Fight Doctor: Bigfoot's Big Testosterone Problem

Fightland Blog

By Dr. Michael Kelly, D.O. as told to Fightland staff

Last week MMA fans everywhere had their hearts broken when it was announced that the legitimacy of the already-legendary fight between Mark Hunt and Antonio “Bigfoot” Silva was being called into question by the revelation of elevated testosterone levels in Silva’s blood. As a consequence, Silva lost his Fight of the Night bonus money and got suspended from the UFC for nine months and MMA fans everywhere once again had to come face to face with the realization that nothing in this uncaring universe keeps its promise.

According to a statement released by the UFC, Silva, who had been approved for testosterone replacement therapy (TRT),“had been in compliance with therapeutic guidelines on all pre-fight tests performed prior to the event. The results of his test on the day of the event indicated a level of testosterone outside of allowable limit.” In other words, leading up to the fight Silva’s testosterone levels were fine. On the day of the fight, however, he was over the limit. Which is where things get touchy.

Silva is blaming (and apparently planning to sue) his doctor, who, Silva says, botched his TRT injections during the lead-up to the fight. Silva--who requires TRT to deal with the effects of a hormone condition called acromegaly but who has been suspended before after testing positive for steroids—claims his doctor administered the testosterone incorrectly and unwisely upped his dosage only two weeks out from fight day.

In addition to our despondence over the realization that one of the best, finest, and seemingly noblest fights we’d ever seen had been tainted, this debacle made us realize just how little we actually understand about TRT, the difference between testosterone and steroids, the reason why so many of the world’s toughest men seem to be so low on the hormone required to make humans tough, and medical science in general. So we called up our fight doctor, Dr. Michael Kelly--a sports-medicine specialist, part-time ringside doctor, and the author of the book Fight Medicine--to get some answers.

Dr. Michael Kelly: Over the past 15 years or so low-testosterone syndrome has been identified. There’s a failure in the adrenal axis. There’s a feedback mechanism between the pituitary gland and the testes, and there’s a signal that tells the testes to make testosterone, and some people get a breakdown in that axis and something goes awry with that feedback mechanism.

This can happen for several reasons. Some fighters or athletes or patients in general will have some sort of trauma to or infection in the testicles or something related to the testicles that make them not produce testosterone. There also may be some evidence that low testosterone levels can be associated with chronic traumatic head injury. It’s an area of active research.

And sometimes what we’ll see is someone who’s been taking steroids for a long time, whether prescribed or not, there’s something about that exogenous, or outside-the-body, administration of testosterone—the gels--that over time can disrupt that normal mechanism. Some people when they get off the testosterone and try to go back to normal without steroids, they physiologically can’t and they requires lifelong hormone replacement.

Low testosterone is terrible for a professional fighter. It leads to a lack of strength and aggression. Men with low testosterone tend to be depressed, irritable, easily angered. They’re not going to go into the ring with the right aggression, the right mental outlook, or significant strength. For men, testosterone is involved in so many functions in the body.

For a therapeutic exemption for TRT you need a diagnosis, usually from an endocrinologist, a doctor who specializes in hormones, showing that there’s a need for it. Then, if you’re being supplemented with testosterone the levels need to be checked and kept within the regular physiologic range. Because if they’re being supplemented to treat a medical problem, they’re just going to get into normal range. It doesn’t really give them an advantage. The problem—and this is one of those situations you see in all sports, not just MMA—some athletes are very sophisticated and what they’re purposely doing is taking high doses of steroids then stopping them abruptly then going to their doctor and they get tested for low testosterone and then they say that they need testosterone replacement. That’s why it’s so important they’re testosterone is not at a super-physiologic level.

There’s testosterone injection and there’s topical applications. Now, the topical applications, the gels, they can give you very steady levels of testosterone in your bloodstream and they work very rapidly. Sometimes what guys do is they take the test and put the gel on after and get themselves back up to a superphysiologic level. After the blood test and urine test and the weigh-ins they put the gel on and there’s massive amounts of testosterone in their blood for the fight. That’s why you want to test them after the bout to make sure they’re not trying to slip something in between.

The terms “steroid” and “hormone” are synonymous. Testosterone is a kind of steroid. It’s a normal substance in the body. That’s why it’s legal to have testosterone replacement therapy but not steroids. Steroids is a class of substitutes in the body that have multiple effects at a cellular level. Testosterone has a muscle-building effect and brings strength and aggression.

All the other anabolic steroids—the designer steroids—they’re basically derivatives of testosterone, used to either intensify the bodybuilding effect or minimize the adverse effects or trying to make the molecules something that can’t be identified. The non-testosterone anabolic steroids are illegal because there’s not really a medical purpose.

The fact that so many tough fighters—guys you would think would be flush with testosterone--are claiming low testosterone levels and getting TRT is why we need to test for it. The typical guy who’s going to go into MMA and become a champion, by definition, will probably be at the higher end of normal when it comes to testosterone. And they have a lot of muscle growth and muscle mass. So why are we seeing fighters in their 30s coming in and they have legitimate medical reasons for this? Maybe they’ve had an infection and it’s affected the testicles; some guys who have had trauma to the testicles—and they’re just not producing the testosterone. Or is the issue that someone’s used testosterone or steroids for a quite a bit in the past and it finally caught up to them physiologically? And then there’s question of whether there is a relationship between head injuries and testosterones levels. It’s all very hard to figure out.

And the fact that Silva has acromegaly adds a whole other level of difficulty. Acromegaly is an excess of growth hormone in the body that naturally occurs. Growth hormone has many similar components to testosterone in terms of building muscle and strength. But prolonged exposure causes the bones to keep growing, which is why people with acromegaly get that very distinct frontal brow and the jaw gets bigger and the hands and feet get real large. And the internal organs grow continually, and eventually that will lead to a problem.

So the question is, is acromegaly associated with low testosterone? Usually it’s not but it can be. The growth hormone is usually released from the pituitary. So there might be something wrong with his pituitary gland and it’s not getting the stimulus to the testicles to produce testosterone. Most patients with acromegaly later in life have a lot of metabolic problems, issues with diabetes, testosterone, endocrine problems. So it’s entirely feasible.

Then there’s the problem of human error. It can be difficult for doctors to get to that sweet spot with testosterone replacement. It usually takes a month or two to make an adjustment, so if Silva’s doctors tired to make that adjustment just two weeks before the fight, it’s very feasible they overshot the mark.

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