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Testosterone Replacement Therapy (TRT) in Boxing and MMA? What's All the Buzz About?

Lee Cleveland Updated
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During the last several years there's been a lot of discussion about the highly controversial procedure of Testosterone Replacment Therapy (or TRT), especially in Boxing and Mixed Martial Arts.

As a matter of fact, news coverage of TRT seems to be surpassing anabolic steroids.

A hand-full of fighters in both sports have been busted for their alleged use (or over-use) of testosterone replacement therapy.

Testosterone Replacement and its Intent

As a man ages, his levels of testosterone gradually decrease and its believed this natural decline starts between the ages of 30 and 35 and progressively continues as he ages.

As a result of low testosterone, a man may experience erectile dysfunction, loss of sex drive, depression, stress and difficulty concentrating among other things.

Presumably, about 10-20% of men over 50 can benefit from some form of Testosterone Replacement.

In an effort to address the aforementioned issues, the medical community has responded with several forms of treatment procedures including injections, testosterone patches, testosterone gels, oral tablets and a long-acting subcutaneous implant and a testosterone stick (applied in similar fashion to underarm deodorant).

There is a natural need for testosterone replacement as some men, even in their 20s and 30s, suffer from an inadequate production of testosterone.

So What Does Testosterone Replacement Have to Do With Boxing and MMA?

Today, synthetic testosterone via Testosterone Replacement is widely considered a performance enhancing drug (or PED).

In 1996, the New England Journal of Medicine suggested increased testosterone levels will give a man increased muscle size and mass, especially when training (Bhasin et al, NEJM 1996).

And in 2003, another study was released asserting increased testosterone resulted in greater muscle strength, but had no effect on endurance (Storer et al, J Clin Endocrinol Metab 2003).  However, more recent studies insist enhanced testosterone levels cannot turn a weakling into a strong man but might be able to make an already-strong athlete stronger. 

Increased testosterone levels "might" enhance strength and overall performance but there's still no certainty. Moreover, such effects are probably influenced by a man's physicality prior to the therapy.

So its highly unlikely TRT can turn an average fighter into a world champion - The big question is: Can it give an elite fighter that little extra boost he needs to separate himself from the rest ?

High profile fighters such as boxing's Lamont Peterson, 29, and the UFC's Frank Mir, 33 and Quinton "Rampage" Jackson, 34, and Forrest Griffin, 33, are just a few of the many fighters who have been cleared by doctors for Testosterone Replacement Therapy (TRT).

In the boxing and MMA communities cases have been made for and against TRT use. Some say it is medically necessary, such as Lamont Peterson, while others say it's a potential danger to both the fighters (due to its side effects) and their opponents.

TRT Abuse and Testing
Last April, Testosterone levels for UFC's Alistair Overeem were well above any reasonable threshold and the fighter was suspended as a result.

Nevada allows a 6-1 ratio of Testosterone to Epitestosterone but California is 4-1. And some countries, like Japan, don’t regulate estosterone levels at all.

Problem: There's no uniformity in testing.

According to Nevada Athletic Commission Director Keith Kizer, some athletes are "naturally" 5-1 but many, if not most, are lower (like 4 to 1). As a result, he insists Nevada's 6-1 limit is fair and gives a fighters a little wiggle-room in case they happen to be genetic freaks.

Pictured: MMA Heavyweight Contender Allistar Overeem
Courtesy of Sherdog


In Overeem’s case, the UFC star allegedly had a whopping 14-1 ratio - Well above the allowable Nevada limit (6 to 1).

Not surprisingly, Alistair Overeem had been the target of widespread indictments for years as the MMA heavyweight was somehow able to pack on 40lbs of solid muscle in a short time.

Should therapeutic use exemptions for TRT be allowed in Boxing and MMA?

Last year, the rematch between jr welterweight champion Lamont Peterson and Amir Khan was cancelled as Khan's team refused to fight Peterson because the latter had tested positive for synthetic testosterone after a series of random drug tests administered by the newly formed Voluntary Anti-Doping Association (VADA).

peterson khan1

After the positive drug test, it was discovered Lamont Peterson was treated by Dr. John A. Thompson in October 2011 - two months prior to his first bout with Khan - for chronic fatigue caused by abnormally low levels of testosterone.

And according to a letter written by Dr. Thompson and disclosed by Peterson's attorney Jeff Fried, the prizefighter was treated by the physician for health concerns and the therapy was not an attempt to enhance athletic performance.

"The amount he received is a physiologic dose of testosterone and has been safely administered to thousands of people in this country and internationally since the 1930's. It is my professional opinion that no therapeutic alternative exists to increase low testosterone other than hormone replacement therapy."

And Peterson's purported Testosterone to Epitestosterone level supports Dr. Thompson's claim. The fighter's 3.77 to 1 ratio was well below Nevada's 6-1 threshold.

So why was Peterson punished if his testosterone level was normal?

Answer: Because VADA, unlike state commissions, test to detect "synthetic" (or unnatural) testosterone regardless of whether a fighter's actual  testosterone level is normal or even below expected levels.

And since synthetic testosterone is considered a PED, Lamont's ratio could have been an testoserone-deficient 1.5 to 1 and he still would have been penalized.

As long as a fighter's testosterone levels fall within normal levels, should he be penalized? He might actually be testosterone-deficient.

However, as UFC President Dana White indicated last month, a fighter might be able enjoy the presumed benefits of exaggerated levels of TRT during training and cycle down to normal levels just prior to the fight (while retaining those strength levels he attained during training)

UFC President Dana White said last month:

Pictured: UFC President Dana White
Courtesy of Daniel Henderson, Sherdog


If you asked me three months ago, it's legal. It's sports science, but everybody figures out a way to take a great thing and cheat and make it bad," said White.

"Those of you who know what testosterone replacement is, if you're older, your testosterone starts to get lower. They can give you testosterone to get you back up to (the level of) a 25-year-old."

"What guys are doing, I believe guys are doing, is jacking up this stuff through the roof through their entire training camp then getting back down to normal levels right before the fight, which is cheating. I hate it. I don't like it."

"I'm going to fight it. And if you are using TRT in the UFC, we're going to start testing the (expletive) out of you, through your entire camp," White added.

Side Effects
Moreover, TRT is not without its fair share of side effects which include an increased risk of prostate cancer and fluid retention. 

Moreover, testosterone enhancement is a lifelong therapy. Once someone starts using it, their body, realizing its getting testosterone from another source, stops making its own.

Unless you're 60 or older, that in itself, might be a scary enough unless you are truly in need of it for medicinal purposes.

TRT Debate Rages On

At this moment in boxing, unless fighters agree to undergo random, VADA testing, testosterone replacement therapy will go unnoticed if a  fighter's testosterone level is at or below the state commission's threshold at the time of the test. (Directly or before and/or after a bout).

TRT in boxing and MMA... Do we even know for sure TRT enhances performance? And if so, at what level?

Should TRT be allowed for therapeutic reasons so long as TRT levels stay within a normal range during training and at fight time?  

The debate will rage on.

Disclaimer:  This is not the opinion of a medical professional or someone even close. Always consult a physician or specialist when considering the use or Testoserone Replacement Therapy (TRT).

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