Association of Ringside Physicians calls for phasing out of TRT

by Kirik Jenness |

Association of Ringside Physicians has released a consensus statement on Therapeutic Use Exemptions for Testosterone Replacement Therapy.

The Association of Ringside Physicians (ARP), an international, non-profit organization dedicated to the health and safety of the boxer and mixed martial arts athlete, has released a consensus statement on therapeutic use exemptions for testosterone replace therapy in professional combat sport athletes, as follows:

The incidence of hypogonadism requiring the use of testoster one replacement therapy (TRT) in professional athletes is extraordinarily rare. Accordingly, the use of an anabolic steroid such as testosterone in a professional boxer or mixed martial artist is rarely justified. Steroid use of any type, including unmerited testosterone, significantly increases the safety and health risk to combat sports athletes and their opponents. TRT in a combat sports athlete may also create an unfair advantage contradictory to the integrity of sport. Consequently, the Association of Ringside Physicians supports the general elimination of therapeutic use exemptions (TUE) for testosterone replacement therapy.

Dr. Ray Monsell
Chairman, ARP

The cynical story about a TUE for TRT goes like this:
•MMA fighter takes illegal PEDs.
•PEDs inhibit your body's natural generation of testosterone (sometimes permanently, yikes)
•Fighter stops at the end of the cycle, and natural levels of testosterone lower.
•Fighter goes to a sympathetic MD and complains of fatigue, poor sleep, etc.
•Doctor diagnoses low testosterone, and prescribes Testosterone Replacement Therapy (TRT).
•Fighter goes to AC and gets Therapuetic Use Exemption (TUE).
•Vitor Belfort kicks everyone in the head and knocks them out.

The cynical story is that lots of fighters are doing it, and that AC TUEs in MMA are irresponsible.

"That’s a joke. Forget it. It’s a joke," said Dr. Don Catlin, a member of the International Olympic Committee's medical commission responsible for reviewing TUE applications. "I think in all the years I’ve done it, we’ve given two."

However, several factors are casting this narrative in doubt.

First, TUE in MMA is rare. as determined by a survey of the leading Athletic Commissions in the US.

"We've given out three in 12 years," says Nevada's Keith Kizer in 2102 (they were to Dan Henderson, Todd Duffee, and Shane Roller). New Jersey's Nick Lembo put the number at "less than five." The busiest commissioner in the world, Ohio's Bernie Profato has given only two, to Henderson and Strikeforce fighter Bristol Marundo.

So out of 15,000 regulated fighters, only a handful of TUEs have ever been granted. That is not an epidemic.

"It’s very rare, but there are some legitimate needs," Lembo explains. "My biggest concern is that most commissions don’t even test for these things in the first place so we’re over-penalizing the people that are coming forward and saying, ‘Hey, do whatever you want to me. Test me before and after the fight. Test me randomly. I need this, I’m on it and I’m going to be within normal limits.’ There are a lot of commissions who don’t believe in TUEs for any reason, but why be hard on the ones coming forward?"

A second factor - one that until now was largely unknown - is that head trauma can lead to low levels of testosterone. In a truly important piece, Mike Chiappetta explains.

In 2007, a paper published in the Journal of Athletic Training reported the first known connection between mild concussions and hypopituitarism, a deficiency that can lead to low testosterone.

That research, along with how traumatic brain injuries impact the pituitary gland, is being continued by Dr. Daniel F. Kelly, the director of the Brain Center and Pituitary Disorders Program in Santa Monica, California.

Kelly is currently in the midst of a study of 75 former NFL players. In an interview with MMA Fighting, Kelly said that preliminary data from the study suggests that pituitary damage is occurring in a subset of the retirees.

That study seems to corroborate a 2006 finding in Turkey that found that head injuries incurred by pro kickboxers have resulted in damage to the pituitary gland.

Dr. Fahrettin Kelestimur, a professor of endocrinology at Erciyes University in Turkey who authored the 2006 study, told MMA Fighting that the most common damage has caused growth hormone deficiency and hypogonadism, respectively.

