By Tom Deters DC

NOTE TO READER : Dr. Tom Deters has published hundreds of article in the areas of strength and conditioning, performance nutrition and performance enhancement. As former Editor in Chief of Muscle & Fitness magazine for fifteen years, he has trained with, worked with and interviewed dozens of professional bodybuilders, NFL strength coaches and has been featured on national television to discuss anabolic steroids and performance enhancing drugs. He is one of the co-founders of www.JiuJitsuMania.com and holds an advanced belt in Brazilian Jiu Jitsu.


If you wanted to argue that combat athletes (MMA fighters and their cousin competitors in Brazilian Jiu Jitsu, boxing, Muay Thai and wrestling to name a few) subject themselves to some of the most intense, brutal and stressful training in all of sport, you would have a pretty solid argument.  Not only do combat athletes train at highly anaerobic levels, but they endure stress, pain, undergo extreme measures to make weight and experience pre-fight adrenaline dumps that few athletes will ever experience.

These young men who entertain, motivate and inspire millions deserve not only our respect, but the very best medical and health care on the planet. How ironic, that due to both ignorance and misunderstanding of medical research data by the mainstream media, the general public, some (not all) sanctioning bodies and the athletes themselves, fighters are conditioned to be “testosterone phobic”. This could actually jeopardize their health and well-being. Despite the contention of some that testosterone is the “bane of our existence”, leading to over aggressive behavior, increased rates of prostate cancer and heart disease, medical research suggests quite the opposite.

Athletes get caught in this cross fire of confusion, misconception and misunderstanding. Take the current case of Nate Marquardt’s suspension (who had been successful in the UFC). I never met Nate, don’t know the man and he is not the focus of this article, but HRT (Hormonal Replacement Therapy – in this case testosterone) is. Testosterone replacement therapy is on the rise nation-wide as an anti-aging therapy (as well it should be). This past April, mounds of medical research presented at the 19th Annual World Congress on Anti-Aging Medicine was abundantly clear that properly restored testosterone levels reduce the risk of various forms of cancers, heart disease (and a variety of other diseases) and help the body function more optimally.


So, right about now, you might be thinking that testosterone therapy makes sense for a 40s, 50’s plus guy, but for a twenty-something fighter it really doesn’t apply. I mean, young studs have high testosterone levels, right? Maybe. Maybe not!

How can that be? To understand the answer to that question, let’s talk about the endocrine system (the body’s interrelated hormonal systems) for a quick minute.  The body has a number of glands that produce various hormones (think of them as chemical messengers) which activate receptors on cells and then direct the body’s cells to undergo certain processes. By definition, this hormonal system is inter-connected and the activity of one hormone can impact the other. To make the best sense of how hormones work, it is best to always view their activity in the context of the system. In other words, abnormal levels (either high or low) of one hormone can and will affect the levels and or activity of other hormones.

It’s time to introduce a pivotal element to this equation – “stress”.  Stress can be physical, mental or emotional.  Combat athletes subject themselves to extreme levels of mental and physical stress, the result of which becomes increased cortisol levels (a hormone secreted by the adrenal cortex).  I have discussed cortisol and cortisol management in detail on this site in Stress And Cortisol Part I and Cortisol Management Part II which explains how training and especially overtraining along with emotionally based adrenaline dumps jack up cortisol which does a whole bunch of nasty things as far as physical performance and conditioning are concerned. I also talked about ways that athletes can reduce and control cortisol levels. But here is the real deal: think of cortisol as Momma: When Momma ain’t happy, ain’t nobody happy!  What that means is that chronically high cortisol levels can cause functional (either relative or absolute) decreases in other hormonal levels and or activity. It can lower testosterone and or thyroid hormone levels and or cause “normal” levels of those hormones to become less “effective”.   Wow – so a 25 year old stud could be going through twelve weeks of pre fight intense overtraining, pain, dealing with anxiety, cutting weight etc. could have a lower that normal (or a low normal) testosterone level? Absolutely!


Anti-doping / anti-Performance Enhancement hysteria, fueled and distorted by media that always wants to find a “sexy” or scandalous story, has caused the pendulum to swing far past where it should, which may cause officials, who are sensitive to public opinion, to enforce policies that may not be in the best interest of the health of the athlete.

