http://www.bloodyelbow.com/2013/3/1...some-ufc-fighters-that-he-feels-should-retire The constant fear of losing your job is a heavy cross to bear. The MMA landscape is precarious at best, and a bad performance leading to a loss can mean a pink slip. The result of such pressure can be seen in balls out performances like the one we saw with Matt Grice vs Dennis Bermudez, or in the ever increasing instances of testosterone use, whether it be under an exemption, or without, the latter being contraindicated in the rule set. With both of these examples, a question of safety comes into play. TRT can give an athlete an unfair edge, and is considered as cheating by most. Performances like the Grice / Bermudez bout, or more recently, the Silva / Stann bout, bring to mind issues of continuous head trauma sustained during fights which can lead to CTE. I recently conducted a long interview with Dr. Johnny Benjamin, a leading board certified orthopedic surgeon who also carries a specialty in spine surgery. He has worked with athletes for many years and is a Medical Advisory Panel member of the ABC. In addition to his professional credentials, Dr. Benjamin also actively campaigns for VADA in an effort to level the playing field for athletes. The first part of this interview was posted Saturday, where he opined about the safety of female athletes that might face transgender female fighter, Fallon Fox. That story can be found here. This final post is dedicated to his opinions on TRT and head injuries in MMA. Here's what he had to say: SD: What are your thoughts on the series of punches Stefan Struve ate that not only dislodged a tooth, but fractured his jaw? JB: When I saw it, I wasn't really surprised, because when I see a fighter get tired and start mouth breathing, trying to get as much air as possible into their lungs, I always think it's just a matter of time before they get their jaw broken. If you're not clenched down on that mouthpiece, you're very susceptible to what happened. We all know that Mark Hunt punches like a mule kicks, so it wasn't surprising at all, the outcome of that fight. SD: How long would you personally recommend that Struve stay away from combat activity, considering the severity of his injuries? JB: Many people think, and Stefan will probably think, 'The doctor said I'm good to go, so I'll get right back in the gym and go at it', but, even though we're great at healing bones, it's not so easy to heal the brain. How many times has he been knocked out? I know he's a young man, but he's been knocked out more than a few times. At some point, someone really needs to ask the question, should he still be fighting? That many concussions, so quickly, and at this young age ... a person has two types of age, chronological and physiologic age. Stefan's license may say he's 25, but in physiologic years, he's much, much older than that, with all the concussive force that he's sustained. I'm sure nobody will like to hear this, but Stefan Struve really needs to think about retiring. If it's not him that will make that decision, then Dana White needs to start talking to him about retiring. The question out there is how many sustained concussions is too many, and according to the latest literature that's coming out, the answer is starting to look like it's somewhere between two and three. That's where you start having permanent changes. Knowing that data, Stefan is definitely beyond that number (Stefan has been TKO / KO 5 times), and someone really needs to initiate serious discussion with either him or his promoter that he probably needs to do something else for a living. SD: We just watched Wanderlei Silva go for broke in his fight with Brian Stann and sustain several blows that put him on the canvas, yet he came back for the victory. What are your thoughts there? JB: Anybody who loves fighting, loves Wanderlei Silva. You just can't not like Wanderlei. It's impossible. Once again, if you like human beings, if you like people who can still remember where they put their car keys or the names of their kids, Then you should have hope that there's a life after fighting for Wandy, because he won't fight forever, and he won't live a long life if he continues doing what he's doing. The types of concussive force that he's sustained can also lead to depression, which can make it a pretty difficult life in the future. I've been saying it for a few years now, Wandy, I love you, but please stop. Please retire. SD: What about Brian Stann? He was knocked down, blasted hard several times, and eventually knocked out. Would that type punishment, for him or Wandy in that one fight, be enough to constitute multiple concussions? JB: You can absolutely receive multiple concussions in a single fight. That is one of the most dangerous instances. There's something called second impact syndrome, where after a concussion, you receive another one in a short time, and you can die from it. The thing about Brian Stann is that you have to wonder if he's received any concussions while he was in the military. Has he been involved in any blast situations with IEDs or things like that? Lots of data we're receiving now, regarding concussive force, is coming from soldiers. Just because you can come back from a big punch with concussive force like Cheick Kongo did in the Pat Barry fight, doesn't mean you should continue to fight. SD: What's your opinion of guys with very solid chins that can take enormous punches, seemingly without being phased? JB: The funny thing about that is, you have a solid chin until one day, you just don't. Chuck Liddell is a prime example. You could beat that man with a baseball bat, and he wasn't going anywhere. Then, all of the sudden, something changed, and he couldn't take it anymore. Over time, the punishment accumulates. It's not only in the fights. Think about all the training these fighters do. All those blows count also. If you want to look at a different sport, look at Roy Jones, Jr. Roy got clipped many times in his career, and he wasn't going anywhere, but after Antonio Tarver got him, Roy got knocked out several times since. Something changed. People like to say, 'Oh, he has a granite chin.' You have a granite chin until you don't anymore. SD: What do you think of the new PET (positive emission tomography) scan research regarding CTE and do you think use of it can be applied practically for combat sports? JB: Well, it's not widely available, and it's very expensive, so I don't see it being used for screening purposes, but what is exciting about it and where it can be useful, is that in the ongoing research, we can start to determine guidelines that say, 'After this many concussions, in this period of time, a certain amount of time needs to pass and tests need to be administered before a person can return to contact.' All this research that's coming out will hopefully allow us to set better guidelines on how much damage is too much, and what are the things we need to look for in a person that may be showing the effects of too many wars.