What's your opinion on TRT in mma?

El Guapo!

I'd be interested to hear what everyones thoughts are on TRT.
It seems to be in mma news more and more lately with new fighters coming out of the woodwork and saying they require a TUE, and it's creeping into boxing now too, so I think it'd be interesting to have a discussion on it.

I'm kind of on the fence about it at the minute.
On one hand, it seems to me that this is just a new excuse fighters are using to get around the testing laws. It's all too coincidental that athletes in a fighting sport all suddenly have this low testosterone issue which requires treatment.
How come this is a relatively new occurence? Why haven't fighters been having TRT for years and years? And how come there's such a steadily increasing amount of fighters requiring it? It just seems too convenient or something and it just doesn't sit right with me.
There have also been a couple of articles I've read on the subject that say it's all too easy for an athlete to "trick" their GP into thinking they have abnormally low test levels.

Then on the other hand, there is of course people out there who genuinely need this treatment and they have every right to avail of whatever treatment necessary to keep them healthy. I just wonder how many professional athletes fall into this category.
But then that begs the question, if someone has dangerously low test levels, should they be competing in a sport such as mma at all?
And isn't it supposed to be man v man in the cage, fighting with no chemical advantage over the other guy? Both guys being natural and the only advantage they may have is their natural talents and how hard they've trained to be there. So if this is this case, shouldn't you have to fight with "what God gave you", and not use any treatment to bring your test levels up un-naturally?

The whole thing is a bit of a grey area at the minute and I'm not sure the athletic commisions really know what to do about it just yet.
I think there needs to be proper studies carried out about the use of TRT in professional sports. And I also think there needs to be clear and concise rules and regulations, so that there's no confusion from case to case. I know this may be a nightmare to try to regulate but surely something has to be done as there seems to be widespread confusion about the subject.

ASJ112

How come this is a relatively new occurence? Why haven't fighters been having TRT for years and years?

I'd imagine they have been on it for years, the fact that you can get a TUE to legally use testosterone as an athlete in places like Nevada, just made more people publicly come out as using it lately.

But then that begs the question, if someone has dangerously low test levels, should they be competing in a sport such as mma at all?

1:1 is normal T/E level, I find it hard to believe you would find any fighter in the UFC with a T/E level below that. Chael Sonnen claims to have hypogonadism, but his T/E levels were 16.9:1, while Overeem's were 14:1. Even if Sonnen does need it medically, those levels are insane.


WADA allow for 4:1 T/E and Nevada allow for 6:1, as long as fighters adhere to the level that is allowed by each commission, then I am ok with TRT. Although I do think it should be at the WADA level of 4:1 for every state in USA and far better testing should be done to verify this(and more random testing to ensure people aren't cycling off).


When you see somebody like Todd Duffee use TRT when he was 25, that does make you suspicious about it.

Stephen_King

No issue with older fighters like Hendo using it if they needed it, cant see the sense in allowing fighters under 35 going near it without a genuine medical reason.

Dean09

Dean09 wrote: »

There have also been a couple of articles I've read on the subject that say it's all too easy for an athlete to "trick" their GP into thinking they have abnormally low test levels.

They don't even need to trick their doctor. All they need is a shady doctor who is in cahoots with them. America is full of these 'wellness' clinics and dodgy doctors

Overeems doctor had a previous malpractice fine and restriction for prescribing roids to people over the internet. And we were supposed to believe it was just a coincidence that Overeem happened to be using this guy. He moves to America, the first thing he is going to do is find a new doctor who can hook him up with a supply.

The whole TRT thing is shady, too easily abused. I mean Todd Duffee, that's taking the piss.

I think the Olympics have given two exemptions in their history.

Mellor

My stance is that its fine for people who need it. The issue is finding those who actually need it and are just chancing their arm.

To clarify, when I say need it. I mean those who are significantly lower that average or a reference level. I'm not including a older guy whose levels decline slightly due to age.

