Nevada bans TRT exemptions

The Nevada State Athletic Commission (NSAC) announced on Feb 27 that it had unanimously approved a motion to ban therapeutic use exemptions (TUEs) for testosterone replacement therapy (TRT) in Nevada, effective immediately. The ban includes the sports of boxing, kickboxing, and mixed martial arts and covers all future and past applicants of TRT exemptions in these sports.

The ban was passed after ESPN’s Outside the Lines featured an article on Feb 25 comparing the high rate of TRT exemptions in mixed martial arts relative to other sports. Also, the Association for Ringside Physicians released a consensus statement on TRT exemptions on Jan 27 supporting the general elimination of these exemptions in combat sports.

Hours after the ban, Vitor Belfort withdrew from his title fight against UFC Middleweight champion Chris Weidman. The bout was scheduled to take place at UFC 173 in Las Vegas on May 24. Belfort’s likely application for a TRT exemption for the fight had become a controversial issue, as there were many in mixed martial arts who felt he should not be granted approval considering his past failure for 4-Hydroxytestosterone, a PED (performance enhancing drug), in Nevada after a Pride fight in Las Vegas on Oct 21, 2006. Belfort has been undergoing TRT since 2011.

The bout was announced a few weeks after Keith Kizer stepped down as NSAC Executive Director. Kizer was an outspoken opponent of TRT exemptions.

Belfort has been replaced by Lyoto Machida, who is coming off a win over Gegard Mousasi at Fight Night 36 on Feb 15. UFC announced the new fight on the Feb 27 edition of Fox Sports Live.

“I’m really excited for this opportunity to fight UFC middleweight champion Chris Weidman,” Machida said in a statement. “I’m going to train hard and be well prepared for this fight.”

On Feb 28, however, Belfort released a statement on his Facebook page claiming that he did not withdraw from the fight, but that UFC forced him out.

“I never gave up on UFC 173 fight and never said that. Any information about it in the media is not true,” Belfort wrote on Facebook. “What I said was that I’ll ‘quit on TRT’, and not ‘quit on the fight’, to continue my dream to fight.”

Belfort said that he needed more time to prepare for the fight with Weidman, and that he expects to face the winner of Weidman-Machida. “The UFC has decided to put another opponent in my place because of the fact that I won’t have time to suit NSAC’s new rules,” Belfort said. “According to the UFC, I will fight the winner of Weidman vs. Lyoto under the athletic commission new rules.”

Belfort’s attorney Neal Tabachnick reiterated Belfort’s story with “The reason for Zuffa replacing Vitor with Lyoto for the May 2014 middleweight championship bout was because of the Commission’s change in direction on TRT/TUE yesterday,” Tabachnick said. “Zuffa felt that with this change at the Commission, there is no time for Vitor to drop his TRT program, secure a license for a May 2014 bout, and leave Zuffa with time to properly promote the bout.”

UFC released an official statement concerning the status of the Weidman title fight, and Belfort’s future in the UFC. “Belfort, who has previously been granted therapeutic use exemptions, recognizes that he needs an extended period of time to become licensed in the state of Nevada,” UFC wrote. “With [UFC 173] scheduled to go on sale shortly, Belfort agreed to withdraw from the fight in order to allow the UFC’s promotional efforts to move forward on time.”

The NSAC administered a voluntary, out-of-competition drug test on Belfort while he was at an MMA awards show in Las Vegas on Feb 7. The NSAC has the results of the test, but are disallowed from revealing them to the public. Belfort is not currently licensed to fight in Nevada and has not provided the NSAC with permission to release the test results. And he doesn’t have to. The test was administered to “facilitate its due diligence since the commission was aware that Belfort would soon be applying for a license to fight Chris Weidman in Las Vegas in May,” according to NSAC Chairman Francisco Aguilar while speaking to MMA Weekly.

“The test is not relevant as Vitor is not applying for a license to fight in Nevada at this time,” said Tabachnick.

