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By Zach Arnold | October 9, 2013

The NFL, like combat sports, will stay popular regardless of brain damage. Always the cover-up that brings down the titans. #leagueofdenial — FightOpinion (@FightOpinion) October 9, 2013

On Tuesday night, Public Broadcasting via Frontline aired a two-hour documentary on the National Football League called League of Denial. If you have followed the concussion dilemma in American football over the last decade closely, then nothing in the documentary was necessarily news to you. However, the documentary is based on a book written by the Fainaru brothers (Steve & Mark) who also happen to write for ESPN… and ESPN backed out at the last-minute from the cooperation with PBS according to a report in the New York Times that alleged that the NFL … convinced… ESPN that backing out would be the right thing to do.

After watching the documentary online, you can see exactly why the NFL and its business partners wanted nothing to do with the television presentation. PBS presented evidence we already largely knew about but did so in such a methodical, easy-to-understand, detailed manner that you’ll never look at NFL politicos the same way ever again. It had all the echoes of Big Tobacco from a generation ago.

I mention this as a back drop to initial results released from a medical study via the NIH two months ago related to boxers & mixed martial artists who agreed to participate in a study for the Lou Ruvo Center for Brain Health (Cleveland Clinic). If anyone can provide me with a PDF of the up-to-date study results, I would be very grateful.

The NIH abstract from the brain study states the obvious — that both boxers and MMA fighters can suffer from concussive brain damage due to blows to the head in fights. We know about pugilistica dementia. What the study does conclude is that the specific type of brain damage suffered by boxers and MMA fighters is different.

Transversal diffusivity in the posterior cingulate cortex of brain. Translation: the part of your brain that controls your memory, speech, recognition, and pain. Damage to the posterior cingulate means a greater risk of suffering from Alzheimer’s Disease.

The testosterone connection

I bring this study up because of the growing number of MMA fighters who are, publicly or privately, using testosterone to try to extend their fighting careers. Just last week, we saw three names floated in the press – Lavar Johnson, Ben Rothwell, and Joe Warren. We also know that there are four top contributing factors as to why fighters gravitate towards testosterone (anabolic steroid) usage: 1. damage from weight cutting, 2. previous and/or current steroid use that has damaged the endocrine system, 3. abuse of pain killers, and 4. brain damage that impacts how much testosterone your body produces.

We know that steroid usage in MMA is prolific. Damage from weight cutting is also a real concern (see: Leandro Souza). Pain killer usage is heavy. Brain damage amongst veteran fighters is real. Looking at the four factors as to why fighters turn to testosterone, it’s a perfect storm of circumstances.

I mentioned Ben Rothwell’s name as a member of the testosterone brigade in MMA. A quote from an MMA Junkie article talking about why UFC suspended him for 9 months:

“I had applied for TRT after an endocrinologist and Wisconsin athletic doctors diagnosed me with hypogonadism. They felt it was caused by a car crash in 1999 that left me with severe head trauma and in a coma. Doctors told me TRT was something that could stop the hypogonadism from degrading my body.

Let this quote sink in for a minute. He asked a third-rate kinda-sorta commission for an anabolic steroid pass and got it… because he supposedly suffers from brain damage. And they gave it to him! UFC allowed him to fight in the cage while he claims to suffer from brain damage. He got suspended by UFC for elevated levels of testosterone because the Wisconsin commission wouldn’t suspend him. They’re not stopping him from fighting again in the future. They’re suspending him because of elevated levels of testosterone.

The UFC should give Ben Rothwell an ultimatum to come clean. Either the story about the brain trauma is true and he retires from fighting or the story is false and he admits that he worked the system to use testosterone, the base chemical of anabolic steroids. Neither result is pretty but I’d rather hear the truth than another lie from a steroid user in the sport. If the UFC continues to book him for fights while knowing his public claim/admission that he suffers from brain damage, then anything bad that happens to him in the cage makes them & the athletic commission regulating the fight open to potential liability. It is interesting to note that when UFC suspended Rothwell for nine months, he did not put up a fight.

