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Anabolic androgenic steroids in police cases in Sweden 1999-2009
National Board of Forensic Medicine, Linköping, Sweden.
National Board of Forensic Medicine, Linköping, Sweden.
Huddinge University Hospital, Sweden .
National Board of Forensic Medicine, Linköping, Sweden.
2012 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 219, no 1-3, p. 199-204Article in journal (Refereed) Published
Abstract [en]

Anabolic Androgenic Steroids (AAS) are considered drugs of abuse and are controlled substances in Sweden since 1999. Traditionally AAS have been used by elite athletes to enhance performance, but in recent years it has become an increasing problem outside elite sport among athletes, bodybuilders and criminals. Use of AAS is associated with psychiatric side effects such as aggression, depression and violent behavior. Supraphysiological doses and long term use can cause serious physical harm such as cardiovascular toxicity and even premature death. We investigated and evaluated the drug analytical findings in forensic cases from suspected perpetrators in cases from the police where a screening for AAS was requested to get information about the prevalence of AAS use and the occurrence of poly-drug abuse. The study was based on samples submitted from the police authorities to the Department of Forensic Toxicology in Sweden during the period 1999-2009. Urines were analyzed by methods based on GC-MS and LC-MS-MS. We also analyzed the prevalence of AAS use at the prison and probation services. A total number of 12,141 urine samples (6362 police cases and 5779 inmates) were analyzed and 33.5% of the cases from the police and 11.5% of the inmates were tested positive for AAS. The users of AAS were mainly in 99.2% men with a mean age of 26.2 +/- 6.2 years whereas the women were 29.5 +/- 6.5 years old. The most frequently used AAS was nandrolone followed by testosterone and methandienone. Other illicit and licit drugs were detected in 60% of the cases from the police, strongly indicating a frequent poly-drug abuse among users of AAS.

Place, publisher, year, edition, pages
Elsevier, 2012. Vol. 219, no 1-3, p. 199-204
Keywords [en]
Anabolic androgenic steroids, Forensic toxicology, Drugs of abuse, Testosterone
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-78810DOI: 10.1016/j.forsciint.2012.01.004ISI: 000304626800034OAI: oai:DiVA.org:liu-78810DiVA, id: diva2:536047
Available from: 2012-06-21 Created: 2012-06-21 Last updated: 2021-02-04
In thesis
1. Testosterone Use and Abuse: Methodological Aspects in Forensic Toxicology and Clinical Diagnostics
Open this publication in new window or tab >>Testosterone Use and Abuse: Methodological Aspects in Forensic Toxicology and Clinical Diagnostics
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abuse of anabolic androgenic steroids (AAS) is widespread in society and is today a major public health problem, associated with mental and somatic adverse effects and risk behavior, such as use of other illicit drugs and criminality. Testosterone, the most important endogenous male androgen, is therapeutically used in replacement therapy but is also extensively used as a doping agent. Traditionally, testosterone abuse is detected in urine in forensic cases and in serum in clinical diagnosis and monitoring, and free bioavailable serum testosterone is calculated by formulas. Salivary testosterone is however an attractive biomarker, as testosterone in saliva is supposed to reflect free testosterone in serum. 

The aim of this thesis was to investigate the abuse of AAS from a forensic perspective, particularly focusing on testosterone and methodological problems and potential alternative matrices for measurements of testosterone in forensic and clinical assessments. 

In the first study the toxicological findings in individuals suspected of doping offences, registered in the Swedish national forensic toxicology database were investigated (paper I). In paper II, testosterone levels in serum, saliva, and urine in clinical patients during replacement therapy with testosterone undecanoate (Nebido®) were studied. Further, the sensitivity of the current procedure for detection of testosterone abuse was investigated by method comparison using isotope ratio measurement (paper III) and a quantitative LC-MS/MS method for testosterone in serum and saliva was developed and presented (paper IV). 

It was found that testosterone was most frequently detected in the forensic cases and co-abuse of narcotics was common among AAS abusers. Methodological problems in detection of testosterone abuse using the present procedures was identified, indicating a need for new analytical strategies. A sensitive and highly specific LC-MS/MS method was developed for determination of testosterone in serum and saliva, which was shown suitable for analysis of forensic and clinical samples. Salivary testosterone was shown to correlate well with free serum testosterone in both male and female, and a sensitive marker in testosterone therapy, especially in females. In conclusion, it was found that saliva might have a potential as an alternative matrix for detection of illicit administration of testosterone and for diagnosis and monitoring of androgenic status. 

Abstract [sv]

Missbruket av anabola androgena steroider (AAS) är idag utbrett i samhället och är ett betydande folkhälsoproblem, associerat med fysisk och psykisk ohälsa och riskbeteende, såsom bruk av andra illegala droger och kriminalitet. Testosteron, det viktigaste manliga könshormonet används medicinskt vid klinisk substitutionsbehandling, men missbrukas även omfattande som dopningsmedel. Traditionellt detekteras missbruk av testosteron i urin i forensiska fall och i serum i klinisk diagnostik och monitorering och fritt biotillgängligt testosteron beräknas utifrån olika formler. Salivtestosteron är emellertid en attraktiv biomarkör, då testosteron i saliv anses spegla den fria fraktionen testosteron i serum. 

Denna avhandling syftade till att studera missbruket av anabola androgena steroider utifrån ett forensiskt perspektiv, speciellt med fokus på testosteron och metodologiska problem och möjligheten att använda alternativa biomarkörer för detektion och mätning av testosteron i forensiska och kliniska frågeställningar. 

I det första delarbetet studerades de toxikologiska fynden hos individer misstänkta för brott mot den svenska dopinglagen, registrerade i Sveriges nationella databas för forensisk toxikologi. I delarbete II studerades nivåerna av testosteron i serum, saliv och urin hos patienter vid substitutionsbehandling med testosteronundekanoat (Nebido®). Vidare studerades känsligheten för detektion av missbruk av testosteron med befintlig metod genom jämförelser med analyser med isotop ratio (delarbete III) och en kvantitativ LC-MS/MS metod för testosteron i serum och saliv utvecklades och presenterades (delarbete IV). 

Testosteron detekterades frekvent i de forensiska fallen, och ett blandmissbruk av AAS och narkotiska preparat var vanligt förekommande. Metodologiska problem identifierades med den nuvarande proceduren för detektion av testosteronmissbruk, vilket indikerar ett behov av nya analytiska strategier. En känslig och högst specifik LC-MS/MS metod för bestämning av testosteron i serum och saliv utvecklades, vilken visade sig lämplig för analys av forensiska och kliniska prover. Salivtestosteron korrelerade med fritt testosteron i serum hos både män och kvinnor, och visade sig vara en känslig markör vid testosteronbehandling, speciellt hos kvinnor. Slutsatsen är att saliv kan ha potential som en alternativ matris för detektion av missbruk av testosteron och för diagnosticering och monitorering av androgent status.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2021. p. 76
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1762
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-173146 (URN)10.3384/diss.diva-173146 (DOI)9789179297510 (ISBN)
Public defence
2021-03-05, Belladonna, Building 511, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Note

Funding agencies: The National Board of Forensic Medicine,Department of Endocrinology, University Hospital, Linköping, Medical ResearchCouncil of Southeast Sweden and Strategic Research Area in Forensic Science,Linköping University.

Available from: 2021-02-04 Created: 2021-02-04 Last updated: 2021-12-28Bibliographically approved

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