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Further, the numbers were 35% from anti-estrogenic substances (tamoxifen, clomiphene, fulvestrant, toremifene, and raloxifene) and 20% from AIs (letrozole, anastrozole, exemestane, adrostatrienedione, and armistane) in 2022 (World Anti-Doping Agency, 2024b)

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While these reports lack the rigor of controlled studies, their consistency across diverse populations and injury types suggests real effects beyond placebo response