Dr. Goodman of VADA on TRT, PEDs, Fighter Mental Health

Fight Medicine / September 11, 2013 - 8:27pm

Credit: “The Fight Doctor” Jon Gelber, M.D., FightMedicine.net

In our continuing effort to create an open and honest conversation about substance testing and performance enhancing drugs, FightMedicine.net sought out Dr. Margaret Goodman, one of the founders of the Voluntary Anti-Doping Agency (VADA). Dr. Goodman has been a strong voice in the ringside medicine community and has been a ringside physician at many big boxing and MMA events. She is probably best recognized by her red hair as she examines legendary fighters both in and out of the ring.

Dr. Goodman and VADA were recently in the news when both B.J. Penn and Rory MacDonald both agreed to be tested openly by the organization prior to their UFC 152 bout. Unfortunately, Rory suffered a cut during training and the fight was postponed to UFC on FOX 5.

Dr. Goodman and VADA recently were encouraged when female MMA fighters Rosi Sexton and Sheila Gaff volunteered to be tested before their Cage Warriors 49 contest on Oct. 27.

In addition, Georges St-Pierre has also suggested VADA as the organization for which he would be willing to submit to testing before his UFC 154 title unification bout against Carlos Condit.

FightMedicine.net: Could you tell us a little bit of how you first got involved in VADA and what the main mission of VADA is.

Dr. Margaret Goodman: Well, I was a ring physician and head of the Medical Advisory Board for a number of years with the Nevada Commission.  Even when I came on they were already doing extensive drug testing.  It didn’t really so much include performance-enhancing drugs (PEDs).  It was mainly detailed drug screens for stimulants, narcotics, and things of that nature.  But it became clear – you started to read that all these other sports athletes were getting caught and there was testing going on – that this was something that needed to be included (PED testing).

Dr. Flip Homansky, who used to be the Chief Physician with the Athletic Commission and Head of the Medical Advisory Board for many, many years, and he was a ring physician for over 20 years, then became a commissioner and really prodded the Commission to go ahead and add performance-enhancing drugs, mainly anabolic steroids.  And that was around, I think, 2001 if I’m not mistaken.

The problem is the way athletic commissions test most of it. This is how I ended up thinking that VADA would be a good idea. If you look online at the Association of Boxing Commissions, you can look at the regulations and the rules and requirements for licensure.  And if you look at it, you’ll see that there’s very few commissions that do any testing, drug testing, at all.  And even less conduct testing for performance-enhancing drugs, and that’s for a number of reasons.

Obviously, I always felt that when I was associated with the Association of Boxing Commissions that their commissions could push through whatever they really wanted, and to some degree that’s true. But there’s budgetary issues. A lot of commissions don’t feel they have the upper hand to require those kinds of tests, let alone more expensive test like MRI scans, expensive neurological tests, etc.  So a lot of commissions don’t do anything, and it’s only recently where probably more commissions than not do HIV and Hepatitis screens, so adding performance-enhancing drug testing is certainly down on the totem pole as far as getting that going.

So after I had left the Athletic Commission over the last several years, I was writing for The Ring magazine.  I had a column called The Fight Doctor.  And I started to look into this issue more and more and realized that not only in other athletic endeavors, but extensively in boxing and in MMA, performance-enhancing drugs were a strong issue, but nobody was really dealing with it to the extent that they needed to.  And the way testing goes on in most commissions is it’ll be right after a fight.  Even if they do include anabolic steroids, it might be at the weigh-in, or it might be before the fight.  What we used to do, because we had to collect so much urine for steroids in addition to just the regular drug screen, we used to have the athletes do the steroid screen before the fight and then do the other test after the fight just so we would have enough.

But the bottom line is, it’s really only during right around the fight, and obviously we’re missing the main time periods where athletes were abusing these substances – while they are in training, in preparation for a fight.  So ideally it would have been nice to do a traditional Olympic type program where 24/7, 365 days a year.  So I realized that there was a problem.  I realized it wasn’t being addressed.  It appeared that it wasn’t going to be addressed to the degree that it needed to, and one of my people said, “Well, if you really care about it, why don’t you just do it yourself?”  And lo and behold, that seems to be the right way to go, although I think I was extremely naive on how complicated it was, besides the aspect of the expense, that it’s just very complicated in setting up this type of program.

