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The Medical Facts Behind TRT

Here we sit just days before the climax to one of the most thrilling trilogies of all time: Vitor Belfort vs Dan Henderson. In 2006 while both were fighting for Pride, Henderson outlasted Belfort and won by decision. In 2013 the two met in the UFC, while both were on TRT, and Belfort became the first man to end Henderson via punches. The third fight will involve the same two men, but will be without a significant third party: testosterone. TRT, which is used to exogenously replace testosterone levels in men with hypogonadism, was banned by the Nevada State Athletic Commission in February of 2014. Dana White mirrored this decision for the UFC at the same time. This monumental devision was met with both support and disdain from fighters throughout MMA. Many, if not most, fighters felt that this decision was huge equalizer for the sport, banning the "fountain of youth" that many older fighters depended on to maintain their careers. Other fighters who had sought exemptions for their clinically diagnosed hypogonadism felt that this decision took away their right to use a medically prescribed substance that was key to their health. As we sit on the brink of Hendo v Belfort III, there is a significant amount of misinformation on both sides of the table. Here, we present the medicine behind testosterone replacement.

**This is not a medical guide on the use of TRT. Any decision to use TRT should be between you and a health professional. We are not giving any medical advice or advocating the use of any medication.**

What is hypogonadism and is TRT a legitimate medication?

Hypogonadism in males is one of two things: either the failure of the testes to make sperm or to make testosterone. For the sake of MMA, we are referring to the latter. Medically, hypogonadism is diagnosed when you have symptoms of hypogonadism and significantly decreased levels of testosterone. The major symptoms of hypogonadism are decreased energy, libido, and even muscle mass. Low testosterone can be diagnosed with a simple blood draw.

Testosterone replacement IS a legitimate medication for patient who have diagnosed hypogonadism with low testosterone levels confirmed on three different tests (required because of testosterone levels can fluctuate greatly throughout the day). Administering testosterone to a man with symptoms of hypogonadism but normal testosterone levels has not been shown to improve symptoms. It should be noted that testosterone levels normally decrease with age and it is estimated that 20% of men over the age of 60 have low testosterone. Henderson (45) and Belfort (38), who had both been taking TRT for years, would be exceptions to the above. One of the risk factors for hypogonadism in younger men is anabolic steroid use. There are many forms of testosterone including gel, patch, pill, and injection.

What does TRT do and why does it make older fighters better?

The use of TRT in appropriate patients can cause increased energy, mood, muscle mass and essentially reverse the symptoms listed above with hypogonadism. TRT can cause older fighters who have hypogonadism to benefit like any other person. Some say that this is reversing the effects of time, and, in some respects, this is correct. Decreased testosterone, no matter the cause, can be significantly hindering to a person’s life. Does it cause fighters to hit harder, move faster, and fight better? The answer is case dependent, but probably doesn’t hurt.

Is TRT a performance enhancing drug and can you abuse it?

Technically, TRT can enhance performance in older athletes so in that sense, yes, it is a PED. However, many athletes likely have legitimate hypogonadism and use TRT simply for everyday life. This does not mean that TRT cannot be abused. Distinguishing between these two groups of fighters is very difficult and not a realistic pursuit, which is likely why there has been a blanket ban on TRT in the UFC. Fighters, like Chael Sonnen, claim that the ban on TRT forces him to choose between enjoying his every day life and fighting.

The views of this show are strictly our own personal opinions and are in no way affiliated with any institution or any of our employers. All medical knowledge expressed is solely based off our own knowledge and no private patient information was obtained or used to formulate these opinions.

Asad Khalid, M.D., Jie Chen, M.D. and Rob Williams, M.D. are orthopedic surgeons and sports maniacs at heart. Aman Khalid and Aditya Patel are law students and former "athletes." Follow the show @jocsanddocs and listen to them on iTunes.