Identification of the abuse of performance-enhancing agents in medico-legal investigations; based on a death of a body-builder

Sportsmen abuse Performance-enhancing agents (PEA) to enhance their muscle mass and strength, while the side effects PEA may cause consequences and sudden deaths. However, the relatives usually are not aware of PEA-abuse, because most PEAs are purchased by the sportsmen from black-market. Therefore, the pathologists might miss PEA-abuse and may dispose of the postmortem with a wrong cause of death. This concept introduces a guideline to identify PEA-abuse and to give recommendations for the proper medico-legal investigation of deaths due to PEA-abuse. A 37-year-old bodybuilder who had a healthy-lifestyle died suddenly. Though the relatives were unaware, the Forensic pathologist profiled the findings and suspected PEA-abuse. The scene was visited but did not find PEA. Family physician revealed the abuse of PEA such as testosterone, cutting steroids, insulin-like growth factor and caffeine, and has had elevated liver enzymes. A high-risk autopsy was conducted. The face had acne and heart had concentric hypertrophy. Histopathology showed hypertrophy of the cardiac muscle and lung parenchyma and fatty liver. Therefore, we propose a postmortem guideline to identify PEA-abuse among sportsmen; (1) Establish seven PEA-abuse profiles; Social, physical, psychological, clinical, sports, pathological and toxicological, (2) Before autopsy, to identify the types of PEA (i) Contact the physicians and (ii) visit the scene, (3) At the autopsy, use special approaches; (i) Consider as high-risk autopsy and (ii) If gene doping is suspected, do molecular autopsy. (4) To ascertain COD, consider abuse profiles, scene and autopsy findings. (5) For prevention, organize awareness programmes and (6) to prevent premature deaths recommend to employ a clinical screening tool.