Testosterone Replacement Therapy: An introspective look at the debate from all angles

UFC President Dana White is a passionate man, who at times seems to have the ability to use his blunt and assertive nature to draw some serious attention and loud noise towards the topics he’s usually less than content with. With his recent comments and semi-threats regarding the use of Testosterone Replacement Therapy – stemming from what was apparently a few isolated and recent events – he seems to have the entire MMA world listening attentively yet again.

With that said, TRT is an issue that has been popping up in conversation for the past 4-5 years, with its frequency of which increasing steadily up to what seems to be its proverbial boiling point that we’re now witnessing.

There have been many opinions on the subject matter since the term was first mentioned in the media for the very first time. Although we’ve never had more information on the subject than we do now, so I’m going to make it my job to list every perspective on the topic as they all bring up and make some valid arguments, which I’ll be splitting up into simple groups of pro’s and con’s.

But first off, for those of you who may be new to the topic and just lacking information or even those of you who may know quite a bit, but want some more background info on the discussion, let’s get a few definitions out of the way to give you a basis and keep you in the loop. And who knows, like myself, you just might be a bit surprised by some of the information contained in these basic Wikipedia definitions:

TRTTestosterone Replacement Therapy otherwise known as Androgen replacement therapy is a hormone treatment often prescribed to counter the effects of male Hypogonadism. It is also prescribed to lessen the effects or delay the onset of normal male aging. Additionally, androgen replacement therapy is used for men who have lost their testicular function to disease, cancer, or other causes. As men enter middle age they may notice changes caused by a relative decline in testosterone: fewer erections, fatigue, thinning skin, declining muscle mass and strength, more body fat. This dissatisfaction with the changes of aging has led to the development of the idea of androgen replacement therapy.

HypogonadismOtherwise known more specifically in men as Hypoandrogenism is caused primarily by either dysfunction, failure, or absence of the gonads (hypergonadotropic) or impairment of the hypothalamus or pituitary gland (hypogonadotropic), which in turn can be caused by a multitude of different stimuli, including genetic conditions (e.g., GnRH/gonadotropin insensitivity and enzymatic defects of steroidogenesis), tumors, trauma, surgery, autoimmunity, radiation, infections, toxins, drugs, and many others. Alternatively, it may be the result of conditions such as androgen insensitivity syndrome or hyperestrogenism. More simply, old age may also be a factor in the development of hypoandrogenism, as androgen levels decline with age.

An interesting thing to note in both definitions is the use of the words “normal” and “natural”. Remember those terms most when reading the rest of this article, as those terms are the most valid and legitimate pieces of firepower in this argument. Now on to some pros and cons for you:

Pros:

- For reasons which are rather self-explanatory, the school of thought supporting TRT favours all of our oldest and most beloved fighters, allowing athletes who in most cases have paid their dues and are veterans of the sport, to continue competing at their highest level for a few more years.

- This “bonus” time truly allows legacies to be cemented, as well as all combinations of super-fights, pay-per-views and blockbuster-sized events to become a reality, which may not have had the opportunity of happening otherwise.

Cons:

- The reality? You’re augmenting your body in a completely unnatural way, giving you the ability to do something that you shouldn’t be able to do given the age you’re doing it at. As unfortunate as it is to hear, especially for the fighters participating in the therapy, it’s a fact.

- There is a direct correlation between long-term steroid abuse and a lack of natural testosterone production. With the exception of fighters or any male for that matter suffering from an actual lack of natural testosterone production or hypogonadism, no regular healthy male with a clean medical history, athlete or otherwise, should ever require the treatment under any normal circumstances.

Conclusion:

Age is the human body’s natural response to the stress of physical activity and its effect on you as an individual. It’s what your body uses to measure it’s threshold for pain as well as the amount of strain and duress your body can be put through given how long its muscles, joints, bones, nerves and tissues have been taking successive impact over a given amount of time.

Jon Jones recently stated that he’d be completely fine with an older athlete using TRT to even the playing field. While this is admirable, it is completely unnecessary and the wrong approach to the topic.

The fact of the matter is this, if you require augmentation be it physical or chemical in order to compete at the level you once have at earlier stages of your age and career, than either deal with the consequences like an adult and compete with the disadvantage or retire. The situation is no longer seems to be filled with the grey area that it once was, in fact it’s safe to say that it’s never been more black and white.

The keyword of the day here is “Natural”. With the exception of a specific naturally occurring condition known as hypogonadism, no athlete of any kind should ever require or use any chemical or foreign substance on their body that will change the way it performs in a way that is not natural. It would be no different than fighter now being allowed to grab the fence or knee strike to the head of a downed opponent whenever he likes.

