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Thread: Endocrinologist: Chael Sonnenís initial diagnosis of hypogonadism not definitive

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    Default Endocrinologist: Chael Sonnenís initial diagnosis of hypogonadism not definitive

    Endocrinologist: Chael Sonnen’s initial diagnosis of hypogonadism not definitive


    Just prior to his rematch with now-former middleweight champion Anderson Silva, Chael Sonnen dramatically declared that he needed to undergo testosterone-replacement therapy, or he would die.

    A year later he told California regulators that, if he discontinued the treatment, he would have the hormone levels of a 93-year-old.

    A doctor who recently reviewed Sonnen’s medical history would agree the fighter now needs to use prescribed testosterone to compete as a professional athlete. But she is uncertain whether he needed it in the first place.

    In a letter written to Sonnen’s management, which was forwarded to the Nevada State Athletic Commission with the fighter’s second request to undergo TRT for UFC 167 this past month, University of Arizona endocrinologist Karen Louise Herbst concluded the fighter meets the criteria for hormone-replacement therapy (TRT). She said he is “likely permanently hypogonadal” because he has used testosterone since 2008.

    “It may be that suppression of his gonadal axis for that long may never allow a return to normalcy, and discontinuing his testosterone use at this time would be very disruptive to his career,” she wrote.

    But Herbst also expressed reservations about his initial diagnosis of testosterone deficiency. She said that based on “initial data,” it is “not clear that there was a definitive (without a doubt) diagnosis of hypogonadism.”

    It is unclear how Herbst came to work with Sonnen. NSAC Executive Director Keith Kizer told MMAjunkie she was referred to the fighter by the UFC and would be reviewing fighters’ medical histories for the promotion in the future. UFC Vice President of Regulatory Affairs Marc Ratner said the UFC had no hand in the process and said Herbst was Sonnen’s doctor.

    Sonnen and his management did not respond to requests for comment.

    The commission granted Sonnen a therapeutic-use exemption (TUE) for UFC 167, a Nov. 16 pay-per-view event. He lost to former champ Rashad Evans via first-round TKO. He is one of three active UFC fighters granted a TUE for TRT from the commission, along with ex-champs Frank Mir and Dan Henderson.
    “The whole notion of granting TUEs to young men for hypogonadism is nonsense,” wrote anti-doping expert Don Catlin in an email to MMAjunkie. “Young men do not get hypogonadism. As a member of the [International Olympic Committee therapeutic-use exemption] committee for the last 20 years, I should mention that we only granted one TUE, and that was for someone who had no testicles.”

    Three years ago, the 36-year-old Sonnen introduced hypogonadism and testosterone-replacement therapy to MMA after a post-fight drug test came back with an elevated testosterone-to-epitestosterone (T/E) ratio following his first bout with Silva at UFC 117.

    During his appeal of a one-year suspension issued by the California State Athletic Commission, which oversaw the event, Sonnen claimed he was approved to undergo TRT and had disclosed it beforehand to the commission’s executive director.

    To bolster his defense, he brought an Oregon-based osteopath to testify to his need for hormone-replacement therapy. Dr. Mark Cznarnecki told the CASC the fighter suffered from “mental fogging” and would be anemic without testosterone.

    Czarnecki, who said he was in the process of completing a “hormone-based residency program” with the American Board of Anti-Aging and Regenerative Medicine, clarified that he did not recommend to Sonnen any alternative treatments. Yet he stated the fighter could not safely compete inside the octagon without testosterone.

    The CSAC halved Sonnen’s suspension, but later re-suspended him when it found he had made false statements about receiving approval from the NSAC for TRT.

    Herbst reviewed Czarnecki’s initial diagnosis and concluded the fighter’s case for deficiency would have been stronger had he been tested differently for hypogonadism. According to her evaluation, Sonnen gave two blood samples on Jan. 11, 2008 – one in the morning and another in the afternoon – that led to a prescription for testosterone.

    “A second morning testosterone level that was lower than 300 ng/ml would have been more convincing than a level of testosterone drawn in the afternoon when levels are known to be lower in men,” she stated.

    While testifying on Sonnen’s behalf, Czarnecki told the CSAC he performed two blood tests on the fighter, one on Jan. 11 and one four days later. The latter ruled out primary hypogonadism, which results from congenital defects or physical damage to the testes.

    That would point to the disease’s secondary form, which occurs when hormone levels decrease as the result of disfunction in the pituitary gland, which tells the body to produce testosterone. While both primary and secondary hypogonadism can cause health problems, doctors disagree on whether the secondary variety is a disease that should be universally treated with hormone-replacement therapy.

    Herbst did not identify the type of deficiency suffered by Sonnen but wrote there was no evidence that he had abused testosterone over five years of treatment.