You mentioned it’s complicated. What kind of roadblocks have you met along the way inhibiting the widespread testing that you think needs to happen?

Well, number one, I didn’t perceive that it was going to be as complicated in putting together the actual policies that are necessary; protocols for the testing.  In speaking with Dr. Don Catlin – he’s considered the father of anti-doping – he was the one that set up the first anti-doping lab that was at UCLA and he’s an M.D.  He also is a scientist in all of this and understands the process probably as much as anyone in the world.

And so I had interviewed him and talked with him a long time before I even came up with the idea of putting together VADA, and so when I was doing an article for The Ring, I talked to him again.  And he made it really clear what I had to go through to really put together this.  And if you look at our website and you look at our policies and protocols and forms, you’ll see how complex it is.  And it certainly is in keeping with what’s used by the U.S. Anti-Doping Agency (USADA).  And in talking and putting together the program, what you need to do this type of program is you really have to do it to the ultimate.  Otherwise your program has no credibility and it’s not of as much value as you would want it to be.  So you couldn’t do it halfway.  At first I was like, “Well, okay.  Well, we’ll just start.  Hopefully, we’ll have fighters that want to demonstrate that they are in favor of clean sport and will allow us to do the testing.”

I didn’t understand that in order for it to be done the right way, you had to have the right protocols and procedures.  And so Dr. Catlin hooked me up with our attorney, Ryan Connolly, who’s just a great guy.  He understands all of the legal aspects and at the ground floor when they started the UCLA lab as well.  He comes from an anti-doping background and worked with Dr. Catlin for a number of years at UCLA and is just very, very knowledgeable.  And so helped us set up the right protocols and procedures.  So that took actually months and months to come up with.

The other roadblock, and it wasn’t really so much a roadblock, but because we were a small entity just starting out, we had to work with the appropriate types of groups that actually do the collection.  In athletic commissions, and the way it still is, for example in Nevada, and I’m pretty sure it’s the same way in California, is the inspectors. They are actually the individuals that oversee the fights while the fighters are wrapping their hands or getting their hands wrapped and gloving up and watching the fighters in the dressing room and staying with the fighters at ringside, they’re the ones that often end up collecting the actual specimens.

So what we needed, because this was obviously just like doing a traditional anti-doping program where you have to actually go to the fighter or where the athlete is, we had to have doping collection officers.  And those officers have to be extensively trained and certified.  And there’s only a few companies in the world that have these individuals or train them and have them under contract.  So it was tough finding those groups that would work with a new agency.  So we had to prove our worth.  In other words, have the right policies in place.  And the same thing went for the labs.  We wanted to work with WADA (World Anti-Doping Agency) accredited labs of which there are only a few in the world.

So you really have to demonstrate that you have a legitimate program that is free of conflicts of interest, that’s done extensively as it can be, because the worst case scenario if you have positive results or abnormal results, you want to be able to back those up to the extent to which you need to.  So it took months and months.  It took about eight months to really get this program set up the way it needed to be.  And obviously it’s a learning process, but I think we’re in keeping with any anti-doping program as far as having the most stringent protocols and features in places.

Who covers the cost for those collectors and for all the other things that are entailed in the testing?  Do the fighters pay for it or is it through your organization?

Well, it can be a done in a number of ways.  Practically, we’re a non-profit, so we survive on contributions and donations.  So it can be done that way.  And in some instances, for example, with BJ Penn and Rory MacDonald, that kind of instance, because we wanted to demonstrate what our program is all about and those athletes had volunteered to submit themselves to our testing, we’re covering the cost for it.VADA is based on donations.  However, athletes or promoters can pay to have their fighters tested, which can be either written off as a business expense or as a contribution.  The fighter themselves can pay for it.

Obviously, it’s a little bit different than the testing that’s now done in athletic commissions in that we include testing for human growth hormone (HGH), for erythropoietin (Epo).  We also do more extensive anabolic steroid testing that includes carbon isotope ratio testing.  So all of those things are more costly than you would have with an athletic commission typically.  But the main point, it wasn’t so much that we were trying to set up VADA as a testing program as much as it was supposed to be an educational program.  And so you’re looking into it, other media entities are looking into it, the fighters are looking into it.  It just opens up the discussion.  That was the whole point.  The bottom line was not to have fighters lining up around the block asking to be tested, that certainly wasn’t the point.  It was the educational aspect.