The rules of this sport aren’t located solely in the octagon, they are a part of life, because this very sport is an entire lifestyle for all of its athletes.

And for the fighters who do happen to have an unfortunate and naturally occurring case of legitimate hypogonadism,  as unfortunate as their situation may be, TRT is a priviledge allowing them the ability to function at a normal level, that wouldn’t be possible otherwise.

Therefore as Dana White recently stated, they should be rigorously tested on a very consistent basis to be sure that they are never given the opportunity to abuse the therapy and increase their testosterone to abnormal levels, allowing them to benefit from the hormonal spike ultimately providing them with an advantage.

That’s enough out of me, let us know what you think in the comments below.

Give us your opinions and thoughts on the subject and please always remember to keep the message boards heated and fun, but free of prejudice and vulgarities.


25 Comments

  1. Avatar of Evan Holober

    Evan Holober

    February 18, 2013 at 3:07 am

    Dr. Mike:

    Any opinion from you in this thread would be greatly appreciated.

    Good write up Bryan.

    • Avatar of Bruce Lee

      Bruce Lee

      February 18, 2013 at 10:18 am

      Thanks Evan,

      I'm a sexual medicine physican and so that is the angle I am usually coming from in my work. In that scenario we are doing what Bryan is talking about: Taking somebody who is low for one reason including age and bring him / her into the normal range for reasons of sexual function. I don't treat any athletes whatsoever. Like every other fan I have an opinion which is less related to my job and more to my gut feeling.

      To me one of the key issues is that normally total testosterone declines by 1% per year (yes, it's happening to all of us). With that normal dynamic we would expect that people's function related to T would decline 1% per year – in the normal setting. i.e. we get less horny and less strong, fast and less effective healers and less endurance in the normal setting.

      What I try to do in my job is identify the patients who's function is declining faster than would be expected for age. I would not treat a guy who says my function (be it athletic or sexual) is slowly declining over the years but it feels natural and in keeping with what is happening to my friends and spouse as far as I can tell. I would treat the guy who says wow I feel off – my spouse wonders why I'm napping all the time and she isn't and now she wants more sex than me etc. If I test the second guy and on two different morning readings he is low then we would treat him and if he responds well we would keep him on treatment. IF he wasn't low – don't treat. IF he was low but didn't improve on T – take him off.

      For athletes (which I don't treat in my practice) my opinion is a little philosophical: Contrary to what Jones thinks I wouldn't treat a guy who is declining but still well within the normal range. If a guy has declined sharply from his previous levels but is still technically within the low end of the normal range or if he was clearly low I might treat him up to the middle of the range if it helped.

      Generally I adhere to these guidelines which recommends treated men to the middle of the normal range (and it doesn't consider age): http://www.endo-society.org/guidelines/final/upload/final-androgens-in-men-standalone.pdf

      For people who don't agree because it isn't natural I wouldn't argue with them. They have a right to their opinion but I would say this: It would be natural in the case of any endocrine (hormone) deficiency to lose function and suffer or die. So whether your deficiency is thyroid hormone or insulin or growth hormone or melatonin or estrogen or progesterone or testosterone or parathyroid hormone if we don't treat the deficiency quality of life is greatly diminished or you die. That's natural. If you're a diabetic fighter you must be natural and not use insulin and when you die…oh well – that's natural. Seems harsh.

      So lets say we test every fighter on a range of health related issues every month as part of UFC (or whatever company) health care benefits: blood sugar, kidney and liver function, testosterone, cholesterol etc. We know what they were at when they joined and throughout their career. If a guy goes on treatment because he is low he may be even more tightly monitored with random tests as determined.

      Sorry, I'm at the lake and it's a long weekend and my wife is calling me for bacon, eggs and freshly baked and iced cinnamon buns…gotta go (without editing)

      • Avatar of Bryan Fontez

        Bryan Fontez

        February 18, 2013 at 12:38 pm

        Wow that was great Michael!

        Thanks a lot for the insight and for taking the time to read and respond.

        Enjoy those buns ; )

      • Avatar of kungfurule

        kungfurule

        February 18, 2013 at 4:13 pm

        somebody weaked you they must have low test. lol

      • Avatar of enjoylife321

        enjoylife321

        February 18, 2013 at 4:40 pm

        @Michael…..How significant an advantage if any do you believe an athlete would gain from taking their testostorone levels from mid range to high range but still within the endo societies guidelines ?

        • Avatar of Bruce Lee

          Bruce Lee

          February 18, 2013 at 8:32 pm

          @ Enjoy, I would respond with two points.

          In my sexual medicine practice I am treating largely people who's disease or condition has caused a decline in sexual function. I see a lot of MS patients, cancer patients, depressed patients, a ton of diabetic patients and others all of whom have had their sexual function affected by their health situation. I work to help them regain some semblance of a normal sexual life. This doesn't give me a lot of experience with your question.