Only a handful of state commissions require an MRI in order to grant a fighter’s license, but MRIs don’t always show the problem. A blood draw is more likely to determine if an issue exists, according to Kelly. Tests for luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, growth hormone (GH) and IGF-1 (insulin-like growth factor 1) could serve as an effective screening tool to determine any pituitary damage.

Dr. Kelly, who has been working on issues pertaining to the pituitary gland for nearly 20 years, in 2008 co-authored a study that concluded chronic hypopituitarism occurred in approximately 20 percent of patients who had suffered mild, moderate or traumatic brain injury.

"(MMA) fighters are getting repeated insults to the head, sometimes more than concussive events," Kelly said. "And if you did a careful analysis of those people, I'm sure you'd see a significant rate of pituitary gland dysfunction. That's my prediction."

"I guess what’s really amazing, if you look at it another way, is how infrequently it occurs, and how sturdy the system is, how much damage it can take. The pituitary gland is this tiny little thing that’s less than a centimeter cubed. It’s sitting in a little, bony depression in the skull base and it’s getting banged around, and the connection is getting banged around repeatedly, yet it keeps it on ticking in most people. It’s a pretty resilient system, but only up to a point."

A third consideration is that TRT is not a magic bullet.

The number of fighters on TRT is not known with complete precision, nor is it known precisely how long they have been doing so. However, last year Bloody Elbow did an admirable survey of fighters known to be on TRT, and how the did. The fighters went a combined 15-17:
Chael Sonnen (5-4)
Vitor Belfort (2-0)
Dan Henderson (4-4)
Quinton Jackson (0-2)
Forrest Griffin (1-0)
Frank Mir (0-2)
Todd Duffee (1-1)
Nate Marquardt (2-1)
Shane Roller (0-3)

The great exception of course is Vitor Belfort, who is on one of the hottest streaks in the sport's history, and has become the poster child for those opposed to TRT. However, one fighter is just anecdotal evidence, and does not necessarily represent the issue as a whole.

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tags: Regulation   TRT   TUE   

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Recent Comments »

GSPsShadyHandWraps site profile image  

1/30/14 2:15 PM by GSPsShadyHandWraps

"Is there any evidence, or has there ever been any study whatsoever, showing a direct correlation between steroid use (nevermind merely using TRT to return to normal levels) and punching power? Or even strength and punching power? I'm not aware of any."Common sense should tell you that if you gain even 1 kg of pure muscle mass then you are obviously going to put more bodyweight behind the force of your punch. No there is no study that shows a "direct correlation" between steroid use and punching power, studies need to be funded and a study like that would be at the end of the lineEmpirical evidence from baseball show steroid abuse makes you hit a ball much harder to the point of breaking all previous records including your own. Hitting a ball with a bat is pure rotational power, like a punch."And in any case, we're back to what I said before. If we can't have fighters getting too strong, because then they'll do too much damage to each other, then shouldn't there be caps on the amount of training they can do? The amount of weight they are allowed to put on the bar in the gym? The whole notion is completely bizarre, right?"The notion? No its your argument that is bizzareHow about you go try out how that works in real life, train 3 times per day, 7 days per week for 6 months and see how it works out for you. The body has natural mechanisms that doesnt allow you to get "too" strong or train "too much"Taking synthetic steroids bypasses this and allows you to train harder than someone who is not taking them. Yet rather than ban the disease, you want to ban the symptomBy your logic, why even have weightclasses since we shouldnt artifically limit things in order to protect fighters? Lets just have Faber fight Velasquez rather than make up arbitrary weight divisions. The whole notion is bizzare right?

