How Legitimate Is TRT?

By Carlin Bardsley

With the recent firing of Nate “The Great” Marquardt and the saga of Chael Sonnen, one of the most controversial topics has become the legitimacy of TRT, or testosterone replacement therapy. While some such as Marquardt, Sonnen and other fighters currently on TRT insist that it is a perfectly legitimate and necessary medical treatment; those on the other side of the argument state that it is merely a way for fighters to circumvent the rules against steroids and gain an unfair advantage.

TRT first entered the UFC lexicon around the time of UFC 74, when then-heavyweight champion Randy Couture was preparing to defend his title against Gabriel Gonzaga. There were whispers around that time that Couture was using steroids, to the point where Couture himself claimed he was in a “steroid witch hunt”. Shortly after that, Joe Rogan went on ESPN news and claimed that Couture was on “hormone replacement therapy” and hailed what science can do for older fighters. Rogan has admitted to using both HGH (human growth hormone) and TRT but seeing as how Rogan is a commentator and not a competitor it amounts to a lifestyle choice and Rogan has no athletic commissions he has to work around.

TRT is typically prescribed to middle-aged males whose testosterone levels are decreasing, or those that suffer from hypogonadism. Some that come from an amateur wrestling background have contended that the frequent and extreme dehydration that comes with weight-cutting from an early age lead to pituitary gland problems and subsequent hypogonadism, but that has yet to be conclusively proven. When appearing on the HDNet show “MMA Live”, urologist Dr. Nickolas Tomasic stated “In my opinion, the incidence of a low testosterone level, hypogonadism condition in a world-class athlete in his early 30s would be quite low. There could be other factors involved, previous exposure to radiation, chemotherapy, testicular injuries, those things would be quite, quite rare, but also possible previous anabolic steroid use could be a factor as well.”

Some fighters insist their TRT use is on the level. Dan Henderson was the first athlete to receive a TRT exemption from the state of Nevada, back in 2007. He told ESPN.com that his levels were “so low they were off the charts”. But even with his therapeutic use exemption (TUE), he monitors his levels between fights “just to cover [his] own ass”. Henderson’s levels have never spiked the way Marquardt’s did prior to his suspension or measured at the outrageous levels that Sonnen’s came back at in his post-fight test after facing Anderson Silva. Henderson suggested that year-round testing would be a good way to monitor and curb abuse of TUE’s.

Perhaps unsurprisingly, fighters that have not used TRT or have been involved in a PED (performance enhancing drug) scandal have come out against it. During the Q&A prior to UFC 132, Matt Hughes came out strongly against TRT, stated that it is a real problem in MMA and stated that he has never used any PED’s. BJ Penn came out even more strongly, stating on his Twitter account “all this testosterone replacement therapy stuff is total BS. A true martial artist would never consider cheating! If you can’t do it of carbs, fats, proteins and vitamins and minerals you’re weak! Fighters on ‘roids = blue collar crime. Coaches of fighters on ‘roids = white collar crime. Everyone has to come together and get this “ped” cancer out of our sport!”. The always outspoken MMA legend Bas Rutten took to his pulpit on MMA Live to address the issue: “… if you’re taking it for an injury, it’s cool. If you’re lower testosterone and you want to be average, that’s cool. If you take it for performance-enhancing drugs, you’re a loser…I think that Nate Marquardt crossed the line because he did it, he took the choice to do it and he wrecks up a main event, that’s a serious thing. Not if you’re a lower card guy, then I say, okay, if you do it, do it and don’t get caught. But that’s what I’m saying, you got to do Olympic testing. Go test in between also, do the HRT, let them make sure that you never get over that certain amount for testing.”

While Marquardt has steadfastly maintained his innocence throughout the entire affair, even his coach Trevor Wittman was against the controversial therapy, telling MMAfighting.com “I look at it as white and black, like you’re still doing an enhancing kind of thing. But if the doctor okays it, does that make it right? I don’t know. That’s something I can’t explain, but I’ll tell you what I’m doing now, and that’s sit down with every fighter I deal with and find out if they’re seeing a doctor and for what reason. If it’s anything that has to do with enhancing, then I’m going to step away.” Another factor that works against Marquardt is his history, having previously tested positive for anabolic steroids. Even if Marquardt’s testosterone levels are low, one has to wonder whether it is due to previous steroid abuse, as Dr. Tomasic indicated was a possibility.

In his column on MMAjunkie.com, noted combat sports expert “The Fight Doctor”, Dr. Johnny Benjamin echoed those possibilities when it came to Chael Sonnen: “Some common reasons for significantly low testosterone levels in an otherwise healthy young man are pituitary-gland issues, primary gonadal issues and/or side effects of anabolic steroid use. As an FYI, pituitary dysfunction was ruled out in Sonnen’s case. So, that leaves two likely choices – with one being far more likely than the other.”

If a solution is to be found, it may have to come from a federal government level, as Dr. Margaret Goodwin indicated as a possibility on Eddie Goldman’s NHB radio show; or more likely a common ground among state athletic commissions. NSAC Director Keith Kizer appears to be trying to close the loophole at least a little, saying that Nevada will not provide a TUE for anyone who has previously tested positive for PED’s. As Henderson and Rutten suggested, year-round testing for those with TUE’s seems like a fair thing to ask. After all if an athlete like Henderson is willing to do it of his own volition to prove his levels are steady then why wouldn’t anyone using their TUE legitimately comply with a similar request from an athletic commission? It may prove to be the difference between differentiating between athletes such as the 40 year old Henderson, whose TRT use appears to be on the level and cases such as Marquardt, Sonnen and the 25 year old super-chiseled Todd Duffee, whose cases appear to be spurious at best.

Marquardt’s suspension has now been lifted by the PSAC, and the fighter has taken the offensive: “I think you know who these guys are – Ben Askren, B.J. Penn, Paul Daley, Hector Lombard, cowards talking crap about a guy when he’s in such a situation. They’re trying to take advantage of the situation. They’re bullies. Those are the guys I want to beat up.” Penn took up Marquardt on his offer, saying that he would come down to Marquardt’s gym to fight him if Marquardt takes a drug test every day for three weeks prior to the fight. Marquardt has yet to respond. One has to wonder if there really is anything wrong with Marquardt’s testes after his statements, as it takes real brass balls for a guy who is now in his second PED controversy and whose coach doesn’t agree with his choices to come out and start calling people “cowards”.

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