The ban on TRT exemptions includes both new applicants for TUEs and fighters who have received TUEs from the NSAC in the past. NSAC Commissioner Skip Avansino proposed the motion after a discussion among the NSAC’s Commissioners about the possibility of a statewide ban occurring. Avansino’s motion was seconded by Commissioner Pat Ludvall. Avansino argued that the NSAC did not have the resources to effectively monitor exemptions. Avansino and Lundvall also stated that the NSAC has no obligation to honour exemptions issued by other states.

“I’m comfortable with the information we have before us, and I would welcome and encourage the ABC (Association of Boxing Commissions) to look at this issue for all commissions in all states across the country,” said Francisco Aguilar, Chairman of the Commission. “I think it’s important that there be a standard set, and I think we’re not afraid of making that standard known, and then following the discussion after this point in time.”

“I do believe that this is something that gives people an unfair advantage for these actual benefits,” continued Aguilar. “And I think that it’s unfair for those fighters who are lucky enough to not have to go through the process. It’s not fair to them when they have to meet a competitor who is, somehow, could be [using] an advantage.”

“Over the last six months, we have been able to learn and understand more about this issue and we were able to ask questions and gain insights into what this is. With a full grasp of the issue and that knowledge we gained, we were able to make the decision to end [handing out TUEs] effective immediately.”

“I know in granting TUEs for TRT in the past, it caused me a great burden because there is always a person there fighting on the other side who isn’t asking for anything, who is going to be tested, who is going to be tested randomly, and is clean,” said NSAC Chairman Bill Brady. “So I think we have an obligation to the fighter who doesn’t want an exemption and is clean; an obligation to them to make sure they’re getting an honest and fair fight. So if this takes away that judgment that I have never liked, that I’ve been uncomfortable when I’ve been involved in it, then I think this is an appropriate motion and one that I support.”

“In my medical opinion, and this is my opinion, I would assume that if someone has tested positive for performance enhancing drugs, or is known to have used performance enhancing drugs, I would assume that’s the cause of their low testosterone,” argued Dr. Timothy Trainor, a consulting physician for the NSAC.

Trainor estimates that less than 1% of the general population is affected by primary hypogonadism, the most common reason why fighters apply for TRT exemptions. Past steroid abuse can replicate primary hypogonadism.

Marquee fighters that have received TUEs for TRT by athletic commission in the US include Vitor Belfort, Dan Henderson, Chael Sonnen, Frank Mir, Forrest Griffin, Quinton Jackson, and Antonio Silva, among others. Henderson, Mir, Griffin, Sonnen, as well as Shane Roller and Todd Duffee are six fighters that have received exemptions for TRT in Nevada specifically.

The UFC subsequently released a statement supporting the NSAC’s decision and announced that it would also ban TRT exemptions:

“The Ultimate Fighting Championship fully supports the decision made today by the Nevada State Athletic Commission regarding the immediate termination of therapeutic use exemptions (TUE) for testosterone replacement therapy (TRT),” said UFC President Dana White. “We believe our athletes should compete based on their natural abilities and on an even playing field. We also intend to honor this ruling in international markets where, due to a lack of governing bodies, the UFC oversees regulatory efforts for our live events. We encourage all athletic commissions to adopt this ruling.”

White told after the ban was issued that UFC will disallow TRT exemptions on international shows where the UFC acts as its own regulatory body and conducts its own testing.

“We follow Nevada,” White said.

White had also appeared on BT Sport a few days prior to Nevada’s ban, where he discussed the issue of TRT exemptions. “When you really break it down and look at it. It’s science. As you get older, your testosterone starts to get older and science has figured out a way to get it back up to even,” said White. “But, like in all things, when money is involved, people will find ways to cheat. Even though this thing is legal, people have figured out how to cheat on it, so it has to go away.”

White continued, “What it is, it ruins good fighters. Once you get on this stuff, or any type of steroid, you can’t get off it. You have to continue to use it because once you start using it, your body stops producing it like it did before, so, it’s definitely not good for you. It’s made for 45, 60-year old men. That’s what it’s meant for. It’s not meant for young well conditioned athletes.”

White, as well as the UFC itself, has had an inconsistent position on the usage of TRT exemptions in the sport. Belfort claims that it was a UFC doctor that started his TRT therapy in 2011. Quinton Jackson made a similar claim in 2012, according to ESPN.

