Ask the Fight Doc: What would happen if TRT were completely banned in MMA?

For one column, let’s pretend regulatory bodies around the world decided that testosterone-replacement therapy was no longer permissible in MMA.

How would it affect fighters currently on TRT – and just how many fighters would it likely impact?

In the latest installment of Ask the Fight Doc, MMAjunkie.com medical columnist Dr. Johnny Benjamin discusses the potential fallout.

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Doctor B, why is TRT legal in MMA? – Anonymous

TRT, or testosterone-replacement therapy, is a legitimate medical treatment for those men whose testes do not naturally produce sufficient quantities of anabolic steroid hormone, testosterone (T).

Common reasons for a man to have significantly low T levels:

• Testes (gonads) did not develop properly in pre-adolescence
• Testes were surgically removed or injured due to trauma
• Brain injury to pituitary gland (secretes hormones that regulate testes)
• Years of intense training and weight-cutting (usually easily reversible with rest and proper hydration)
• Prior exogenous (put into your body from outside) anabolic steroid use

T levels naturally fall about 1 percent per year once a man enters his 30s. It is part of the normal process of aging. True symptomatic low T affects less than 1 percent of healthy men. Treating secondary low T in an adult male is an elective decision; you are not likely to die or suffer horribly if left untreated.

Banning all TRT use even that with a therapeutic-use exemption (TUE) from a doctor would likely affect far less than 1 percent of elite fighters. It would be extremely difficult for a man to have the physical wherewithal to progress to an elite professional level of MMA having untreated low T since his pre-teen years. Simply put, such a young man wouldn’t have the muscle mass and strength needed to succeed in MMA and reach the elite level.

It has been well documented that the most plausible scenario for an elite athlete to have permanent, significantly low T (that is not clearly medically documented as a teen or via surgery/trauma) is prior anabolic steroid use, which is universally illegal/banned in organized sports.

If a fighter suggests that his significantly low T is the result of years of head trauma sufficient to cause brain (pituitary) damage, then the fighter should not be cleared for competition due to significant brain injury.

If a fighter suggests his significantly low T is the result of years of intense training and significant weight cutting, he often needs only to rest his body and properly hydrate to correct this issue. It’s a natural way to correct it.

In combat sports, the multiple regulatory agencies (state athletic commissions) have neither uniform policies and procedures, nor adequate resources, to properly and vigilantly monitor performance-enhancing drugs, including testosterone. Therefore, in my opinion, all TRT (with or without a TUE) should be prohibited in combat sports since it would hinder less than 1 percent and protect 100 percent.

Administration of T (exogenous) can be detected via CIR (carbon isotope ratio) testing. Detection of any amount of administered T would be illegal and thus eliminate the need for confusing T/E ratios.

As men naturally age, we lose muscle mass, strength and speed (among other things). Developing super-physiologic (greater than what naturally occurs) performance through better chemistry is potentially dangerous to a clean competitor and must be stopped in combat sports that are inherently dangerous by definition. Cleaner athletes create safer combat sports.

Dr. Johnny Benjamin is MMAjunkie.com’s medical columnist and consultant and a noted combat-sports specialist. He is also a member of the Association of Boxing Commissions’ MMA Medical Subcommittee. Dr. Benjamin writes an “Ask the Doc” column approximately every two weeks for MMAjunkie.com. To submit a question for a future column, email him at askthedoc [AT] mmajunkie.com, or share your questions and thoughts in the comments section below. You can find Dr. Benjamin online at www.drjohnnybenjamin.com, and you can read his other sports-related articles at blog.drjohnnybenjamin.com.