And there’s so much misinformation out there still.  You still hear the discussion of whether or not testosterone is an anabolic steroid, and that just shouldn’t be a part of the confusion out there.  This should be something that should be understood and known.

One thing I always said when I was a ring physician, and I always go back to this, I would talk to fighters at weigh-in and you try to, while you’re examining them, hear them talk and so you get an idea of where they are at during that point in time, so that when you’re working their fight, you know more about when there’s changes going on as far as neurological changes especially.  But I used to try to talk to them about substances and even simple things like why aspirin is dangerous to take before a fight.  And so you find that there was a lot of misinformation and lack of knowledge in simple things like that in understanding that it (aspirin) would make them bleed, or be harder to stop a cut.

So there were those kinds of entities.  And so that’s really the main point of what we’re really trying to do with VADA is be an educational resource for athletes to understand what’s safe for them to take, what’s not safe for them to take as well as what’s legal and what’s part of clean sport.  And it also was supposed to be a way for athletes to take control over their own career.

That was always something that always bothered me and continues to bother me a great deal in that they’re kind of at the behalf of either the networks or the promoters.  They themselves don’t have as much control over what they’re doing.  And this is a way for them to demonstrate that and also to maybe, I would like as time goes on, to be a resource for what you’re doing as far as educating athletes about safe ways to drop weight, safe ways to put on weight, safe dietary habits, fluid replacements, avoiding dehydration as well as substance abuse and also be a way for athletes that are abusing these substances to have someone to go to.

One thing that VADA has is we have a psychiatrist and a psychologist available that has a lot of experience in the fact that there’s almost (never) a day that doesn’t go by anymore where you’re seeing either an MMA fighter or boxer or somebody getting arrested, somebody having problems with drugs or psychiatric issues.  And there has to be someplace for these athletes to go and seek help.  And obviously, athletes in football or baseball have players’ unions.  They have somebody to contact.  But boxers and MMA athletes don’t have somebody specifically to contact.  So we want to be a resource for that as well.

Do you think mental health is something that’s not really addressed, that it’s kind of an unspoken issue in combat sports?

Oh, I think it’s a big problem.  Whether you want to chalk it off to – and this is something that I’d written about in The Ring before, you know, whether you want to chalk it off to head injury that are contributory to it, all you have to do is look at what’s going on in the NFL as far as the football players that are in litigation and the class action suits going on for injuries that they’ve sustained and for evidence of possibly chronic brain injury as a result of their sport.

You obviously see that in boxing, in MMA, but it’s also tandem with psychiatric issues: depression, violent outbursts, perhaps even bipolar disorder.  You see all these things going on and obviously in the general population there are problems. They get ignored, especially in athletes.  I’ve written about this too for The Ring. When it happens after someone loses the fight.  Nobody wants to talk about it.

I think too often after a bout people say, “Oh, the guy’s tired or who wouldn’t feel depressed,” but these things get pushed under the rug.  The athletes have to pretend like it doesn’t exist.  And then you combine that with athletes that have been using performance-enhancing agents, and then you’ve got depression, whether or not that’s related to the usage, whether it’s related to their career, whether it’s related to getting hit in the head, it is a big problem that gets ignored.  It should be treated sort of strongly as a broken hand, a tendon injury, a cut.  But it gets ignored and not talked about.

And when you see these athletes – I think there was a period of time where you had a few MMA athletes within a couple of years that had either been victims of silent acts that had resulted in their death or have taken their own life or substance abuse that have resulted in their death.  And it’s just so sad that it gets ignored.  But it certainly shouldn’t be.  And the more that you see these fighters fighting, the more injuries you see, the more problems that they’re having, they have to be recognized.

The UFC has this great insurance policy that they’ve started for athletes that have injuries.  I hope that it includes access to psychiatrists and psychologists for them.  I don’t know that if it does, but I would hope that it does.  But that would be a good question to find out.