Other athletic commission’s may follow Nevada’s lead. The UFC is obligated to follow suit when it comes to the decisions made by other athletic commissions. Should another athletic commission allow (or continue to allow) TRT exemptions, UFC would have to follow the commission’s guidelines.

On Feb 28 the CABMMA, Brazil’s national athletic commission, announced they would no longer issue TUEs for TRTs.

“We discussed this subject for a long time here at CABMMA,” CABMMA’s medical director Dr. Marcio Tannure told SporTV News. “As we use Nevada’s athletic commission as a model, we decided to make the same decision here in Brazil and no longer grant TRT exemptions for any fighter.”

Dan Henderson, who is scheduled to fight Mauricio “Shogun” Rua in Natal on Mar 23, has applied and received approval for a TUE for TRTs in Brazil. He is exempt from the CABMMA’s ban because he submitted his application before the ruling take place. He will be the last fighter granted a TRT exemption in Brazil.

“Dan Henderson already requested the exemption, but I don’t know yet if he’ll be granted. I believe that Dan Henderson will get an exemption for this fight.,” Dr. Tannure said.

Dr. Tannure was originally hesitant about CABMMA’s position on banning TRT exceptions when the NSAC’s band was announced. “We already debate this subject for a long time here in Brazil. Is a controversial subject, but it’s on the rule,” Tannure said just a day before CABMMA announced their own ban. “We may change our dealing or not. We haven’t made a decision about it yet.”

The Association for Boxing Commissions (ABC) will be asking their medical and legal committees for opinions on the NSAC’s ban, but is recommending that member commissions follow current protocols for TRT exemptions.

“I will ask the medical committee to consider and review Nevada’s new position on the matter which is a strong deviation from their past practice,” ABC President Tim Lueckenhoff said in a statement to “I will also ask our legal committee to counsel us about the legal ramifications, if any, from an outright ban without exception for any reason.”

Andy Foster, the Executive Director of the California State Athletic Commission (CSAC), said that California would maintain its current policies regarding TRT exemptions. New Jersey State Athletic Control Board (NJSACB) Director Nick Lembo told MMA Fighting that New Jersey would review the NSAC’s decision, but won’t make any immediate changes to their policies on TRT exemptions.

In June 2013, the CSAC put TRT exemptions for new applicants on hold until they could update their bylaws making exemptions more difficult to acquire. The CSAC, however, did not plan on rejecting an application for a TUE for TRTs for fighters who have been previously granted an exemption in California.

New Jersey released a media statement following the NSAC’s ban:

“Since January 1, 2008, NJ has had 4,930 MMA contestants compete in agency regulated bouts.

The New Jersey State Athletic Control Board has only granted one initial TRT therapeutic use exemption of those 4,930 MMA contestants. That one exemption was subsequently revoked when that individual failed an agency required random monitoring test several months subsequent to his NJ bout contest date.

The NJSACB has also honored exemptions to two of the 4,930 MMA contestants based on exemptions originally granted in multiple other jurisdictions and after additional testing and board certified endocrinologist documentation was supplied.

The NJSACB has refused TRT exemptions to over a dozen applicant contestants.

In addition, the NJSACB has never granted a TUE for TRT to any of the multitude of professional boxers, Thai fighters or kick boxers subject to its purview.

At this juncture, the NJSACB will continue to adhere to the very strict International Olympic Committee therapeutic use exemption standards.”

Coherency in policy among the various state athletic commissions on the issue of TRT exemptions is important because the UFC is obligated to follow the laws of any state it holds events in. That means, while UFC’s official company policy may now be against TRT exemptions and they will not grant TRT exemptions for international UFC shows where they act as their own regulatory body, the UFC must honour the laws concerning TRT exemptions in states like New Jersey, California, and elsewhere. So, if New Jersey says they are permitting TRT exemptions, then UFC fighters can possibly receive TRT exemptions if fighting in New Jersey. Likewise with California, or any other state that choose to allow or to continue to allow TRT exemptions.