Dean09 wrote: »

It's all too coincidental that athletes in a fighting sport all suddenly have this low testosterone issue which requires treatment.
How come this is a relatively new occurence? Why haven't fighters been having TRT for years and years? And how come there's such a steadily increasing amount of fighters requiring it? It just seems too convenient or something and it just doesn't sit right with me.

More people everywhere are getting those tests and subsequent TRT. It's not strange that athletes are also. In the past they would of been ok to just take it return to normal levels without worrying. With testing is getting better and better that was no longer possible.

And isn't it supposed to be man v man in the cage, fighting with no chemical advantage over the other guy? Both guys being natural and the only advantage they may have is their natural talents and how hard they've trained to be there. So if this is this case, shouldn't you have to fight with "what God gave you", and not use any treatment to bring your test levels up un-naturally?

If somebody has a staph infection, a cold, inflammation. Should they not take any medication if they wish to fight and go in naturally? Of course not.
The people who need TRT are the people who would be suffering without it and need it regardless of a fight career. Those who don't need it it are ruining it for those that do.

ASJ112 wrote: »

1:1 is normal T/E level, I find it hard to believe you would find any fighter in the UFC with a T/E level below that. Chael Sonnen claims to have hypogonadism, but his T/E levels were 16.9:1, while Overeem's were 14:1. Even if Sonnen does need it medically, those levels are insane.

That's not correct.
1:1 is a average T/E ratio, not level. It's nothing got to do with levels.
A UFC fighter is just as likely to vary slightly from the average ratio, up or down, just like anybody else, its normal it doesn't mean you have high or low test. It's not related to total test in the system.
Sonnen's levels were that high because he was taking synthetic test due to his condition. A high ratio is completely expected if he had the condition, and in no way "insane". If his body wasn't producing test, its most likely wasn't producing epitest.

I'm not having a go at you for not understanding the difference between T/E ratio and total test. It's not your fault. Most journalists at the time of the Sonnen and Overeem cases either didn't know, or ignored it to create a better headline.

WADA allow for 4:1 T/E and Nevada allow for 6:1, as long as fighters adhere to the level that is allowed by each commission, then I am ok with TRT. Although I do think it should be at the WADA level of 4:1 for every state in USA and far better testing should be done to verify this(and more random testing to ensure people aren't cycling off).

WADA used to be 6:1.
4x or 6x times isn't really the issue.
If somebody is found to have synthetic test in their system, without a TUE, regardless of T/E level, they should be punished.

For anyone granted a TUE, they should be monitored by total levels randomly as well as before the fight. T/E is no longer relevant I would imagine.

The ACs need to keep doing T/E checks but they also need to include isotope test to find synthetic test, and anybody with a high T/E ratio needs to be tested for total levels automatically, not only if they request it.

Mellor

Deleted User wrote: »

They don't even need to trick their doctor. All they need is a shady doctor who is in cahoots with them. America is full of these 'wellness' clinics and dodgy doctors

Overeems doctor had a previous malpractice fine and restriction for prescribing roids to people over the internet. And we were supposed to believe it was just a coincidence that Overeem happened to be using this guy. He moves to America, the first thing he is going to do is find a new doctor who can hook him up with a supply.

The whole TRT thing is shady, too easily abused. I mean Todd Duffee, that's taking the piss.

I think the Olympics have given two exemptions in their history.

I imagine a dodgy doctor willing to prescribe TRT isn't hard to find. But that's not all you need. Sonnen, Peterson, and many others claimed to need TRT. They were still banned as TRT is against the rules without a TUE.

To get a TUE you need much more than just a doctor to ok it. You need to provide medical history, test results, etc. I've no problem with issuing TUEs, as long as they are so hard to get that only legit cases stand a chance, and borderline cases are denied.

UL_heart_throb

It's definitely a funny one. I'd love to talk to a real endocrinologist about it and get the entire thing explained to me from start to finish.

From what I understand, TRT is indicated for adult men with hypogonadism, boys whose genitalia hasn't developed properly or are not having normal puberty, female-male transsexuals, people with HIV (not routine) and osteoporosis (not routine either).