          If I make an educated guess at the answer to your question I may be no more knowledgable than other Lowkickers – many of whom had educated themselves as best they can and know quite a bit. Using Canadian (Metric (aka SI)) units the normal range is 8-35. Suppose we take a guy from 10 up to 32 and everything else stayed the same (training and nutrition) I would say it would make a moderate difference in muscle building ability. It wouldn't make him much faster unless he trained that. He still wouldn't have a wrestler's skill at using his strength. He wouldn't have better timing or co-ordination (might be worse if he added too much too fast) but…If he was at 170 and he lost five pounds of fat and replaced it with five pounds of muscle and he worked for three months leading into his training camp with that weight / muscle that would be an advantage.

          Take the testosterone and don't work hard in the gym and very little if anything would happen to an athlete. We do see a drop in central body fat in overweight diabetic patients treated.

          The key issue is this @enjoy. The Endo Society's guidelines say to replace guys up to the middle of the range – not above that. Doctors who are prescribing irresponsibly need to be singled out and punished. They are unethical bum making those who need TRT for legit medical reasons look bad. Kick 'em out of the profession.

          Proper TRT replaces what is missing and gets they guy out of the hole he is in and puts him on level ground. It doesn't put him on a hill (advantage). Thanks for the opportunity.

      • Avatar of Baby Ads

        Baby Ads

        February 18, 2013 at 9:42 pm

        @dr michael stupison
        are old porn stars using trt treatment also doc or not?

      • Avatar of ko4u

        ko4u

        February 19, 2013 at 9:01 am

        Its a fight..Who cares what they do? Fedor had been smoking people on roids for years. People talk about a even playing field……In a fight there is no even paying field. Some are good and most are not. If a guy does roids it pushes him out of his weight class. I would bet on a natural 205 lbs to a roided lbs any day of the week. Sonnen has been doing roids for some time and still loosing….. Roids are not everything because skill and talent wins every time!

  2. Avatar of falcon4917

    falcon4917

    February 18, 2013 at 4:42 am

    Bryan, that was a really good article and I agree.

  3. Avatar of japanegro23

    japanegro23

    February 18, 2013 at 4:47 am

    I think it's wrong no matter how you slice it. There is nothing natural about injecting yourself with testosterone. It's funny how people are throwing the word natural and normal around. Bringing testosterone to "normal" levels…. It's "normal" for testosterone levels to decrease as you get older and will decline sooner depending on how you live your life. People are different sizes, shapes, and ages. Why is it that people are un"natural"ly trying to level the playing field when it comes to testosterone? You should play the hand your dealt when it comes to testosterone. I think it's getting out of hand and it's getting ridiculous. I hate it and I especially hate it when some of my favorite fighters come out and say they've used it.

  4. Avatar of enjoylife321

    enjoylife321

    February 18, 2013 at 4:50 am

    Good article Bryan….

    If Testostorone levels derived from a blood sample are proven to be deficient either through genetic factors or lifestyle factors attributed to steroid use then athletes should have the opportunity to correct those levels if it “impedes their current quality of life” and affects their ability to compete safely in their respective sport. Endocrinologists offer the treatment to not only athletes but everyday civilians because there is clear clinical evidence of how hypo or low testosterone affects patients wellbeing. If the medical fraternity and endocronlogists who specialise in this area give the green light for TRT therapy then I’m ok with that. If someone is completely opposed to TRT use, then aren’t they prescribing to the school of thought that doctors offering TRT are reckless renegades acting only in the interest of athletes seeking an unfair advantage. TRT is coming from registered medical professionals. I would like to think of it as athletes improving their health and ensuring that they are not disadvantaged or at risk during competition.

    I don’t see there being an issue with Testostorone replacement Therapy, however I do agree that TRT can be abused just like any prescribed medication or treatment provided by a doctor. We can all find doctors that will write a script for painkillers or patients that will doctor shop.

    There are so many fighters now using TRT that it is becoming mainstream. If the UFC are angry at fighters elevating their testosterone levels above the norm during training(ABUSE) and winding back prior to a fight then they only have themselves to blame for not implementing a more robust and regular testing regime. That’s like a customs officer saying we only check flights from Mexico in December for cocaine packages.

    There are two separate issues in this debate.

    1. TRT use in general
    2. TRT abuse by raising levels during training outside the norm.

    At the present, there is a dangerous generalization that ALL athletes on TRT are abusing it despite no evidence being available to support this. Just because one or two athletes come in looking ripped at a weigh in does not give the right for anyone to make sweeping generalizations that there is widespread abuse.

    You have to produce hard evidence with names of the fighters responsible and test results proving this abuse. One or two cases is not sufficient to claim an epidemic.