If the UFC is truly serious about the end of TRT exemptions for UFC fighters, they can get around states that permit TRT exemptions by simply not booking fighters likely to ask for TRT exemptions in these states. That isn’t foolproof, as the company couldn’t know who may or may not ask for a TRT exemption in the future, but fighters such as Belfort, Sonnen, and Dan Henderson, among others, can simply not be booked in states where the athletic commission would grant them a TUE for TRTs.

UFC hasn’t pulled Henderson from his Mar 23 fight against Mauricio Rua in Brazil, even though Henderson has applied for and will (or already has) likely be granted a TUE for TRT use. At this point, days removed from the ban by both the NSAC and the CABMMA, it would seem unlikely that UFC would pull Henderson from the fight. There has been no indication the promotion has even considered pulling Henderson, even though allowing him to fight would be inconsistent with the company’s stance against TRT exemptions.

The problem with allowing Henderson to fight while receive a TUE for TRTs is that if the UFC truly believes it is a form of cheating, then they are allowing a fighter to cheat after company policy has been set against the use of TRT exemptions. Many people have always seen TRT exemptions as a legalized form of cheating, but it is particularly egregious to allow someone to fight while receiving a TRT exemption after company policy has come out against exemptions.

That Henderson is booked on a show governed by an outside athletic commission allows the UFC to save face because they can simply say that they must acknowledge the decision of the governing athletic commission (which is true). But an interesting question to ask is what would the UFC do about Henderson if he was instead booked to fight on an international show where the UFC was its own regulatory body? Would they announce support for the NSAC’s ban of TRT exemptions, and then announce that, due to short notice, they will permit Henderson a TRT exemption for one more fight? UFC effectively pulled Belfort from his fight with Weidman in Nevada. A consistent company policy would have UFC do the same with Henderson in Brazil.

Reactions to the ban ran from supportive, to recalcitrant, to plain bizarre.

Chris Weidman was supportive of the NSAC’s decision. “This is an amazing day for the sport,” Weidman told MMA Fighting. “This is something that I’ve wanted to see happen for quite some time. TRT was and has always been cheating, and I’m glad Nevada finally recognized that, especially since I’m about to fight there against a known TRT user. Hopefully, every other athletic commission follows because this was long overdue. If you need TRT to fight, you shouldn’t fight. Period.”

“Very happy to see TRT banned, absolutely a ridiculous idea to start with and a major factor of my personal retirement from fighting,” wrote former UFC fighter and current colour commentator Brian Stann on Twitter.

Others that issues support on Twitter for the NSAC’s ruling included long-time UFC referee John McCarthy, colour commentator Kenny Florian, and fighters Isaac Vallie-Flagg, Stefan Struve, Josh Barnett, Tim Kennedy, Cody Gibson, Ulysses Gomez, and Jimi Manuwa, among others. Georges St-Pierre told media in Montreal that he supported the NSAC’s decision, but that there should be drug testing by an organization that does not make any money from mixed martial arts events (the NSAC collects a tax, which is what St-Pierre might have been referring to).

Michael Bisping told MMA Junkie that Vitor Belfort specifically will find another way of cheating, but was supportive of the NSAC’s ban.

“It’s nice to know they’re being branded the cheats they have always been,” Bisping said. “They’ve been chemically enhancing their bodies for quite some time, and I always took a hard stance against it. Fortunately, the UFC and the Nevada athletic commission are branding it for what it is; it’s an unfair advantage and whole thing is just a mockery to the whole concept of sport and fair competition.”

Some were not so supportive of the NSAC’s decision. Alex Davis, manager of Antonio Silva among many other fighters, told MMA Fighting that he was against the decision.

“I think it’s wrong because many people need it for medical reasons,” said Davis. “If you have low testosterone, you need it. They shouldn’t ban it. Some people abuse testosterone in many cases, but I don’t think that banning TRT will change it because there are other ways to cheat the drug tests.

“That’s not the solution. We need better testing. There are a lot of PEDs that we don’t even know yet, but people are using it.

“The only athlete I manage that is on TRT is ‘Bigfoot,’ and it’s proven clinically that he needs it,” continued Davis. “He’s not cheating or anything like that. If you have low testosterone, you should have the right to use it to get your testosterone to normal levels.” Silva tested positive for elevated testosterone by the UFC after his fight with Mark Hunt in Australia in December, his second positive test for PEDs.

