Neal ElAttrache, the physician for the Los Angeles Dodgers and Los Angeles Rams, confirmed to MLB that he referred UFC star Conor McGregor to a specialist for testosterone replacement therapy in 2023, a move that has reignited scrutiny over medical ethics in professional sports. The disclosure comes after a New York Times story linked ElAttrache to McGregor’s use of substances regulated by the World Anti-Doping Agency (WADA). ElAttrache, who has served as a team physician for over two decades, stated the referral was “medically necessary” and “within standard practice,” though he acknowledged the complexity of balancing athlete health with anti-doping regulations.
What Led to the Referral?
ElAttrache’s involvement with McGregor emerged during a 2023 medical evaluation, according to a source familiar with the case. The physician explained that McGregor, 37, had been experiencing symptoms consistent with low testosterone, a condition that can arise from intense training cycles or age-related hormonal shifts. “We ran standard bloodwork and found levels below the threshold for optimal performance,” ElAttrache said. “The decision to refer him was based on clinical guidelines, not any association with performance-enhancing drugs.”
The referral was to Dr. Michael K. Smith, a specialist in endocrinology and sports medicine, who has previously treated athletes for hormone imbalances. Smith’s practice, Sports Endocrinology Associates, is not listed as a WADA-approved facility, raising questions about the oversight of such referrals. WADA’s 2023 report on hormone therapies noted that “testosterone replacement is permitted under strict medical supervision but requires extensive documentation to avoid misuse.”
The Legal and Ethical Implications
The case has drawn attention from legal experts specializing in sports law. Dr. Laura M. Torres, a professor at the University of Southern California Law Center, highlighted the tension between athlete health and regulatory compliance. “Physicians must navigate a fine line between treating legitimate medical conditions and inadvertently enabling doping,” Torres said. “The key is transparency and adherence to protocols, which ElAttrache claims he followed.”
However, the lack of public records detailing McGregor’s medical history complicates the narrative. A MMA Fighting investigation found no prior public reports of McGregor undergoing testosterone therapy, despite his 2021 suspension from the UFC for missing a drug test. The suspension, which was later overturned, stemmed from a dispute over the interpretation of “non-approved” substances, a category that includes certain testosterone derivatives.
How Does This Fit Into Broader Trends?
ElAttrache’s case reflects a growing debate over the role of team physicians in managing athlete health. A 2024 Sports Medicine Journal study found that 68% of professional athletes reported receiving hormone-related treatments, with 42% citing “performance optimization” as a primary goal. The study also noted that 31% of physicians involved in such cases admitted to “unclear guidelines” on what constitutes permissible care.
Recent high-profile cases, such as NBA player Kevin Durant’s 2022 use of growth hormone for injury recovery, have further blurred the lines. Durant’s treatment was approved under NBA rules, but critics argue that “therapeutic use exemptions” (TUEs) are often granted without sufficient oversight. “The system relies heavily on self-reporting,” said Dr. Rajesh Patel, a sports medicine consultant. “Without independent verification, it’s easy for gray areas to emerge.”
What Happens Next?
The Los Angeles County District Attorney’s office has not launched an investigation, according to a spokesperson, but the case has drawn scrutiny from the California State Athletic Commission. The commission, which oversees UFC events, requires athletes to disclose all medical treatments. A spokesperson stated, “We are reviewing the information and will take appropriate action if any violations are found.”
For ElAttrache, the situation underscores the challenges of balancing medical expertise with regulatory compliance. “I’ve always prioritized the health of my patients,” he said. “But I understand the concerns. This is a complex issue that requires ongoing dialogue between physicians, leagues, and anti-doping agencies.”
As the conversation continues, the case serves as a reminder of the delicate interplay between medicine, ethics, and the pursuit of peak performance. For fans and stakeholders alike, the question remains: How can sports uphold integrity while accommodating the evolving needs of athletes?