    • Avatar of Rigo

      Rigo

      February 18, 2013 at 1:20 pm

      Finally someone with common sense.
      exactly what i was thinking, using TRT does not mean they are well over their levels of T, it means REPLACEMENT , meaning its just filling the gap that our body is no longer producing by many factors one being age.

      Anyone who is opposed is obviously has no idea about TRT and how it works.
      saying that because they are getting it from outside their body isnt natural , your wrong if you look at it like that you would have to say that all supplements out there too should be ilegal since they help you too , protein shakes, creatine, vitamins etc, since we can get all that from foods.

      Truth is TRT is not like anabolic Steroids, Steroids can take you to a next level the normal human body could not and never will , there is a limit for humans on how strong can we be or how musclelar we can be , Steroids will get you past those limits thats why we see those bodybuilders looking insaly rip and buff.
      TRT will only level you to a normal state, and as long as they don't abuse it there should be no issue at all with it, just implement more regular testing for fighters and that's it.

      As far as i know Hendo and Belfort have never show any high level of T in any of their fights, and we can't blame warrrior legends like that for wanting to do what they been doing most of their lives, if they can keep competitive why not?
      if anything if proves that they are better skillwise if you eliminated the age factor.

      • Avatar of Bryan Fontez

        Bryan Fontez

        February 18, 2013 at 5:56 pm

        Not trying to devalue what you've just said, however you've got a lot of it wrong.

        TRT is replacement. But most athlete's with an exemption use it because in most cases they've already abused steroids and screwed up their body's natural production of testosterone.

        Lastly. Steroids are used to increase testosterone but also have other side effects it's a means to an end. TRT is pure testosterone, it's cutting all the crap out of the middle including the side effects and getting exactly what you're looking for.

        So no it isn't natural in any way shape or form and in sports it isn't the right thing to do. Especially not for a healthy male.

        If you disagree or have any other questions just scroll back up to Dr. Mike's answer at the top.

        Hope that helped.

  5. Avatar of sambo

    sambo

    February 18, 2013 at 7:41 am

    There is a good reason why athletes rarely competed after 35 until recently.
    maybe the ufc should start a 40 + division and let the real top 5 compete for the belt
    TRT is no different than steroids when it comes to fair competition

    • Avatar of Bruce Lee

      Bruce Lee

      February 18, 2013 at 10:33 am

      Lets clear up some terminology: All hormones made from a base cholesterol ring are steroids. This includes cortisol, estrogen, progesterone etc. Some steroids would be a disaster for an athlete like cortisol. He'd get fat and become diabetic and skin would tear easily. BUT when we talk about steroids in athletes what we really mean is Testosterone or some synthetic derivative. So TRT IS steroids (in the way we use the term in sports). When you hear of steroid use it is never any of the others like estrogen, progesterone, cortisol etc.

  6. Avatar of Billy Jack

    Billy Jack

    February 18, 2013 at 8:35 am

    TRT is nothing but a anabolic steroid pure and simple. To me nobody should be allowed
    to take it because it is cheating.

  7. Avatar of ripstic5021

    ripstic5021

    February 18, 2013 at 2:39 pm

    Great article for sure Brian but to me you said it all right here.

    'TRT favours all of our oldest and most beloved fighters, allowing athletes who in most cases have paid their dues and are veterans of the sport, to continue competing at their highest level for a few more years.'

    Allowing an athlete to UNNATURALLY compete at their highest level is completely absurd
    .
    Jon Jones thinks its okay to let an older fighter use this to 'level the playing field' That is just ridiculous. Are we going to start allowing teenage kids to use illegal hormones to make them on the same level as athletes in their prime physical condition?

    Jon Jones are you going to allow Chael Sonnen to tie one of your arms behind your back before the fight to level the playing field? I don't think so.

    This is not a complicated issue, the only arguement for this sort of therapy would be from UFC wanting to make more money off their older more established fighters. Much like when baseball looked the otherway when VETERANS like Mark Mcguire, Barry Bonds and Sammy Sosa were belting out 60 home runs a season. Definitley the most popular and profitable seasons for Baseball.

    Everyone should have the same rules to follow whether they're old or young, fat or skinny, potent or impotent. NO ONE should have an unnatural advantage of any kind.

  8. Avatar of kungfurule

    kungfurule

    February 18, 2013 at 4:12 pm

    I hate to admit it but I agree with DW's idea that if you are on TRT you should be tested through your entire camp to make sure you are in normal ranges the entire time. Plus I would add that if you are on TRT there should be random testing even when out of camp. I think if they did that then abuse of TRT would be very difficult indeed if not impossible. And thanks for educating us masses DR mike and Bryan :)

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