And in the bizarre category, former UFC fighter Matt Riddle made a few headlines when he claimed that Dana White is bald, insecure, and taking TRT himself.

“Honestly, [White] just can’t help himself,” said Riddle. “Unfortunately, we have a very insecure, bald man who uses TRT as the President of the UFC. When he sees a dude like me, who is 28 and all I do is rip tubes and kick ass, maybe some part of him doesn’t like me. I don’t know why, I’ve never been mean to him.”

The average thirty-year-old man has a total testosterone level between 300ng/dL and 1100ng/dL. In New Jersey, for instance, a fighter with a TRT exemption cannot test above 700ng/dL, or it is considered a failure.

If a man supplements his own hormone levels with an external source of testosterone, it prevents his own natural ability to produce testosterone. Depending on dosage, duration, and preparation type, the usage of an external source of testosterone can cause a man to become dependent on testosterone replacement therapy in order to be healthy. Thus, if a fighter uses enough PEDs for a long enough time, they become dependent on them not to raise their testosterone above healthy levels, but simply to keep testosterone at healthy levels.

ESPN’s Outside the Lines found that the average age when an MMA fighter is granted a TRT exemption is 32. The youngest was 24.

PEDs increase musculature, strength, and aggressiveness. Post-workout recovery is also faster. Cardio may decline, because PEDs cause the musculature to become so massive that more blood is required to be pumped by the heart, putting a strain on the heart and other vital organs. High blood pressure and increased tendon tears are also complications caused by PED usage.

Psychological addiction is also common, meaning fighters believe they need PEDs to compete and can’t be competitive without them, as are mood swings. Any doctor can prescribe PEDs, but board certified endocrinologists are the most common types of doctors sought out by fighters looking for TRT exemptions.

The PED tests conducted by the NSAC only look at the testosterone-to-epitestosterone ratio. They are easy to beat if a fighter uses PEDs throughout training and knows when to taper off.

Nevada’s ban on TRT exemptions was passed only a few days after ESPN’s web site published a stunning report on the number of TRT users in mixed martial arts. The ESPN report, by journalist Mike Fish, found that regulatory bodies for other sports rarely, if ever, gave out exemptions for TRT.

For example, the International Olympic Committee did not issue a single TRT exemption at the 2012 Olympics, despite featuring 5,892 male athletes. The US Anti-Doping Agency issued only one TRT exemption in 2013 among its thousands of athletes. MLB has issued only six over the past six seasons, despite an average of 1,200 players being on MLB rosters each season. The NFL claims TRT exemptions are rare. And no boxer has ever been issued a TRT exemption by a state athletic commission. The NSAC has never even received an application for a TRT exemption from a boxer, which is astounding when one considers boxing a cousin sport of mixed martial arts, with similar physical and psychological demands.

In the past five years, at least fifteen mixed martial artists have been issued TRT exemptions.

According to ESPN, many states don’t test for PEDs. For states that do they are confined to post-fight testing, with Nevada believed to be the only state that attempts out-of-competition testing. Little is known about UFC’s testing for their own international events. In comparison, the NFL and the MLB conduct year-round, random testing.

Hypogonadism is believed to be common in less than 0.1% of the male population of thirty-year-olds. And many anti-doping agencies do not believe that low-normal levels of a hormone such as testosterone is enough to warrant a TRT exemption anyway.

The ESPN piece also set about to debunk the theory that hypogonadism among mixed martial artists is more common than in the general population because of head trauma caused by participating in the sport, as opposed to the abuse of PEDs.

“Quite frankly, [Belfort] has hypogonadism,” said Dr. John Pierce, medical director of the Ageless Forever clinic in Las Vegas, who has treated Belfort. “Now why is that caused? I don’t know. More than likely it is secondary to repetitive head trauma over the years.”  Dr. Pierce also makes the same claim about head trauma being the cause of low testosterone in former UFC Heavyweight champion Frank Mir.