With regard to men with hypogonadism, this means either their testes aren't producing enough testosterone or their hypothalamus-pituitary axis isn't working.

As already mentioned it is well accepted that testosterone levels decrease in middle age, a man at 45 will have lower testosterone levels than he had at 20. TRT isn't designed for treating this natural decline in T production. However, if these levels do drop, and the clinical features are there, it is indicated.

The first question that arises is, how do guys like Randy Couture, Dan Henderson, Chael Sonnen etc. develop hypogonadism? I mean these guys could probably get the part of the live action version of Desperate Dan comic book. I wouldn't be surprised if these were the type of guys that had to shave on the morning of their communion and then again at dinner time.

Maybe there is some relationship between extreme production of testosterone in youth with a more severe decline in middle age? Maybe us normies keep more stable levels? Just thinking out loud here.

Others have argued 2 other possible reasons why these guys have low testosterone levels. The first is, they all have an extensive career of wrestling and weight cutting, going back to when they were 10 years old. There is apparently some link between continuous weight cutting, body fat levels going up and down, lots of hard cardio and strength work and a drop in Testosterone levels later. Again, haven't read any science on this so don't know what to make of it.

The second is, and it is fairly well accepted across the board, is that synthetic testosterone use/abuse causes testicular atrophy, which causes hypogonadism. This is to say, if you use too much artificial testosterone as a body builder, you are much more likely to suffer hypogonadism as an adult. This raises the question about whether these guys were using testosterone earlier in their careers as a PED. And if they were, does that change their entitlement to use TRT now? Ethical question.

Anyway, moving along to how hypogonadism is diagnosed. They test the blood for total testosterone and they can also test for 'free testosterone'. Free testosterone is apparently the testosterone that is bioavailable and functional, while the rest of the testosterone is bound to a protein that doesn't make it that useful. However, testing for free is harder and is only done as a double check.

What is worth noting is that serum testosterone levels vary through the day. They usually peak in the morning, and usually fall off at night, following a circadian cycle. The peaks and troughs of this graph can vary a lot from individual to individual. So if you're getting a test, you should be tested around 9am not 4pm. Apparently 40% of low testosterone measurements are due to taking it at the wrong time of the day. So they really should take 4 or 5 morning measurements or even do a 24 hour test.

Anyway, I'm giving a;; that ^ because that forms the basis of my opinion.

I think all athletes should be entitled to the same medical treatment non-athletes are entitled too, as long as the treatment isn't abused for a performance enhancing effect.

For the athletic commissions to authorise TRT they should have documented proof of the hypogonadism. This means a subjective report from the athlete giving their symptoms (complaints of fatigue and irritability and getting fat etc.). They need to have numerous repeated blood tests for testosterone. I think ideally they need 3 24 hour tests (i presume this is possible).

They need to supply multiple urine samples to calculate their E:T ratio prior to TRT. This needs to be repeated when they're on TRT too, to see how much it has changed.

Finally, athletes shouldn't be able to take TRT within 2 weeks of a fight. I don't know if this is ethical.

With regard to the T:E thing. Apparently they still don't know exactly how epi-testosterone comes about and what pathways it has. It's fairly well accepted that it's created in the testes like testosterone is. It can't be converted to Testosterone nor can testosterone convert to epi-testosterone.

Most people have equal production of T and E and equal elimination in the urine. So this means they have a ratio of 1:1. However, lots of people have really high levels of natural testosterone and abnormally low levels of epi-testosterone. These people do not take anabolic steroids and will have a ratio of ~16:1. Some scientist decided that 6:1 ratio was the fairest and most reliable way of accommodating people with naturally variable ratios without allowing drug cheats in. There is debate over whether 6:1 is actually fair for everyone as someone who is naturally 1:1 has some room to artificially move it to 6:1. The reason why this urine test is used because any artificial testosterone source you take will increase your T level and not affect your E level. The logic being normal person is 1:1, normal person on steroids is 20:1.