    Dr. Jeffrey Brown, a Texas-based endocrinologist who reviewed Sonnen’s paperwork for MMAjunkie, said he takes three blood samples over the course of an hour in the morning and averages the hormone levels of a patient in order to get the most accurate number. Additionally, he gets a full medical history and measures other hormones before deciding the type of deficiency.

    Making a diagnosis on incomplete information, he noted, “you can be misled.”

    While Brown cautioned that he hadn’t reviewed Sonnen’s full medical history, he agreed with Herbst’s conclusion that the fighter’s initial diagnosis is inconclusive.

    “Based on this, if that’s all they went on, in my opinion, that’s not enough (to prescribe testosterone),” he said.
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    Quote Originally Posted by The Donosaur View Post
    I'm no doctor, and probably not even particularly smart...

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    Good old perscription steroids.

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    Quote Originally Posted by dimerules28 View Post
    Good old perscription steroids.

    The part of the article that I disagree with is where it says young men don't get hypogonadism. Men in their 30's get it quite frequently, and it isn't just from steroids. A tumor on the pituitary gland, a varicocele or hydrocele in the testes, and other things such as a rise in prolactin cause men's testosterone to drop below 300 all the time. Otherwise we wouldn't be indundated with ads for TRT on tv and the radio.

    Given, the most likely cause of hypogonadism in a professional athlete is very likely steroid abuse. TRT is fine by me if the athlete is using it to get his testosterone levels from sub 300 back into the normal 400-600 range. It is when they use it to artificially put their levels over 900 that is abuse.

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    Well, here's our opportunity to put Chael under the same scrutiny we have put Vitor under this year, or to defend him as vigorously, depending on your perspective I guess. I've stated my opinions many times on this board, I hate TUE's. Now, lo and behold an endocrinologist comes along and casts more doubt.

    Fire away people.
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    "Shit just got real here in the Max!" Michael "The Voice" Schiavello at K-1 World Max Rd of 16 2010, Zambidis vs. Chahid.

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    hypogonadism can be bad and lead to larger issues. if meds are needed then they are needed, now I am not saying they need to be abused.

    I think you can make a panel of Docs--that rotate from state to state (that way it is not the same docs everytime and can slow down the corruption)--majority has to say TRT are needed. Then agree that a TUE is to be given.
    Last edited by TBEAR; 12-12-2013 at 01:14 AM.
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    Quote Originally Posted by JPeezy View Post
    The part of the article that I disagree with is where it says young men don't get hypogonadism. Men in their 30's get it quite frequently, and it isn't just from steroids. .
    I stopped reading agter this cause no they dont get it "frequently". Idk what cereal box you got your info off of but men in their 30's do not frequently get hypogonadism. And yes trt is 100% perscription steroids.

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    Quote Originally Posted by earle View Post
    Well, here's our opportunity to put Chael under the same scrutiny we have put Vitor under this year, or to defend him as vigorously, depending on your perspective I guess. I've stated my opinions many times on this board, I hate TUE's. Now, lo and behold an endocrinologist comes along and casts more doubt.

    Fire away people.
    Vitor is a juice pig. Idk if im gonna get banned for saying that but its true.

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    Quote Originally Posted by dimerules28 View Post
    I stopped reading agter this cause no they dont get it "frequently". Idk what cereal box you got your info off of but men in their 30's do not frequently get hypogonadism. And yes trt is 100% perscription steroids.

    I get my info from medical journals and a family member who is an endocrioloist. I stopped reading your your mess at the beginning. According to research approximately 30 percent of men ages 40 to 79 are affected by hypogonadism, also called androgen deficiency, a condition marked by testosterone levels below 300 ng/dL (nanograms per deciliter). It frequently starts to pop up in your 30's.

    Then there is the fact that you don't know the difference between testosterone and artificial steroids....

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    Quote Originally Posted by JPeezy View Post
    I get my info from medical journals and a family member who is an endocrioloist. I stopped reading your your mess at the beginning. According to research approximately 30 percent of men ages 40 to 79 are affected by hypogonadism, also called androgen deficiency, a condition marked by testosterone levels below 300 ng/dL (nanograms per deciliter). It frequently starts to pop up in your 30's.
    I won't even try to debate this, I'm no expert. Interesting that you mention the 30% in the age range of 40-79, I don't think Vitor or many others are in that age category yet. I wonder what the stats are for 20-30 or 30-40?

    Quote Originally Posted by JPeezy View Post
    Then there is the fact that you don't know the difference between testosterone and artificial steroids....
    Well, he did say "100% Prescription steroids", not artificial steroids, word play, I know. Testosterone is still a steroid, even though it's natural. So if your doctor is prescribing it, then it's a prescription steroid IMHO.
    --------------------------------------------------------------------
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