The argument is that repeated head trauma causes damage to the hypothalamus or pituitary gland in the brain, which harms the release of natural testosterone in the body. Most instances where this is the case have been caused by extreme injury, including cerebral hemorrhage. It would also cause multiple hormones to be affected, not just testosterone.

ESPN interviewed four endocrinologists and neuropathologists who said that they were “unaware of any controlled studies in which it had been shown head trauma in an athlete had shut down hormone production.”

Even if one were to be generous to Dr. Pierce’s arguments about head trauma being the cause of hypgonadism among mixed martial arts and assume that he is correct, then that in itself is a good argument as to way a fighter who required TRT due to hypogonadism caused by head trauma should be disallowed from fighting. If someone has taken so many blows to the head that their brain cannot produce enough testosterone to live a healthy life, then that fighter should not be licensed to fight.

Alternatively, if Dr. Pierce is incorrect and hypogonadism among mixed martial artists is caused by prior abuse of PEDs, then those fighters that require TRT should still be disallowed from fighting because it is giving them a permission slip to make-up for past instances of cheating. Fighters who require TRT because of PED abuse are using it simply as an escape plan for physical damage they have incurred from cheating in the first place. This ought to be disallowed in mixed martial arts. Thus, whether caused by the specific circumstances of head trauma or by PED abuse, TRT exemptions for hypogonadism should be disallowed for mixed martial artists.

“What people have to understand is a [testosterone exemption] is granted for a disease, not for a [low] lab value,”  Dr. Richard Auchus, a consultant to USADA and leading endocrinologist at the University of Michigan, told ESPN. “If you say idiopathic hypogonadotropic hypogonadism, meaning ‘I don’t know why you have it, but you have low testosterone production and there is nothing wrong with your testes’ — well, that can happen because you are taking exogenous androgen [steroids]. That doesn’t cut it.”

“Most notably, we must bear in mind that the blanket elimination of TUEs alone will not mean that PED usage and abuse will be reduced in these combat sports,” Dr. Sherry Wulkan, lead ringside physician for the New Jersey State Athletic Control Board and the Association of Boxing Commissions, said in response to the Association of Ringside Physicians (ARP) call for a ban on TRT exemptions, released in January.

Shortly after the ARP’s statement was released, Dr. Wulkan released a statement:

“In my opinion, the determination as to whether athletes requiring replacement therapy should be allowed to compete is an administrative decision for the athletic Commissioners and Executive Directors,”  Wulkan said.

“The determination as to whether or not a patient currently requires a given therapeutic intervention is a medical decision. It is incumbent upon physicians to treat patients, (provided the appropriate work-up and documentation has been done), to help assure their best quality of life. The ABC medical committee, which I serve as Co-Chair with Dr. Wayne Lee, in 2011, published strict requirements to determine whether, in fact, a TUE for TRT should be granted. We had already established guidelines which fully addressed the concerns now raised in the ARP’s press release. ‘Steroid use’ and ‘unmerited testosterone’ have never been supported or encouraged by any combat sports physician or athletic commission of which I am aware. However, some athletic commissions have been lax in their drug testing for PEDs for all athletes.”

Wulkan went on to describe the procedure for a fighter to receive a TRT exemption in New Jersey:

“In New Jersey, it is a very onerous procedure to be considered for the grant of a TUE for TRT.

“The procedures in New Jersey, are as follows:

A letter from a Board Certified Endocrinologist stating that the athlete stopped all hormone replacement therapy for a minimum of 8 weeks prior to repeat testing. The letter should include copies of medical records that address the following issues:

If the athlete has been on testosterone (T) therapy already, then the combatant should cease using testosterone therapy for at least two months, preferably three, before measuring baseline T

Measurements must be made using an accurate method such as calculated free testosterone by equilibrium dialysis

Results should demonstrate T levels consistently below the low normal value for the reference laboratory

The obtained values must be interpreted by a Board Certified Endocrinologist in this case.

Provide LH and FSH values measured at the same time as T above. In this case, the obtained values must be interpreted by an endocrinologist.

Provide results from stimulation of the gonadal axis by hCG as applicable

Provide confirmation that the athlete does not have any short term illness or other condition that would influence testosterone production at the time of evaluation, and that the athlete is NOT on any medication that may affect T levels such as narcotics or corticosteroids, or androgen replacement therapy.