The point chael p sonnen makes is that the limits used are not fair. They don't account for the unusual athletes who have naturally variable levels. He likes to make the point that having a screwed up T:E ratio is only circumstantial evidence of steroid use. If you want to test for steroids you can actually test for them using spectrometry or crystallography or isotope or what ever it is. And find the banned substance. Furthermore, if you were a drug cheat, and you were taking artificial Testosterone, why wouldn't you take equal amounts of artificial epi-testosterone to keep your ratio in check? One of the reasons is epi-testosterone is much harder to find because it has no anabolic effects.

By the way, a presumption in this entire discussion is that using anabolic steroids for Performance enhancement is wrong, which, not everyone actually agrees with.

danlen

Good post.

Kev M

UL_heart_throb wrote: »

Finally, athletes shouldn't be able to take TRT within 2 weeks of a fight. I don't know if this is ethical.

Whaaat?? So they should come off and crash right before a fight? Probably not the best idea... If testosterone was truly the only substance being used, for an extended period of time, two weeks cold turkey would leave the fighter in an absolute mess.

On the original question, my opinion is that it is a very grey area in which everyone has an opinion. Bottom line is PED use is a big part of mma (and most sports) even at lower amateur levels and isn't going anywhere. TRT is just steroids with a doctor's note, nothing more. I personally have no problem with seeing it in mma, I just get disappointed when good fights get cancelled because guys get caught.

Mellor

UL_heart_throb wrote: »

The first question that arises is, how do guys like Randy Couture, Dan Henderson, Chael Sonnen etc. develop hypogonadism?

I think you are jumping the gun there, Randy didn't undergo TRT afaik, maybe he did under he radar. And Dan hasn't disclosed his reason for receiving a TUE.

Apparently 40% of low testosterone measurements are due to taking it at the wrong time of the day. So they really should take 4 or 5 morning measurements or even do a 24 hour test.

It's probably possible to get a doctor to take the test at the wrong time to make a case for TRT, but people need to understand that its not simply a case of getting your doctor to back you up to get a TUE. You need to provide a medical history over a period. I think this longer than 7 days you suggest, I have a feeling its 30 days. Its reviewed by the Athletic Commission's doctor and its up to him to make his opinion. For Chaels case, this is what the NSAC doctor said.

Although he was critical of Sonnen’s doctor, it was Dr. Trainor’s opinion that Sonnen appeared to have a legitimate condition that required treatment. He recommended that Sonnen be granted a Therapeutic Use Exemption for his testosterone treatment, although he did offer conditions.

“If someone has a TUE exemption, they should be tested the morning after they fight to get what their serum levels are in case they take something right before fight,” said Trainor, explaining that taking an injection too close to the fight could conceivably become a performance enhancer.

He recommended that injections be stopped several days prior to the contest, and then resumed following the contest, and that a morning after the bout test be administered and required to return a result indicating normal testosterone levels. Such a test should be required of any participant granted a TUE exemption for testosterone treatment, in Dr. Trainor’s opinion.

The TUE grant also includes that he must stay withing normal total testosterone levels during treatment.

Logical Fallacy

Off the top of my head the most prominent TRTers are long time wrestlers. I know it's always easy to imply that a mid 30's athlete who needs TRT would imply steroid abuse at a young age but a huge part of wrestling is weight cutting, and the effect of weight cutting on the bodies production of testosterone is massive.

Interesting right up here on the case of 3 college wrestlers in the states who died during contest prep.

Most alarming was the program’s effect on testosterone. The average drop was 33 percent, along with a 47 percent drop in luteinizing hormone, or LH, a pituitary hormone that controls testosterone synthesis. Even worse, the wrestlers’ sex hormone-binding globulin went up by 21 percent. SHBG binds active testosterone in the blood, and the more SHBG your body has, the less testosterone you have in your blood.

That's a pretty steep impact right there. No idea how this carries over to the long term, but wrestlers seem to be pretty active.

Gonna check around PudMed and see what I can find.