For what it’s worth, I’ve always felt that enforcing Performance Enhancement Drug rules on the grounds of “fairness” is a crock. I mean, sure if one athlete is juiced and the other isn’t there can be an advantage. But where do you draw the line? Unless you get two athletes with the same genetics, same environment, same trainer, same diet, same mental conditioning etc. a fight will not be “fair” (in terms of all things being equal).  All athletes are trying to tip the scales to gain a competitive advantage with better coaching, smarter and harder training etc. to get an edge over their opponents. “Hey, this fighter has a longer reach, or has a better trainer or more experience” is perfectly acceptable, yet hardly equal or “fair”. Yet no one screams “foul”.  What about Tiger Woods getting LASIK surgery to see better? What about Nick Diaz getting scar tissue removed so that he doesn’t cut as easily? There are so many variables to equality and fairness it’s incredible.

Performance Enhancement policies established on the basis (intention) of protecting the health of the athletes seems to be a much more solid (legitimate) argument.  Everyone knows that athletes will go to extreme measures to win in order to get paid. So, banning a foreign substance which can be defined as a non-naturally occurring substance in the body, which may also have serious health consequences (either short or long term) can be reasonable defended. Methamphetamines, THC and synthetic anabolic steroids are all examples of foreign substances that have been used to enhance performance (or training recovery) and may carry with them negative side effects. It is tough to defend the use of those types of substances as they are definitely not naturally occurring in the body.

But let’s say an athlete is diabetic. Are they allowed to supplement (inject) insulin – a bio-identical compound (a chemical that your body makes naturally), to maintain proper insulin levels in the blood? Sure. It makes perfect sense, common sense and is completely consistent with protecting the athlete’s health (not to mention his energy or performance levels!).

And what about thyroid medication? What if an athlete has low thyroid hormone levels? Can doctor prescribe, and would the rules allow this? Sure. But what if that athlete has normal levels and takes thyroid in an effort to cut weight? Ah…now we are getting into the area of abusing even a naturally occurring, bio-identical to go far beyond normal ranges, and hence negative health side effects could arise.

So what about the big, bad “T” word – testosterone? Testosterone has taken so much bashing the past few decades it is unbelievable. Once thought to be the source of all anger and aggression, prostate cancer and an accelerant to heart disease – not to mention a performance enhancer – testosterone is typically misunderstood as a healthy hormone as well as a performance enhancer. It gets labeled and spoke of in the same breath as synthetic anabolic steroids – and everyone knows how “bad” those are, right?


As noted above, the research presented at the 19th Annual World Congress On Anti-Aging by one of the world’s foremost experts in testosterone replacement therapy, Ronald Rothenberg MD (amongst others) suggested that the most significant health benefits (disease prevention and quality of life) occur when patients don’t just replace testosterone to re-establish “normal” levels, but to optimize testosterone levels to the levels of a 25 year old (the “high” normal range)!   Great news in the anti-aging category, but what’s that got to do with young health male – “stud” – fighters?  Lots!

I’m glad that the more progressive regulating bodies are making allowances for medically necessary HRT (hormonal replacement therapy – in this case testosterone) even for younger athletes – as was the case with Nate Marquardt. It’s a matter of health and well-being.  I’m hoping too that there is a clear understanding of the distinction between “normal” versus “optimal”. That’s a key point! Who wants to be “normal” in terms of health? Normal means that I better get ready for my first heart attack in my 60’s!  I would much rather be optimal, wouldn’t you?

Typically, “normal” total testosterone levels can range from 280 – 1100 ng/dl (depending on the lab), while optimal levels (for health and well-being) are believed to be at the high end of that range. Athletes using testosterone replacement therapy who drive their levels beyond the high normal (or with unacceptable testosterone ratios) will be “busted” on drug tests. We all know of the possibility of abuse which can negatively impact the athletes health, however testing procedures are designed to control that. Let’s be clear, we are not advocating any form of abuse, we are talking about optimizing medically necessary testosterone replace in athletes who may not have ever imagined that they needed it.

To add insult to injury, some athletes – even under medical supervision – may try to boost their testosterone during pre-fight training and then “go off” six weeks before the fight to “pass” the drug test. Ouch! In this case, the athlete heads into the most stressful period leading up to the fight, pulls the plug on testosterone use with no time for his own system to “turn back on” which can lead to a nasty mental and physical crash. This is definitely not healthy.

Athletes and their trainers /doctors need to do all they can to become educated and, ideally, monitor the athlete throughout their training and work in partnership with governing bodies. Salivary cortisol levels (considered the Gold Standard vs. blood levels), free testosterone, bound testosterone, sex hormone binding globulin, thyroid levels, blood sugar levels and others to get a complete picture of how the “system” is holding up to the stress of pre-fight training.

Athletes wanting to optimize and protect their health and pass drug tests need to work closely with experienced medical doctors to carefully monitor and optimize and control both testosterone and cortisol levels during pre-fight training.

Any lack of diligence in this area will cost the athlete money and thrust him into negatively slanted media scrutiny – just ask Nate Marquardt.



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