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ABC Response to NSAC elimination of Testosterone Replacement Therapy (TRT)

By Tim Lueckenhoff/President, Association of Boxing Commissions

In July 2011, the ABC’s medical committee, formed under my tenure, published a Handbook of Ringside Medicine. This handbook established guidelines for dealing with TRT and TUE’s. At this 2011 annual convention, this publication was distributed to the attending members. In addition, a very detailed presentation was provided by the ABC Medical Chair Dr. Sherry Wulkan on the issue of TRT TUE’s in both 2011 and 2012.

Since 2011, the ABC medical committee has suggested that its members follow its TUE protocols recommended by the ABC medical committee and modeled upon international Olympic standards. At this point, the ABC will continue to recommend its members follow these extremely tough therapeutic use exemption standards.

These standards, in place since 2011, would allow TUE’s for TRT in only the rarest of cases to a very select group of contestants who have a specified legitimate medical need. I note that the Olympics has seen fit to grant a TRT TUE for more than one individual, including for an individual who lost his testicles in an accident. Our current policy would allow a TUE in that instance.

However, I will ask the medical committee to consider and review Nevada’s new position on the matter which is a strong deviation from their past practice. I will also ask our legal committee to counsel us about the legal ramifications, if any, from an outright ban without exception for any reason.

At the ABC, we are always interested in the subject of PED usage and proper testing and are pleased that Nevada’s action is igniting a healthy debate on the subject matter.

In short, the ABC guidelines state that—

ABC TRT TUE Policy
July 2011

A letter from a Board Certified Endocrinologist stating that you stopped all hormone replacement therapy for a minimum of 8 weeks prior to repeat testing.

The letter should include copies of medical records that address the following issues:

A clearly established diagnosis of primary or secondary hypogonadism.

Include the results from any relevant imaging studies.

Provide results from the endocrinologist’s physical examination including a description of all symptoms such as, but not limited to: incomplete sexual development, reduced sexual desire and activity, change in hair pattern, small or shrinking testes, Height loss due to vertebral compression fracture, Low bone mineral density (dexa scan), Reduced muscle bulk and strength.

Provide at least three separate measurements of Baseline testosterone therapy.

Samples should be taken in the morning of free or bioavailable testosterone levels.

If you have been on testosterone (T) therapy already, then the combatant should cease using testosterone therapy for at least two months, preferably three, before measuring baseline T.

Measurements must be made using an accurate method such as calculated free testosterone by equilibrium dialysis.

Results should demonstrate T levels consistently below the low normal value for the reference laboratory.

The obtained values must be interpreted by a Board Certified Endocrinologist.

Provide LH and FSH values measured at the same time as T above. In this case, the obtained values must be interpreted by an endocrinologist.

Provide results from stimulation of the gonadal axis by hCG as applicable.

Provide confirmation that you do not have any short term illness or other condition that would influence testosterone production at the time of evaluation, and that you are NOT on any medication that may affect T levels such as narcotics or corticosteroids, or androgen replacement therapy.

Provide a detailed treatment plan including how systemic T levels will be monitored to ensure maintenance of therapeutic levels. The dosage must be decided by an endocrinologist in this case. The intervals between assessments of therapeutic maintenance levels must be so stated and the results of at least two therapeutic levels submitted by an endocrinologist.

Please be hereby advised that you will be subject to at least three separate drug tests prior and immediately thereafter your fight date, the timing and type of which is to be determined by the regulating agency.




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