Have you found that you’ve gotten some resistance by fighters or promoters or has VADA been received as a good idea?  Are they ambivalent?  What’s the feeling that you’ve gotten out there?

I think there’s the element of ambivalence.  I think just when you start anything new, there’s a strong element of fear as far as nobody wants anything in existence that’s gonna stop fights from happening.  It’s the same thing I faced when we started requiring MRI and MRA scans. It’s like, “Well, wait a minute.  Yeah, nobody wants to see anybody get hurt, but you guys may start finding things that are going to impede or stop a fight from taking place.”  So it’s the same kind of thing.  And obviously, that is an issue and I certainly understand that.  But unfortunately, performance-enhancing drugs are a part of the sport, on both sports, boxing and MMA, and need to be addressed.

And everyone likes to say that they want to protect the health and safety of the athletes, but it’s not an easy thing to do.  So yeah, I wouldn’t say we’ve had resistance so much as, number one, obviously there’s expense involved and the time commitment.  You have athletes, especially a lot of the MMA guys, that have participated in the Olympic programs and are used to being tested throughout the year, so it’s not as much of an unknown to them.  But it is a commitment.  You have to make yourself available.  You have to let our organization know your whereabouts at all time so that if you are called upon to be tested, you have to be available.  So there’s that entity.

I think that there is a strong element of fighters out there that want their opponents to be clean, they want to demonstrate that they’re clean, and I think that this is a way for them to do it.  And so we have had a lot of positive feedback.  I think if there’s any group that’s given us the greatest positive feedback has been the fighters themselves.

That’s good to hear.

Yeah, which is really cool.  I think that’s what you’d want.

Definitely.  You mentioned there’s the you, WADA and the USADA, how do you guys differ?  What’s the niche that you’re filling that they (WADA and USADA) may not be?

Oh, obviously we’re just geared towards boxing and mixed martial arts.  That’s one entity.  With USADA, typically the athletes that they’re testing are doing 365 days a year. We’re predominantly geared towards beginning our program for an athlete eight weeks before they have a competition, although we do have athletes that are willing to, and we have boxers that are, doing it for an entire year, which was certainly difficult to coordinate.  As for as the exact other aspects, I would say that as far as you look at the protocols that we have and our policies, they’re probably very similar.

How well have you interacted with the state commissions?  What interaction have you had with Nevada or with the other big state commissions like California or New   Jersey?

We haven’t had to interact with New Jersey, but, for example, when the Penn-MacDonald fight was to take place in Toronto, I had a really good interaction with Ken Hayashi who heads the Ontario Commission and they were very positive about us forwarding the results to them.  The Association of Boxing Commission has been very, very positive and has welcomed us forwarding the results. And really, what we try to do is to be as transparent as possible and keep everyone in the loop, so to speak, so that whether it’s a boxer or MMA fighter, we let the record keeper that’s appointed by the Association of Boxing Commissions know that fighters are in our programs and forward the results to them.  We’re a new program and we haven’t had huge numbers of athletes that we’ve been testing, but we’ve certainly made our program available to athletic commissions.  I hope to be able to do that even more soon as far as offering educational tools on supplements, etc.  But no, I’ve had really good response so far.  Haven’t had any issues.

How about the MMA organizations like the UFC, what kind of interactions have you had with them and why do you think they don’t adopt these independent testing services regularly?

I don’t know why.  You would have to ask them.  So far we’ve had very little interactions because we’ve really just had the first two years. But we’ve been in contact with them and will continue to keep them informed as far as the test results.

I’ve had really good contact with Bellator with Bjorn Rebney who really is very excited about our program, very positive.  I think that the only issue with Bellator would be for them to not adopt something like this is the cost.  Obviously they’re a newer entity, they’re just getting started and advancing themselves more and more.  So I think it probably wouldn’t be fair to expect them to be able to cover a program like this, but they’ve been very, very positive as far as anxious to even have us include their athletes in the VADA program.

That’s also good news. When Rory MacDonald pulled out of UFC 152, do you think that was a setback?  You guys already got your message out there, so was it really a setback?  What are your thoughts on him having to pull out?