Provide a detailed treatment plan including how systemic T levels will be monitored to ensure maintenance of therapeutic levels. The dosage must be decided by an endocrinologist in this case.

The intervals between assessments of therapeutic maintenance levels must be so stated and the results of at least two therapeutic levels submitted by an endocrinologist in this case.

The athlete is subject to at least three separate drug tests

Wulkan continued: “The athlete is subject to at least three separate drug tests prior and immediately thereafter the fight date, the timing and type of which is to be determined by this agency. Samples of blood, urine and/or hair may be taken one month, two weeks, and immediately post competition in an attempt to ensure competitive equity.”

Wulkan was also critical of the position adopted by the ARP. “Without a Commission’s adherence to the above ABC medical committee and NJSACB adopted procedures and requirements, the ARP’s position may seem the easier and more rudimentary solution for all involved,” wrote Wulkan.

Dr. Wulkan continued by saying, “The glaring and overlooked concern regardless of the ABC medical committee TUE requirements or the ARP’s recommended ban, is the fact that the large majority of athletes using performance enhancing drugs are not, in fact, subject to ANY testing because measurements of PED are minimal or non-existent in many jurisdictions.

“It might have been more prudent for the ARP to endorse the concept of regular and stringent drug testing for PED’s via hair, blood and urine by all athletic commissions.

“The ARP may have placed the cart before the horse by cracking down on TUE applicants who freely and voluntarily come forward seeking medical clearance at a time when commissions are still granting TUEs, while ignoring the fact that those who are not forthcoming are either not tested or are tested in a fashion that is not designed to catch PED usage, or testing that it fraught with obvious and glaring weaknesses.

Random testing and blood testing ought to be widely  implemented next. Dr. Wulkan is correct in saying a more prudent course than the banning of TRTs is the endorsement of regular and stringent hair, blood, and urine tests, and more thorough testing using carbon isotope ratio tests, the latter of which examines the atomic make-up of testosterone in the urine to determine if it is natural or synthetic. Although the PED issue will never disappear, it can be contained if all athletic commissions adopt such regular and stringent testing.

One problem is budget. Nevada does not have the money to implement costly testing. The NSAC’s annual budget falls somewhere below $400,000, which is miniscule. As an example of how much testing costs, the cost to randomly test Manny Pacquiao and Timothy Bradly for their Apr 12 fight in Las Vegas is about $35,000. Top Rank Promotions has agreed to pay for that testing. And many other state commissions do not even have the budget afford to the NSAC.

One entity that does have the budget to conduct expensive, stringent testing is the UFC. The UFC claims to be against PED usage. If that’s the case, the UFC should implement the stringent testing described by Dr. Wulkan. The UFC can conduct its own hair, blood, and urine tests using the best medical technology available. They can do so for all of their fighters at all of their events, and they can do so randomly during training camps and after fights. They won’t catch everyone, but they can put a lid on PED usage in the UFC. They still have to adhere to commission bylaws, but they can supplement those bylaws with their own in-house rules.

There are other problems. Belfort’s position on TRT usage after the NSAC itself is strange. He desires to continue to fight in the UFC, and plans to stop taking TRT in order to get a license to fight in states that now disallow it, including his home country of Brazil where Belfort is a substantial drawing card. But if he can continue to compete without TRT, why was he granted an exception in the first place? It would seem to indicate that Belfort’s TUE for TRT was superfluous.

The most logical explanation for Belfort’s continued desire to fight is that he will simply cheat in order to maintain his testosterone levels. If Belfort, as well as other TRT users, chooses that route, then the NSAC’s ban on TRT will simply have made it so that fighters who were undergoing additional testing are now undergoing less testing (or no testing at all), and being tested in a way that makes it easy for them to beat the test, yet continue to use PEDs.

Nevada’s ban of TRT exemptions is a step in the right direction for mixed martial arts, though. It is clear that TRT exemptions were being handed out to fighters by some states with impunity and it is clear that many of these fighters probably should not have received these exemptions. It is a positive that ease of access to TRT exemptions for those who have tested positive for illegal PEDs has been curbed. But the UFC, ARP, and Nevada’s policies on PEDs appear to be tougher than what they actually are.

