Testosterone Replacement Therapy (TRT) is arguably the most controversial topic surrounding the sport of Mixed Martial Arts. The controversy centers on the granting of TRT exemptions to different fighters by various athletic commissions, though the Nevada State Athletic Commission (NSAC) is the regulative at the center of this controversy. The reason I felt led to write an article about this controversy to shed some light on the scientific facts surrounding the TRT debate because many fans and pundits have created opinions about TRT without fully understanding the facts. This article will attempt to explain the medical basis for TRT while distinguishing the difference between it and regular steroid use and abuse. I will also give my opinion on the TRT debate at the end of the article, but the main purpose of this article will be informative not argumentative because many intelligent people can look at this information and come to various conclusions, both pro and con, about the use of TRT in Mixed Martial Arts.
I have an extensive background in Chemistry, and throughout my college career, I frequently ran into the androgenic steroid known as testosterone. Testosterone is a steroid produced by both the male and female bodies, but is primarily known for being the male sex hormone. Adult males produce about eight times more testosterone than adult females. Testosterone is the hormone that regulates sperm production, aggression, and is one of the main hormones that cause the physical and emotional changes during puberty.
Biochemists and other biomedical scientists define something as a steroid because of a unique basic chemical structure that all steroids have in common; the structure is a joining of four cycloalkane rings together. While every steroid has a specific function within the human body, not every steroid is involved in helping the body perform athletically. For example, Cholesterol and many anti-inflammatory medications are a form of steroids, but serve a different purpose in the body than helping a person’s performance. Androgenic steroids are the steroids that people are talking about when discussing steroids and sports performance.
Androgenic steroids are the male sex hormones and the main one is testosterone while androstenedione, dihrydrotestoterone, and dihydropiandrosterone are the three other major androgenic steroids. Estrogen, the main female sex steroid, also plays a vital role in natural steroid regulation because it exists in lowered quantities in males just as females have testosterone. These are the main steroids relating to this discussion of steroids and TRT.
Anabolic Androgenic Steroids (AAS) are synthetic steroids designed to signal the body to produce androgenic hormones in greater quantities than what the body is currently producing. These steroids can also direct the steroids to perform different tasks than what their coding usually allows. For example, some AAS cause the body to produce bulky muscle in a body that is generally more predisposed to produce a greater quantity of lean muscle. AAS originally made help possible for victims of debilitating disease or catastrophe to regain muscle growth and function. As early as the 1970s many professional athletes began discovering that AAS use could substantially boost athletic performance and thus began the precursor to our current controversial sports climate.
The average human body contains another steroid known as epitestosterone, which limits the overall effectiveness of testosterone. Zin the body of the average adult male the ratio of epitestosterone to testosterone exist in a 1:1 ratio, but in some people the ratio of testosterone to epitestosterone can be as high as 6:1 naturally (mine is 2.5:1). In general, steroid test designs determine the ratio of testosterone to epitestosterone in urine or blood. Many companies that produce AAS put synthetic chemical markers that will allow the tests to identify a synthetically designed steroid in the blood or urine. NSAC Steroid tests will come up positive if the testosterone: epitestosterone ratio is above the naturally occurring 6:1 ratio. This does not automatically mean they failed the drug test if their testosterone is above this limit, but it signals the need for specific testing.
Finally, how does TRT relate to all of this? As most men hit their mid-30s the testosterone in their bodies begins naturally decreasing, but sometimes the testosterone decreases so rapidly that it causes the other sex hormones to increase or decrease, most notably an increase in estrogen. The body senses that the ratios of certain sex hormones are off so a positive feedback cycle occurs to the detriment of the body. This can lead to lethargy, sexual impairment, muscular shrinkage, and mood changes. TRT restores the balance by replacing the lost testosterone, but the doses usually never allow the body to increase past the 6:1 limit except in the first initial weeks of the treatment as kind of a jumpstart. NSAC does not allow fighters who have a TRT exemption to test beyond 6:1.
Another use of TRT is the treatment of previous frequent steroid users because AAS use and abuse can cause the body to stop making testosterone naturally because the body realizes it is getting enough testosterone synthetically. That is why Todd Duffee at the ripe old age of 27 has to have a TRT exemption or his body would go haywire. Alistair Overeem will eventually also have to have a TRT exemption or his body will begin to breakdown (side note, going one or two cycles of steroids usually will not cause your body stop production of natural testosterone). Now this next point is very important, JUST BECAUSE AN OLDER ATHLETE IS ON TRT DOES NOT MEAN HE PREVIOUSLY ABUSED STEROIDS. Staying in shape and active helps increase a man’s chances of not succumbing to low T, but genetics more than lifestyle is what really determines if (and when) a male will go through a rapid decrease in testosterone Most AAS abusers and users have ratios that are well over the 6:1 limit. A single 10 week AAS cycle cause a 10:1 testosterone ratio on average, but most users go beyond that by stacking AAS products and getting levels that are as high as 30:1 in some cases (Mark McGwire anyone?). I have never heard of a positive steroid test where the athlete tested below 10:1. Athletes do not fail steroid tests teetering on the edge of the ratio limit.
Now a proper diet can increase your testosterone levels as well as many legal supplements that have androgenic effects (such as some whey proteins). These supplements work differently than TRT or AAS because they supplements can cause a reaction that makes the body want to produce more testosterone if the body is already producing testosterone at normal levels. These methods put pressure on the hormone system to increase the testosterone levels, but TRT is different because the synthetic testosterone binds to the testosterone receptors causing the body to react to the synthetic testosterone as if it is real testosterone. It is perfectly logical to assume that if a fighter who is not on TRT is eating right and taking the correct supplements than they will always enter the cage with a ratio above 3:1 up to 6:1. NSAC and other licensing organizations have good reasons to believe that TRT does not add a distinguishable competitive edge besides the fact that it lets older fighters continue their careers successfully into their later years.
I know I laced the above article with the occasional opinion, but I did try to set my bias aside as much as possible. I would like to state that the previous paragraph on diet and supplements is not 100% proven by the scientific community because only a few double blind tests have been done, but those test do seem to support the position I laid out. If in the near future more experimentation on this subject occurs, I reserve the right to change my mind of the science ultimately comes to a different conclusion.
Here is my official position on TRT: I believe that it should be legal in the sport of MMA even if people are using because they abused AAS products in the past. However, I do, believe that if an athletic commission grants a fighter a TRT exemption then that fighter should be willing to submit himself to a battery of random drug tests to make sure that he is not abusing the exemption to mask current AAS usage. If a fighter is found to be in violation of the 6:1 ratio while using TRT then I believe that fighter should receive an automatic 18 month to 2-year suspension from fighting in a sanctioned MMA event. The athletic commission needs to make sure that fighters are not given an inch, but take it a mile.
I know many people will disagree with me, but I hope people will now disagree with me based on an understanding that there is big difference between the TRT exemption and a steroid abuser like Barry Bonds or Mark McGwire. I respect your opinion and I at least hope you will respect mine.