Obviously, injuries happen.  I saw photos online of the cut; it was a really bad cut in a bad place.  Obviously you need extensive time off.  I think that probably fighting in December is probably the right thing, to give that enough time to heal because of the location.  Headgear can’t really protect  that type of injury that much.  So it’d be hard for him in terms of training.

One of my biggest pet peeves as a ring physician was that the time off for cuts to heal was often not long enough and fighters would get back in and training in the gym and have a fight scheduled way too soon.  And so not necessarily that cut would open up again, but an adjacent area would be predisposed to cutting and it just wasn’t really right.  So, I think that the time that they have, that they do reschedule it for December 8 is probably the right time for Rory.  And sometimes it can work positively or negatively.  I think it was enough before the scheduled fight that it probably will be a positive.  I think the hard part with fighters I’ve seen on multiple occasions is when their fight gets cancelled a few weeks before the fight, two weeks or a week before, something like that.  They spent all this time training and to go back and continue the training, especially if it doesn’t get postponed that much, they can be over-trained and then that can be an issue, but that’s probably not going be an issue here.

Everyone’s talking about testosterone replacement therapy now, or TRT. What are your thoughts on it?  Do you see it as a performance-enhancing drug?

Well, number one, it’s obviously a performance-enhancing drug.  I think that the sad thing is that it’s advertised on television and in the media, online, etc.  I think I was watching an Olympic event and the commercial was for Androgel.  And I think that’s just really, really sad because for athletes it makes it more difficult for them understand.  It’s like, “Wow, people are advertising.  Go get it.”  But the problem is is that a healthy athlete shouldn’t need it.  It’s definitely performance-enhancing.  It obviously has a whole host of side effects besides being cheating.

And it’s just something that’s just not – after all of the discussions that have taken place online and in newspapers and from a lot of the shows that cover MMA, it should be a known fact that whatever form it’s given in, whether it’s Androgel you get from a doctor, that it’s a performance-enhancing drug and is illegal and should not be necessary for essentially just about any fighter.  I think that for someone to get a TUE for it, it should be – I’m trying to think what would be the right way to put it.  I just think that it should almost never be necessary for a fighter needing a TUE for testosterone or an anabolic steroid.  I just think it’s just way overplayed at this point.

Some people point to the fact that there are some studies that show repeated head trauma can cause pituitary dysfunction and that may cause low testosterone.  There may be a loose connection with repeated weight loss also. Do you think these are all valid reasons or do you think these people are doing this to support their idea that they want to use it?

I just think that probably 99.99% percent of the reason why a fighter needs it is because they were using anabolic steroids before.  I think if somebody needs it because they damaged their pituitary that significantly that their hormones are inadequate, then they shouldn’t be fighting.  Then they obviously have had enough trauma in their head.  It demonstrates they shouldn’t be in a cage or a ring or anywhere near anything where they’d continue to take punishment to their head.  So I think the answer is right there.

So basically you’re saying that, if you’ve taken so many steroids or you’ve taken so much punishment that you need this therapy, that’s pretty much a red flag that you shouldn’t really be competing anymore.

Yeah, I think.  The point is that it takes a long time to come off of it, to get your level back to normal.  If somebody was using it as an anabolic steroid for performance enhancement, obviously coming off of it can take months and months till you get your hormone levels back to normal.  I’m not even sure exactly.  It can take a year before you normalize again and feel good again.

So my point being is that unfortunately, I’m not saying it would take a year to determine if somebody really needed it or not, I’m not an endocrinologist, I would certainly use an expert opinion to help me with this, but bottom line is that from what I’ve learned is that it takes an awfully long time off of this stuff to really get your levels back to normal.  So I would hope that the commissions that are granting Therapeutic Use Exemptions are taking enough time and looking at all the various hormones that are involved, just not the testosterone levels or T/E levels to determine whether or not somebody needs a TUE for testosterone or not.  I think that almost never is it indicated.

Do you think that there is enough endocrinologist (hormone doctor) representation out there?  Because it’s usually ringside physicians being involved and they’re usually the orthopedic guys or neurology guys or emergency docs, but I don’t think there’s a lot of endocrinologists really in this business.  Do you think we need to get more of them involved?

