Drug transfer during intimate moments can produce an adverse analytical finding during a doping control: A case report with ligandrol

Selective androgen receptor modulators (SARMs) are a new class of substances that have similar properties to anabolic steroid agents, but with marked reduced androgenic properties. As SARMs have the potential to be misused for performance enhancement in sport due to their anabolic properties as well as their ability to stimulate androgen receptors in the muscle and the bone, they have been prohibited at-all-times by the World Anti-Doping Agency (WADA) since 2008 under section S1.2 of the List. Ligandrol is one of the more popular SARMs. A WADA-accredited laboratory identified bishydroxy-ligandrol in the urine of a female athlete, the major ligandrol metabolite at approximately 90 pg/mL (specimen A) and 200 pg/mL (specimen B). The athlete challenged this anti-doping rule violation and requested a hair test to document possible incidental exposure. About 7 weeks after urine collection, a hair specimen (brown in color and > 20 cm in length) was collected and segmented in 6 × 1 cm segments. Ligandrol was tested by liquid chromatography-tandem mass spectrometry after alkaline incubation and extraction. With a limit of quantitation at 1 pg/mg, no ligandrol was identified. It appears that the athlete was unaware her husband was taking the substance, which was confirmed by his hair test (ligandrol at 7 and 8 pg/mg in 2 × 2.5 cm segments). The Court of Arbitration for Sports accepted the athlete's explanation that she had been exposed to ligandrol through the exchange of bodily fluids with her husband and lifted her provisional ban. This case demonstrates that drug transfer between two subjects is possible during intimate moments.