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A crash course on testosterone, hypgonadism, and doping

By Zach Arnold/

We have all heard about the Lamont Peterson/Amir Khan fight getting cancelled. When you heard that the cancellation was due to Peterson failing a drug test due to detection of synthetic testosterone, you probably groaned. You may not totally understand what that exactly means, but you know it’s bad news.

Photo: Hogan Photos/ Golden Boy

For boxing fans, fighters, promoters, and media, they can learn a thing or two from their MMA counterparts about recent drug scandals and the evolution of doping in combat sports.

What you, as a fight fan, must know about modern day doping practices in combat sports is downright ugly. However, it’s necessary to understand what is going on in order to appreciate the gravity of the doping dilemma in combat sports. You’ve been warned.

What is testosterone?

As Dr. David Black, a famous drug program doctor once stated on the TV show 60 Minutes, testosterone is the base chemical of all anabolic steroids.

In other words, testosterone is what makes a man… well, a man. Your muscles, your sex drive, your energy levels, all impacted by the health of your endocrine system and the levels of testosterone in your system.

In the combat sports world, testosterone is all about physical & mental power. When in excess, it can be a very powerful weapon.

What is hypogonadism?

During a Thursday radio interview in Washington D.C. media circles, Lamont Peterson stated that the reason he got caught for synthetic testosterone is because a doctor gave him soy-based, low-dosage testosterone pellets that allowed his body absorbed low levels of testosterone. Peterson went on to claim that he’s suffering from hypogonadism.

Hypogonadism is when your endocrine system can’t produce normal levels of testosterone. The end result is less energy, a crippled sex drive, less physical power, and less mental focus.

It should be promptly noted that, at most, around 2% of adult males naturally suffer from hypogonadism.

What are the main causes of hypogonadism in athletes under age 40?

For the majority of athletes who proclaim hypogonadism, they are suffering from this medical condition for various reasons. Amongst fighters in the combat sports world, there are four main causes for hypogonadism.

Anabolic steroid usage: Anabolic steroid users damage their endocrine system by using these drugs. Since testosterone is the base chemical of anabolic steroids, you can automatically see the connection here. A steroid user gets the performance-enhancing benefits of drug usage but ends up with nasty side effects. The solution for a steroid user? Get a prescription of testosterone. In essence, you’re double-dipping on the doping. An anabolic steroid user damages their endocrine system and, in turn, gets testosterone pellets or injections or creams & gels in order to make up for their damaged natural testosterone levels. Much like a diabetic takes insulin because their body struggles to produce the right amount, anabolic steroid users use Testosterone Replacement Therapy (has a nice spin to it, huh?) in order to try to get their body’s natural testosterone levels back to within a normal range.

Pain killer usage: If you abuse pain killers, your testosterone levels will get damaged. Methadone is a common culprit. In MMA circles, we have seen a scary amount of fighters who are using cancer-grade, end-of-life-grade pain killers and are failing drug tests because of it. It’s an alarming issue in combat sports because fighters often times are mixing different pain killing medications at once, sometimes combining it with alcohol consumption. It is a serious problem.

Concussions: If you suffer brain damage, your ability to produce testosterone can significantly increase. In MMA, we are seeing a lot of older fighters who are using testosterone and getting a blessing from an athletic commission to do so. The reason it’s a mistake is because older fighters tend to have more brain damage due to the amount of punishment they have taken in previous fights. It is a vicious cycle because the more brain damage you suffer, the more of a need for testosterone you have. By athletic commissions giving brain-damaged fighters a hall pass for testosterone usage, it’s opening up fighters for more brain damage in the future.

Bad weight cutting: If you experience a bad weight cut to make weight for a fight and it’s done improperly, you can damage your endocrine system and your body’s ability to produce testosterone. While many people online debate the link of testosterone damage to weight cutting (especially in the amateur wrestling community), there’s no question there’s a link between the action and the outcome. In combat sports, you will see fighters who get busted for performance-enhancing drugs that are known less about producing bulky muscle and more about producing leaner muscle that helps fighters make weight. Many of these drugs are also horse steroid drugs such as clenbuterol & boldenone.