Well, that’s a good point because I was talking to someone from the Association of Boxing Commissions and I was saying that they really need to put together a committee of physicians including endocrinologists with experience in this to have a uniform standardized determination of when a TUE is indicated, if at all, for somebody that’s asking to use it.  I know that there are individual commissions, for example, New Jersey does a really good job in this.  But I think that it should be more uniform because this is a problem that it’s hard if one commission grants somebody a TUE, it’s hard for another commission to say that individual doesn’t deserve it.  And so there should be a standardized way, and, yes, I think it takes endocrinologists that are well-trained.

And according to Dr. Catlin, there are really only a few people in the world that really understand when a TUE is truly indicated for an athlete.  And that’s why so few are recommended through the World Anti-Doping Agency or probably USADA because there are too few individuals.

But because it has so many serious repercussions for the athletes themselves, I think that it behooves the Athletic Commission before they grant TUEs for testosterone to really seek out these individuals to form a committee.  But yeah, I agree with you, it really needs people with that type of expertise to make determinations, because otherwise these things are given and it starts this vicious cycle for this athlete for a substance that obviously can have great harm for them down the road.  It’s unfair to their opponent and probably, and more often than not, they shouldn’t have been given it in the first place.

What do you see as the biggest medical issue in MMA now and what could we as the medical community do to better address it?

I think being involved on these boards for so long, there’s so many different things.  I don’t think there’s one.  I think most ring physicians would tell you, the biggest problem is lack of standardization in testing, pre-fight recommended testing, post-fight evaluations, examinations that need to be done.  Obviously, performance-enhancing drugs are a big problem, but I think the biggest problem from a medical standpoint in MMA and boxing itself is just lack of standardization.  And this has always been the issue as long as I have even known about the regulatory aspect of these sports.  And I think if you talk to any athletic commission around the country, they’ll tell you the same thing, that that’s the biggest problem out there.  There’s just no standardization.

You go to one venue in one state or wherever, if it’s a tribal nation where you’re competing, there’s just no standardization.  And so you may need a general physical, you may just need an HIV or Hep screen.  You may not even need that in one of these states and then in the other state you need MRI scans and ophthalmologic exams and blood work and EKGs and chest x-rays and urine exams, and it’s just not right.  And it just creates an atmosphere where promoters and even fighters can commission shop depending on what they want to undergo or not undergo or perhaps even want to keep medical issues hidden or not found out.

That’s always been the biggest problem and that’s why so many people continue to say there needs to be some kind of federal oversight.  The one thing that isn’t understood is that even though MMA fights take place in many state commissions, MMA is not under any kind of federal law like boxing is.  And that’s a big problem.  It’s not discussed.  It’s ignored.  I know that most commissions would like to see it under federal law, but it’s never pushed by anyone specifically.  And I think it’s toward the detriment of the sport and it’s definitely to the detriment of the fighters.

Who would be in charge of that? How would you be able to create a national standardization?

A lot of people talk about having a federal boxing commission or a national boxing commission. The problem is there’s so many political aspects to it for people that are against it, even athletic commissions that are against it because everyone likes to have their own piece of the pie and have everything state controlled with no one telling them what to do.

There’s certainly a large subset of athletic commissions that would like MMA and boxing under some kind of federal commission because it would help them, it would give them more power, more juice to standardize things.  But then there’s the whole subset of prominent athletic commissions that don’t want these things more federally regulated and things taken out of their hands.  They’d like to be able to make their own decisions and worry about any kind of federal oversight.

So you need politicians that are willing to stand up and ask for that, and unfortunately, there’s so many other things on their plates, it just never happens.  And there’s so many lobbyist type groups that help these politicians that it just never gets pushed through.  That’s got its own hour of discussion.

Dr. Goodman raised many important points, many of which can be addressed through education. It is the goal of this website to bring together fighters, fans, and medical professionals to spread real information about medical MMA issues.

FightMedicine.net would like to thank Dr. Goodman for taking the time to talk to our site. She is truly a pioneer in ringside medicine and has the fighter’s best interest in her heart. You can read more about VADA at vada-testing.org.

You can also read more about what Testosterone Replacement Therapy really is here.

Jonathan Gelber, M.D. is licensed to practice medicine in the State of California

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FightMedicine.Net would also like to thank Sandra for her transcription services. She can be reached at sh.transcriptions@gmail.com

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