Over 100 athletes banned from the Rio Olympics after proof of a state-run doping program also need to worry about the health impacts of steroids. So do those who used the team’s drug cocktail but were never tested and caught

Further revelations in the Russian doping scandal have rocked the upcoming Olympic Games. Over 100 Russian athletes who would have competed in Rio have been barred due to an investigation into a state-run doping program that involved administering a cocktail of anabolic steroids to the country’s world-class athletes.

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An independent report released this month confirmed that at least 577 athletes in 2010 were given oral turinabol or trenbolone, oxandrolone and methasterone dissolved in alcohol that was “swished in the mouth … and then spit out” to avoid detection.

Despite this, the International Olympic Committee decided Monday to allow Russia to compete in next month’s Olympics.

While the scope of the Russian team’s doping program, which stretched to over 30 winter and summer sports, came as a shock, anabolic steroid use is nothing new when it comes to high-level athletes. From the East German Olympic team to pro American baseball players to the Tour de France, anabolic steroids have shown up all over professional sports.

Everyone from sports writers to ethics professors writing in journals have proposed lifting the ban on steroid abuse in the face of constant rule breaking. If there is no way to level the playing field and stop performance enhancing drug abuse, they reason, why not allow it and regulate it for safety?

But anabolic steroid use can have lasting implications for the many athletes – both on and off the international stage – who take them. For many of the Russian Olympians who weren’t tested and caught in this latest investigation, the potential health effects will still haunt them for the rest of their lives.

Facebook Twitter Pinterest Russia’s Ekaterina Galitskaya competes in the women’s 100m hurdles final at a track and field meet in Moscow on 28 July, 2016. Russia’s athletics federation held a competition for the athletes banned from the Rio Olympics. Photograph: Kirill Kudryavtsev/AFP/Getty Images

The steroids found in Russia’s doping cocktail – nicknamed “The Duchess” by a Russian official – are often abused. Around 3%-5% of the population uses steroids, estimates Thomas Hildebrandt, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai. Doping in amateur sport has gained popularity in recent years, with anabolic steroids showing up in non-professional cycling and triathlon competitions. Most users, however, are men whom Hildebrandt describes as “gym rats” in their late twenties and thirties to early forties.

In his research study of anabolic steroid users, Eric Ip, chair of the clinical sciences department at the Touro University California College of Pharmacy, found that the typical user was “a single Caucasian male in his late twenties who had a bachelor’s degree and worked in a white collar profession”.

While the muscle boosting effects of doping are well known, it is the mental effects, and what happens when someone finally stops using, that are often ignored. Anabolic steroids don’t just make people stronger and faster, they also help give them the feeling of a runner’s high. Anabolic steroids make exercise feel very good, which is where part of their addictive potential lies, explains Hildebrandt.

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Using the drugs discovered in the Russian doping scandal once or twice would not have any lasting effects, but long term use is another story. Anabolic steroids break down white matter in the brain, says Hildebrandt.

The mental effects of anabolic steroids can differ from person to person. In general, when using, it makes people more aggressive with a lower tolerance for frustration. How that manifests depends on what the person was like before they started using, says Hildebrandt. If someone was not an aggressive person, they are not going to start bar fights all of a sudden, but they will be more irritable and quicker to react, he explains.

While they are using, the flood of androgens to the body from anabolic steroids also comes with a host of physical symptoms like testicular shrinkage and breast development in men, and deepened voice, reduced breast size, balding and facial hair growth in women, along with a number of reproductive problems.

Studies of heart function after longer term anabolic steroid use found damage, weakening and an increased risk of heart failure.

Oral anabolic steroids, like those used by the Russian Olympic team, are also associated with liver toxicity, says Ip.

In the case of East Germany’s Olympic doping scandal, the high doses of anabolic steroids the female athletes were exposed to caused masculinization and severe health effects.

A number of East Germany’s former athletes sued over the damage to their health in 2000, winning a settlement from the government.

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The negative effects of anabolic steroids are well established, but research into the exact effects of each of the various anabolic steroids that are abused has been difficult, as most users take a cocktail, like the Russian athletes, and the makeup of the cocktails differ from user to user.

Helping anabolic steroid users get clean is another challenge. When athletes stop using, their bodies stop producing androgens and they enter a low testosterone state which may accelerate brain aging. According to Ip, some users also develop “depressive symptoms when stopping”, which may push them to remain on the drugs.

Unlike traditional recreational drug abuse, research based treatment protocols don’t exist for anabolic steroid use.

Any type of drug abuse comes with its own societal stigma, making it more difficult for addicts to get help. Most amateur athletes don’t seek assistance for fear of exposure. Even in the case of East Germany’s highly publicized state-sponsored doping program, some of the former athletes entitled to compensation from the government never came forward.

With the type of steroid abuse uncovered in Russia, there is a double stigma, says Hildebrandt. Since Russia continues to deny proof of widespread doping, those who partook may never seek help for fear of being branded both drug addicts and cheaters.