mean age was 31.7 years. Deaths were mainly due to accidental drug toxicity (62.5%), then suicide (16.7%) and homicide (12.5%). Abnormal testosterone/epitestosterone ratios were reported in 62.5%, followed by metabolites of nandrolone (58.3%), stanozolol (33.3%), and methandienone (20.8%). In 23 of 24 cases, substances other than steroids were detected, most commonly psychostimulants (66.7%). In nearly half, testicular atrophy was noted, as was testicular fibrosis and arrested spermatogenesis. Left ventricular hypertrophy was noted in 30.4%, and moderate to severe narrowing of the coronary arteries in 26.1%. To summarize, the typical case was a male polydrug user aged in their thirties, with death due to drug toxicity. Extensive cardiovascular disease was particularly notable.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Darke
authors.forename: Michelle
authors.initials: M
authors.lastname: Torok
authors.forename: Johan
authors.initials: J
authors.lastname: Duflou
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D000728:Androgens / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D001284:Atrophy; D023921:Coronary Stenosis / Q000473:pathology; D004845:Epitestosterone / Q000097:blood / Q000652:urine; D006708:Homicide; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology; D008297:Male; D008696:Methandrostenolone / Q000097:blood / Q000652:urine; D008875:Middle Aged; D009277:Nandrolone / Q000097:blood / Q000652:urine; D009517:New South Wales / Q000453:epidemiology; D013197:Stanozolol / Q000097:blood / Q000652:urine; D019966:Substance-Related Disorders / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D013405:Suicide; D013737:Testis / Q000473:pathology; D013739:Testosterone / Q000097:blood / Q000652:urine; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D013739:Testosterone; D004845:Epitestosterone; D013197:Stanozolol; D009277:Nandrolone; D008696:Methandrostenolone
keywords: cardiovascular disease; demographics; forensic science; psychostimulants; steroids; toxicology