Is There Even an Easy Answer to the TRT Debate?

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Is There Even an Easy Answer to the TRT Debate?
Chris Trotman/Getty Images
At the heart of the TRT controversy, Vitor Belfort

The world of mixed martial arts is all-too-familiar with provocative labels—extreme, intense and borderline-insane all rightfully come to mind. These are the characteristics needed to sign a legal contract to fight another person, proceed to train until peak physical condition and then accordingly step foot inside a caged battleground prepared to attack until they surrender—whether or not their consciousness is left intact.

One would think, then, that no topic should ever be treated with a white-glove, taboo approach. When dealing with hyper-skilled caged combatants, what concern is mere diplomacy and politics? And yet, diplomacy and politics are at the very core of the Testosterone Replacement Therapy (TRT) debate. 

Merely broaching the topic is likely to incite a rather hectic session of verbal sparring. There are those that view it as a plague spreading like wildfire, whereas others consider it to be a medically approved necessity.

In recent times, the TRT discussion has grown a nasty habit of polarizing those with differing opinions.

All the while, casual MMA fans grow tired of the pageantry as venerable media outlets analyze the ethical and legal implications of TRT use.

Most just yearn to hear a simple answer: Is it right or is it wrong? Legal or illegal? A genuine concern or a trivial topic of conversation? Is TRT merely just a fanciful label for a new way to cheat?

Ultimately, though, the real question is far more profound: Could the answer even be so simple for an issue so complex?

At face value, TRT ought to be a simple matter. Prescribed by sanctioned medical professionals to fighters experiencing low levels of testosterone, it's on occasion been described as an absolute necessity. The unwelcoming poster child for TRT, Vitor Belfort, recently spoke to MMAfighting.com regarding the matter:

It's hard. I cannot explain why I need something. It's just, the doctors, you know, just they said that I need [TRT]. I did everything by the book. I went to the commissions, the UFC. I never hide from them, so they knew what I was doing. I believe everyone has their personal things. My health is my personal life, you know?...But they knew I doing everything with the UFC together, and never hiding anything. It's just open books with me. Nothing was cheating. I never cheat, everything was by the book, and it is what it is.

Clearly Belfort considers it to be an open-and-shut case. In fact, he presents the notion that ethics have nothing to do with it—TRT is legal and he's merely following the rules. If only his situation were so conveniently transparent—it remains unknown if his present drop in testosterone is the result of his known history with anabolic steroids.

But are complex decisions ever so simple?

Intuition tells us that a 36-year-old Belfort should be at the nadir of his historic career. Gone should be the days of blistering speed and uncanny reflexes. Nevertheless, two consecutive victories by head-kick knockout—in the eyes of certain sects of the MMA community—represent the problems underlying TRT. 

Some exclaim that TRT didn't land those head kicks and that, more importantly, no performance enhancer could ever replace the value of proper technique. 

Such conversations are ultimately futile as one cannot turn back time and repeat an identical fight sans testosterone.

What we can do, on the other hand, is defer to a growing body of evidence demonstrating that the effects of testosterone impact muscular growth, repair and adaptation throughout a training camp. When the cage door closes, can we consider both combatants to be equal if only one is taking exogenous testosterone?

In Belfort's case specifically, it certainly doesn't help that fans feel as though they're witnessing reverse-aging as he continues his TRT treatments. Perhaps photographic evidence isn't entirely damning, but it can certainly leave a lasting impact:

Belfort circa 2011 (UFC 126) on the left as opposed to circa 2013 (UFC on FX 7) on the right

Former UFC welterweight contender Jon Fitch thinks the entire thing is a farce contrived to aid fighters who've wrecked their bodies via steroid abuse. Via MMA Mania:

"This is devised to let guys who have used steroids in their past re-boost their testosterone since they abused their bodies when they were younger", he says..."I am 35 years old, and I promise, I would and will bet money that my testosterone levels are just as good as a younger fighter. You know why? Because I have not wrecked my body with steroids, never used any type of PED and train healthy and properly to compete."

Yet athletic commissions readily issue Therapeutic Use Exemptions (TUE) to those that are willing to make the request—warranting the fighter to use testosterone so long as he stays within preordained ratios. In an ideal setting, such commissions are intended to be wise, non-partisan governing bodies dedicated to absolute regulation. Yet even they undergo discussions as to the exact conditions for approving TRT. 

As the list of aging cage fighters on TRT continues to grow—Frank Mir, Dan Henderson and Chael Sonnen to name a few—so too does the concern that users are unfairly trying to slow the sands of time.

It's that exact sentiment that is echoed by UFC welterweight Tyron Woodley. He shed light on the situation in a recent interview with Sherdog's Beatdown radio:

If your body says it’s time to stop [fighting], it’s time to stop. You shouldn't be able to hit a reset button and go back and act like you're 25 when you’re 39. I think people that do it, supposedly if you do it in moderation, if you have a doctor monitor it, if you look at your levels and they're low and he brings you to 4 to 1 or whatever the ratio is that’s deemed acceptable—but nobody’s doing that. Everybody’s jacking [the ratio] up to 16 to 1 and training like a madman during training camp, every session, every training, sparring, running, and they're just going nuts, and then they bring themselves down slowly, but they've already had six to eight weeks to train like that. You think they're going to be in better shape? You think they're going to be stronger? They've had better rounds. They've had longer rounds and been able to endure more. If you think about as far as the competitive advantage, it’s definitely there.

Woodley makes a strong case against testosterone use—or at the very least, a demand for heightened regulation. Nevertheless, TRT is no panacea for a career on a downward trajectory. All of the aforementioned fighters approved for TUE have lost fights while under its controversial effects. 

Such a reality adds yet another dynamic to the discussion. How do we draw the line between adhering to a medical recommendation as opposed to deliberate augmentation?

Perhaps, when all is said and done, TRT may receive a concrete label. Firm and unfaltering, its use may be deemed as either absolutely just or undeniably unfair. But don't hedge your bets on that happening.

Far more likely, TRT will reside—at least for the foreseeable future—in a hazy gray somewhere between right and wrong. Contentious or otherwise, the matter might be beyond mere side-choosing.

There are a wealth of variables to consider—everything from proper T:E ratios to cut off age limits. As the issues become more complex, the subtleties and nuances add more wrinkles to the debate.

It's best to not create false dichotomies and delude ourselves into thinking that there's an absolute right and wrong to the TRT debate. So long as doctors continue to prescribe TRT as necessary treatments, athletics commissions will find requisite need for granting TUEs. The relationship—however problematic—is causal.

Commissions will need to evaluate the medical evidence proposing the treatment as necessary. Fighters will need to consider their justifications for using it.

In the interim, those on the sidelines will have to reserve judgement—as much as possible—so that the end result can be achieved without bias or any form of subjectivity. Only through proper conversation can MMA fans, athletic commissions and the fighters themselves come to a consensus.

Performance enhancers like testosterone have ramifications that ripple throughout every aspect of the sport. As the list of fighters using—and possibly abusing—it continues to grow, so too will the need for a decision on how to handle it. 

Whatever the answer, it won't be a simple right or wrong.

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