Why should I care about fighters crying a need for testosterone due to hypogonadism?

For the majority of fighters in combat sports, hypogonadism is a result of bad choices that fighters make. Anabolic steroid usage is the most prevalent cause.

In 2010, famous UFC fighter Chael Sonnen got busted for testosterone usage in California. He ended up proclaiming hypogonadism and a need for a testosterone prescription. He even brought his doctor, a general practitioner named Dr. Mark Czarnecki from The Dalles, Oregon to try to justify the need of Sonnen using testosterone.

Around the time of this hearing, Big Pharma started ramping up a major ad campaign about “Low T” and men in their 40s and 50s needing to visit their doctor because of low testosterone levels. Despite the fact that only a small percentage of the male population suffers from low testosterone levels, Big Pharma quickly blurred the lines of what people really need versus what people want & desire to get. In other words, Chael Sonnen couldn’t have asked for a better gift than for Big Pharma to time their testosterone ad campaign around the time he was having his problems. The lines got blurred and the public suddenly was warned about an imaginary epidemic of men suffering from low testosterone.

When it comes to legitimate testosterone usage, a board-certified endocrinologist is the one who should be in charge of managing such treatment. After all, low testosterone levels indicate a damaged endocrine system.

However, in the combat sports world, we see the sport populated with mark doctors. Mark doctors are fan boy doctors who are willing to write up prescriptions for drugs to fighters in exchange for a celebrity rub. Photographs, autographs, going out to dinner to socialize. As we have seen over the last few years in Mixed Martial Arts, the majority of doctors who are writing up prescriptions for testosterone to fighters are not board-certified endocrinologists. The mark doctors who are writing up these prescriptions are General Practitioners and Age Management Specialists, often who get referrals from chiropractors. The end result is that you have fighters getting their own prescriptions with little or no oversight and what oversight there is tends to be sloppy & dangerous. In some cases, fighters are getting prescriptions for injectable testosterone and are giving themselves the shots.

It’s dangerous and it’s absolutely unacceptable.

What are commissions doing about the problem?

The early returns on how athletic commissions are handling the testosterone crisis are mixed to say the least.

You have to remember that commissions are regulatory bodies full of politicians, many of them who have been appointed to their positions due to politics that have nothing to do with actual experience in the combat sports world or on matters of medical knowledge. Many of these commissions exist for liability purposes and to collect revenue from gates. Some commissions, like New Jersey, are obviously better than others. However, money talks and BS walks.

As the testosterone issue has flared up, we are seeing more signs of athletic commissions making decisions based on finances & compromise. In New Jersey, you can get a Therapeutic Use Exemption for testosterone usage. You have to follow the guidelines set forth by the Association of Boxing Commissions. In Nevada, they have their own process to get a TUE for testosterone. Incredibly, Executive Director Keith Kizer says that the process for getting a TUE only takes 20 days in Nevada. In California, a new process to set up Therapeutic Use Exemptions for testosterone is being set up to where a fighter has to undergo at least three to six months of medical testing before any sort of clearance is given. This standard is actually much more legitimate, in my opinion, than the process currently in Nevada.

As for the drug testing aspect of various commissions and their ability to catch undisclosed testosterone usage in fighters, it’s a very mixed bag of results.

Most athletic commissions use standard urine drug testing. This kind of drug testing will only catch the stupidest of cheaters using basic PEDs and those who use PEDs at the wrong time. Since most of these drug tests are done right before a fight and after a fight, it’s pretty easy for a fighter to cycle off when needed.

Amazingly, a lot of fighters have failed the IQ test that is standard urine drug testing. Various AC’s like to tout this stupidity as a display of how tough their drug policies are when, if anything, it exposes just how deep the doping crisis in combat sports really is.

For a standard urine drug test, a typically used measure is called the T/E ratio. The T stands for Testosterone and the E stands for Epitestosterone. For most people, the natural level is on a 1:1 ratio basis. Depending on the state athletic commission you are talking about, some use a more appropriate 4:1 ratio while other states use a more forgiving 6:1 ratio. The higher the T/E ratio, the better the indication is of someone recently using PEDs — or of someone who is such a hardcore drug user that they are too dumb to cycle off their levels.

