The TRUTH on TRT - Testosterone Replacement Therapy under Fire
Performance enhancing drugs (PEDs) have marred professional sports for years. Jose Canseco, A-Rod, Lance Armstrong have all become names synonymous with anabolic steroids, often used because “everyone’s doing them” and to create a “level playing field”. TRT has become MMA’s Achilles heel as this is seemingly the only sport where this drug has been so scrutinized.
What is TRT?
Synthetic testosterone is used to treat primary and secondary hypogonadism. Primary hypogonadism is when someone has low levels of testosterone because the testes are not functioning properly. This could be due to genetics or because of a birth defect. Secondary hypogonadism is when low testosterone levels occur because of diminished signalling from the pituitary gland in the brain. In order to use TRT in combat sports, an athlete had to have a therapeutic use exemption (TUE) in order to legally use TRT. Although the incidence of hypogonadism in a 30 year old male is 0.1%, at least 15 UFC fighters were granted a TUE and taking it, despite some of them having marginally if not near normal testosterone levels. TRT is seemingly an MMA based problem as no boxer has ever been issued a TUE, nor has any athlete competing in the London Olympics by the IOC (5,892 male athletes).
In a monumental move, the Nevada State Athletic Commission (NSAC) went on to ban TRT in February. TUE’s will no longer be granted to athletes in any of the combat sports including boxing, kickboxing, and MMA. The UFC immediately followed suit and issued a ban on TRT. Several big name fighters including Vitor Belfort and Chael Sonnen had to push back scheduled fights to get used to being off TRT. Interestingly, both fighters have previously tested positive for anabolic steroids in the past, with Belfort testing positive for 4-hydroxytestosterone (a steroid) in 2006. Belfort has looked sharper than ever at the age of 37 – on a 3 fight win streak, beating each of these opponents by spectacular knockout.
Myth – MMA FIghters are especially prone to Testosterone deficiency from constant head trauma
Interestingly, most fighters granted a TUE for TRT, were diagnosed by (often shady) physicians as having secondary hypogonadism, apparently secondary to repeated head trauma. Some fighters have also said that extreme dehydration necessary in weight cutting is the cause of their testosterone deficiency. No evidence exists to suggest that the simple “trauma” associated with training MMA results in testosterone deficiency. Such would only occur with severe, major head injury, to the point that a brain hemorrhage would compromise the pituitary gland, such as with a major car crash. Even studies looking at football players’ autopsies who suffered chronic traumatic encephalopathy (CTE) – showed no link hormonally with testosterone deficiency. Furthermore, no professional boxer has ever been granted a TUE. In short, being a mixed martial artist is not a valid reason for needing TRT.
Why is testosterone prescribed?
Testosterone has been prescribed moreso in recent years in part because of its product to consumer marketing. The athletic market has taken interest partly because of its rampant use amongst middle age and older males in the general population. The symptoms of testosterone deficiency (or “Low T” as the infomercials call it) are relatively common and nonspecific – low libido, decreased sex drive, hair loss and fatigue are a few. TRT is often prescribed regardless of proper levels being measured. The benefits can include improvements in muscle mass, cognition, mood, bone density and sexual function. Long term potential side effects can include: increased red blood cell mass (erythrocytosis), acne, potential for prostate cancer, and an increased risk of clots. In older men with possible heart disease and low testosterone levels, TRT is associated with an increased risk of adverse events (strokes, heart attacks, and death). Testosterone supplements make the body's own pituitary regulatory system think the body has enough, and shuts down the production of bodily testosterone, often leading to long term dependence for improved performance (known as the "Farquharson phenomenon" after Canada's most famous endocrinologist) and possible infertility.
Is TRT in MMA wrong?
Yes. It is a form of doping, and a performance enhancing drug. Many are of the feeling that it is milder or morally kosher to do TRT than anabolic steroids. Paradoxically, the only real cause I can see for true hypogonadism in an MMA fighter is previous chronic steroid use. Most men on TRT do report feeling much better, and it in turn becomes a mental crutch, and many athletes will psychologically feel that a higher blood level will give them a competitive advantage. The reality of combat sports like all other professional sports is that PEDs are rampant. Testing of testosterone levels are only done is those fighters with a TUE, so a fighter could be on TRT, not disclose it, and never be tested. Randomized drug testing has only come into play for the last year or so and currently is voluntary. Whether the UFC’s support on the ban on TRT was for publicity or to clean up the sport, or both, I applaud them for taking such a stance. TRT is really detrimental to both fighters in the cage, as one fighter could take more damage from a supraphysiological opponent, whereas the winner really does not know what is in store for him with respect to long term side effects. By fighting clean, we avoid "dirtying" the sport we love so much.