A total ban on TRT exemptions also excludes fighters who legitimately need TRT, as few and as far between as those instances are. However, considering how so few athletes in other sports, including none in boxing, request TRT exemptions, the benefit of a blanket policy banning TRT exemptions outweighs the negatives to fighters who require TRT for reasons other than past abuse of PEDs. There are so few circumstances where a fighter legitimately needs TRT, and in the circumstances where a fighter requires TRT, it’s questionable whether this person should be competing in mixed martial arts in the first place. A person who has a testosterone disorder so severe that they require TRT probably shouldn’t be competing in a sport so physically demanding as mixed martial arts.

Many will argue that athletes in other physically demanding sports have received TRT for legitimate reasons and compete at a high level in this sports. That’s true. But no other sport has developed the problems with TRT exemptions that mixed martial arts has, making the sport of MMA a unique case when it comes to TRT exemptions.

Yet, the best policy for any athletic commission would not be to ban all TRT exemptions regardless of the reason why a fighter submits an application for an exemption, but to develop more stringent bylaws about who receives TRT exemptions and who does not. A cynical view of Nevada’s ban would posit that it was done so simply because Nevada was having a difficult time controlling the issue, and that the most inexpensive way of handling it would be to ban TRT exemptions altogether, so that the state saves the money it spends on thoroughly testing fighters who receive TRT exemptions. There is some degree of truth here, but the full picture is more complex.

Nevada’s stance does present a false dichotomy, though. It seems that the choice is between allowing no TRT exemptions, even for those who need them for legitimate medical reasons, and allowing TRT exemptions even for fighters who are abusing the rule to legally cheat to give themselves a competitive edge. Between those two options, the better choice is to ban TRT exemptions for everyone. But that isn’t the choice at all. Even if state athletic commissions cannot afford more stringent PED testing, the UFC certainly can. By feigning support for the NSAC’s decision to ban TRT exemptions, UFC avoids the obvious question as to why they don’t implement more stringent in-house rules themselves.

There are cases such as Antonio “Bigfoot” Silva, who receives TRT for acromegaly, a legitimate medical reason to apply for an exemption. The problem is that Silva has failed two PED tests. He tested positive for Boldenone after defeating Justin Eilers on an EliteXC show in California on Jul 26, 2008. He was fined $2,500 and suspended one year by the state. According to Davis, Silva’s manager, the positive test was caused by Novedex, a testosterone-booster used to help raise Silva’s naturally low testosterone levels.

Silva subsequently failed a second PED test in December 2013, after fighting to a vicious draw with Mark Hunt on Dec 7 in Australia. Silva tested positive for elevated testosterone and was suspended nine months. UFC conducted the test. Silva also forfeited his win money and his Fight of the Night $50,000 bonus cheque.

Silva presents a unique case because he is a man who requires TRT due to a disease that causes him not to be able to produce enough testosterone naturally. His claims that his two failures were somehow related to his acromegaly did not sway either the state of California or the UFC, though, and both of these groups suspended and fined him anyway. If Silva has a legitimate medical need for TRT, but choose to use that need as a means to try and cheat, then he probably should not be granted a TRT exemption even in a state that allows TRT exemptions for those who medically need them. If Silva had never been caught cheating and required a TRT exemption for his acromegaly, then he probably should be granted one and a blanket policy banning all TRT exemptions would be unfair.

Nevertheless, the banning of TRT exemptions by Nevada and Brazil are the beginning of the battle, not the end. If pro wrestling’s history with steroids is any indication, the end may not be a pleasant place.

Jeremy Wall

Jeremy Wall has been covering combat sports since 2002. He is the author of UFC's Ultimate Warriors: The Top 10, released in 2005. From 2004 through 2006 he was the lead reporter for MaxFighting. After stepping away from MMA for a few years, he returned in 2013, launching the combat sports industry blog Jeremy holds an Honors Bachelor of Arts from Western University and attended law school at Dalhousie University. He also holds the Series 7, Series 63, and Canadian Securities Course investment designations.