Tad Ghostal site profile image  

1/30/14 1:50 PM by Tad Ghostal

"If their argument is that we need to ban TRT because it makes it more dangerous for the guys not on TRT..."Look at your OP, you quoted the line:"Steroid use of any type, including unmerited testosterone, significantly increases the safety and health risk to combat sports athletes and their opponents. ""And their opponents", not just their opponents. I kind of see where you're coming from now, in that it is easy to argue whether the evidence presents a significant increase in risk, but there is definitely evidence there. I'm not educated enough to understand if steroid use of any type is significantly risky, but I think it would be a hard point to argue for given the medical benefits of roids. If they'd had a more moderate position i.e. that steroid use can significantly increase risk, it would be easier to agree with them fully. But then again, it is the Association of Ringside Physicians, they're obviously going to take an extreme stance, any other association of physicians would be calling for a total ban on all combat sports. But I don't think anything to do with fighter safety is a worthless discussion and I am huge fan of testing, especially on the brain. It's a shame there's lots of noise about 'cheating', so at least the ARP are coming at it from a purely health based reasoning. I don't support a ban on TRT, but given the shady nature of some of these 'doctors' fighters seem to be consulting, stricter regulation is easy to get behind. What really worries me is the evidence that brain damage can cause low testosterone and that they could just be enabling guys to get even more brain damaged by treating their low T.

FETT_GayFerPayNINJA site profile image  

1/30/14 10:39 AM by FETT_GayFerPayNINJA

So the studies already done on top level athletes isnt enough for must be MMA fighters in particular?Apparently the data out there already is more than enough for an elite group of doctors who specialize in this...but not orcus.

FETT_GayFerPayNINJA site profile image  

1/29/14 9:34 PM by FETT_GayFerPayNINJA

So you are sayig that there are no side effects or health risks to taking TRT......lmfao Have you ever seen the warnings on the bottles or the commercials?It is also common knowledge that TRT increases your recovery abilities, thus allowing you to train longer and harder, whih clearly makes you more skilled and stronger, whih is clearly an unnatural higher risk to your opponents. You look so foolish trying to defend this.

FETT_GayFerPayNINJA site profile image  

1/29/14 12:50 PM by FETT_GayFerPayNINJA

Are you also stating that there are no health risks to taking TRT???JESUS Orcus. You should really stop.

FETT_GayFerPayNINJA site profile image  

1/29/14 12:49 PM by FETT_GayFerPayNINJA

How common low test is amungst athletes is already studied and documented. This panel sees a CLEAR gap between how common it should be, and how many mma fighters and boxers have the "condition" people are WAY more educated than you Orcus. They formed thier opinions for a reason. Of course though, you know better and are here as the voice of reason to tell us all that these lifelong doctors are wrong, and TRT is great and not unfair at

FETT_GayFerPayNINJA site profile image  

1/29/14 12:46 PM by FETT_GayFerPayNINJA

There is no evidence that synthetic testosterone increases your ability to train harder, recover faster, develop skills at a faster pace as a result, and build more lean mass as a result???Okay pal.

orcus site profile image  

1/28/14 11:50 PM by orcus

Bottom line is that until ALL fighters are tested -- blood tested -- we won't have ANY idea what the "average" testosterone level is for any of these guys, "clean" or not. We won't have any idea if anyone has an unfair "testosterone advantage" over anyone else. We won't have any idea how rare low test is amongst these guys.

sevr1 site profile image  

1/28/14 10:34 PM by sevr1

Thinking about the whole "head trauma causing low T" argument that Rogan regularly references, in regards to being pro-TRT, I had this thought:If it was in fact head trauma that caused so much damage to someone's brain that it messed up their T levels, wouldn't it be more ethical that that person doesn't fight, instead of giving them artificial T and allowing them to take more punishment to an already incorrectly functioning brain?To me, whether roiding or head trauma caused the low T, I'm not sure either type of guy should keep fighting.

orcus site profile image  

1/28/14 5:45 PM by orcus

"No, it's important to the Association that fighters the use of anabolic steroids remain illegal, sythetic testosterone included."The reason they give why TRT use should not be allowed is that it increases the safety and health risks for its user AND his opponent. They gave zero support for either claim, and in fact there IS no evidence for either claim.