In the case of Lamont Peterson, however, he was not testing positive under the protocol of a standard urine drug test. Why? While he was micro-dosing his testosterone usage, he was doing so in a manner in which his T/E ratio was under 4:1. Therefore, a standard, unsophisticated urine drug test was never going to catch them.

This is where the Carbon Isotope Ratio standard comes into play. CIR is essentially a standard used for more advanced urine drug testing that allows you to detect synthetic testosterone usage. Athletic commissions claim that they don’t use CIR because it’s cost-prohibitive. However, it absolutely works as a protocol for urine testing. Peterson got caught because of the CIR drug testing protocol. Keith Kizer of the Nevada State Athletic Commission admitted in an interview that standard Nevada urine drug tests would not have caught Lamont Peterson’s testosterone usage. What makes this so curious is that when a fighter fails a standard urine drug test in Nevada, the testing protocol on the B sample happens to feature Carbon Isotope Ratio testing. So, Kizer has admitted that Nevada’s lower standard of drug testing would not have caught Peterson and, yet, as we discovered in this case the CIR protocol that Nevada uses on appeal only would have busted Peterson. It’s totally backwards in terms of how the current drug testing process works.

The CIR test that Peterson tested positive for was administered by Dr. Margaret Goodman’s Voluntary Anti-Doping Agency, which contracted with the two fighters in question (Lamont Peterson & Amir Khan) to do supplemental drug testing in addition to what drug testing the state of Nevada does. This is the first big positive test for VADA.

What are testosterone users talking about when they are referring to their ‘levels’?

The T/E ratio that is used for standard urine drug testing is not what testosterone users talk about when it comes to their ‘levels’ for testing.

What testosterone users are talking about is the ng (serum) level of testosterone based on blood testing. The current spectrum of accepted ng levels by the state of Nevada is anywhere from 400 ng to 1100 ng. If this sounds like a wide gulf to you, that’s because it is. You can be a little lower than 400 ng for your testosterone levels and still be perfectly fine. In the case of UFC fighter Quinton “Rampage” Jackson, he claimed that his age management doctor told him that his level of 420 ng was ‘too low’ and that he needed to bump it up. Rampage claims it got bumped up to 600 ng but not the 800 ng that he wanted. The end result is that Rampage admittedly gained 15 pounds of muscle but had water retention issues when he missed weight for his UFC Japan fight against Ryan Bader.

The manipulation of levels when it comes to measuring testosterone levels via blood testing results is evident in one manner. If you are an anabolic steroid user, you can damage your endocrine system after usage and go get your blood work done. The results of the blood work will show that you are suffering from low testosterone levels. This is then used for justification to get a prescription for Testosterone Replacement Therapy. This is what makes the wildly varying state-by-state process of getting a Therapeutic Use Exemption for testosterone usage so maddening — and dangerous.

What is the net effect of testosterone usage in combat sports?

Given the rise of admitted & busted testosterone users in combat sports, eventually a crisis will happen in boxing or MMA sooner rather than later. A testosterone user will end up crippling or killing an opponent and the testosterone issue will blow up on a massive scale in the media — and rightfully so.

Testosterone usage gives anabolic steroid users a second chance at doping. Testosterone usage gives those who are abusing pain killers even more reason to continue their vicious cycle. The same can be said about fighters who suffer from permanent brain damage who end up getting a testosterone prescription in order to take more physical punishment and suffer even more brain damage.

Testosterone is power in combat sports. It can increase the knockout ratio of a fighter, even at an older age. Unlike using testosterone in order to increase your strength to hit a homerun or perform better at track & field, testosterone usage in combat sports allows a fighter to not only cause more brain damage against an opponent but also receive more brain damage as their career is extended due to getting permission to use testosterone because their body can’t produce testosterone naturally any longer.

Testosterone usage is a legitimately scary medical problem in combat sports and deserves intense public scrutiny. Lives are at stake here. If you don’t care about the cheaters, then at least care about fighters who are getting cheated against and are in a more vulnerable position to suffer their own form of physical damage.

Visit for more of Zach Arnold welcomes other views on this subject. Please contact at [email protected]



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