If you want to know why I fight so hard when it comes to the quality of athletic commissions, this right here is a shining example of why I do what I do. In theory and on paper, I am a believer of athletic commissions when properly staffed with competent individuals. Unfortunately, most individuals involved in combat sports regulation should be nowhere near the industry. If athletic commissions are meant to create an atmosphere of health & safety as opposed to simply being tax collectors, then why do so many of the major AC’s possess only one line of defense when it comes to examining the brain health of combatants? It’s all about volume. Many fighters go to “one-stop shop” doctors to get all their tests taken care of and medical paperwork sent to the AC’s. In Southern California, Dr. Richard Gluckman is the one-stop shop. He has so much business that the California State Athletic Commission front office practically views him and his assistant Rose Saavedra as an unofficial extension of Sacramento. It’s why there is political favor for Rose Saavedra to work as an athletic inspector on fight shows despite the obvious conflict of interest. It is often doctors like Richard Gluckman who are the only line of defense in detecting any sort of brain abnormalities before a fighter is approved by a commission to fight. You can’t expect the doctors at live shows to be able to perform on-site MRI scans to determine recent or past brain damage. Therefore, the onus is on the front office of the AC’s to perform their due diligence and save the fighters from themselves if they are physically impaired.

As Steve Kim documented in an article about boxer Tim Bradley’s brain health, it was Dr. Gluckman who recently did an MRI on Bradley’s brain. Steve’s article is a must-read when it comes to the health issues Bradley is facing coming off of the brutal fight with Ruslan Provodnikov.

I understand why MMA commentators like Luca Fury scream about people who rip into testosterone usage. He looks at it from the perspective of a handicapper who sees people on social media making claims that testosterone can impact win/loss records for fighters. He denies that T provides an advantage in that category and I (mostly) agree with his sentiments. Therefore, I always argue the testosterone issue in Mixed Martial Arts as a health & safety issue. If you have to use testosterone in order to function as a human being to compete in a fighting contest, then I have major issues with promoters & commission allowing such a person to fight in the first place. If you have brain damage and need testosterone to function, stop fighting. If you abuse pain killers and need testosterone to function, you have a problem. If you previously and/or currently use steroids and want to double-dose on testosterone, that’s a red flag. If you damaged your body from bad weight cuts, that too is a health & safety issue.

As Dave Meltzer appropriately stated last week, never has he seen so many grown men with such muscular bodies in one particular sport publicly cry for the need to use testosterone to function for basic athletic competition. And yet when it comes to issue of testosterone usage in Mixed Martial Arts, be prepared for the avalanche of fans & commentators who will scream “shame on you!” if you say testosterone usage should be banned. I have long stated that athletic commissions should not be giving testosterone passes out to fighters and that if the fighters have a problem with it, then sue the athletic commission(s) and prove that the Americans with Disabilities Act gives you a right to use testosterone in combat sports simply because a doctor wrote you a prescription for testosterone. Establish case law for combat sports if your need for testosterone is so important. Jack Encarnacao wrote an article two years ago about the George Hartman case. Combat sports are legally classified as ultrahazardous, which makes it tougher to argue in front of a judge that an athletic commission should allow a fighter to use testosterone, let alone the concept of getting licensed by an athletic commission for combat sports while suffering from the effects of brain damage. This ain’t golf, brother.

After watching League of Denial on PBS, I will still watch combat sports and American football. As we learn more information from the medical community about brain trauma caused from activity in these sports, the contestants will become more informed about the risks they are taking. As long as you know the risks involved, then have at it. To those regulating such activity, be open & honest & watchful. Be transparent. Be vigilant. Most importantly for fighters & regulators, know when it’s time to stop fighting. There’s nothing wrong with participating in combat sports (or football) but when it’s time to talk away, it’s time to walk away. As we’re learning from the Cleveland Clinic study about brain damage in combat sports, we should place greater scrutiny on testosterone usage amongst fighters. The testosterone usage appears to be a symptom of bigger problems in terms of physical damage. There is no reason to allow older fighters who are suffering from brain damage to use testosterone in order to extend their fighting careers and inflict further brain damage on both themselves & future opponents.

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