Tuff Twins always spawn in a pair consisting of 5 body segments and a head segment each. They are always fought in a double-sized room.
- The Tuff Twins roam around the room randomly, like Larry Jr.
- Normally invincible, but bombs and explosives can destroy their stony exteriors (after 15 damage per segment), making their segments vulnerable.
- Head segments spit Inks while protected by its rock armor.
- Vulnerable head segments, spits Suckers instead.
- Vulnerable body segments, spew bloody shots similar to Boils.
- When a flesh segment is killed it spews blood shots.
- Tuff Twin segments can be split into smaller copies of the boss as long as the new Tuff Twin segments are longer than 2 pieces.
- The Tuff Twins become faster the more rock armor they lose.
- Terra, along with any items that create rock waves like Mega Bean and Wait What? can destroy the Tuff Twins' armor.
- Neither Fire Mind explosions nor Sulfuric Acid tears can destroy their armor.
- Killing all the Bomb Grimaces with effects like Little Horn and Euthanasia can soft-lock Isaac in this fight.
- They appear to be a rocky variation of Larry Jr.
- The Shell appears to be the posthumous version of them.
- Tuff is the name of a type of rock formed from volcanic ash.
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