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Today in MMA History: TRT gets banned after years of controversy

For a few years it seemed like it was everywhere, a legalized doping scourge whose synthetic tendrils plunged deeper into the sport with every passing month. Then one day it stopped, just like that.

On Feb. 27, 2014, the Nevada State Athletic Commission voted to ban the practice known as TRT, or testosterone-replacement therapy, and urged other commissions to follow suit. That same day, UFC officials, who had once been publicly supportive of TRT, expressed their enthusiastic support for the ban in an official statement, writing that the company also intended to “honor this ruling in international markets where, due to a lack of governing bodies, the UFC oversees regulatory efforts for our live events.”

That sound? That was the death knell of TRT in MMA.

What had seemed for years like a near constant source of controversy was, with a few strokes of the pen, more or less eliminated in a single day.

But what a journey it was to get there.

For most MMA fans, the first time they heard about TRT was in 2010, shortly after Chael Sonnen’s famous first fight with Anderson Silva at UFC 117. After weeks of berating and antagonizing the middleweight champ, Sonnen finally got him in the cage for what was billed as a grudge match just heated enough to make Silva want to hurt someone after several title defenses in which he seemed too bored by his opposition to care about putting them away.

For the better part of five rounds, Sonnen bullied Silva around the cage, building up a lead on the scorecards. Then he succumbed to a triangle choke/armbar combination in the final 2 minutes, turning his underdog tale into a glorious comeback story for the world’s top middleweight.

Anderson Silva and Chael Sonnen.

Still, everyone felt good about the fight and pleasantly surprised by Sonnen’s performance until a month later, when the California State Athletic Commission announced that Sonnen had tested positive for elevated testosterone levels.

Sonnen would later admit to using synthetic testosterone – a banned substance classified as a steroid by anti-doping agencies like USADA – but what he didn’t admit to was willfully cheating. He had permission, Sonnen claimed. He was using this steroid on a doctor’s orders as part of a medical treatment for hypogonadism, a condition affecting the body’s ability to naturally produce testosterone.

In other words, Sonnen insisted, he wasn’t taking steroids – he was taking medicine.

“I don’t have an option,” Sonnen later said in an interview. “I either take this medicine or die.”

Medically speaking, this was nonsense. People don’t die from low testosterone levels. But Sonnen’s claim of legitimate medical need initially earned him a reduced suspension from the California commission, which still punished him for not disclosing his testosterone use before the fight.

Sonnen also said he’d been on the drug since 2008 and had received permission from the commission in Nevada, which then told him not to mention it on future pre-fight questionnaires. The CSAC later increased Sonnen’s suspension when this claim was disputed by NSAC executive director Keith Kizer, who called it “ludicrous.”

Still, despite questions about Sonnen’s diagnosis and how he’d come to obtain it, the NSAC later granted Sonnen permission to use testosterone via a therapeutic-use exemption, or TUE. Soon those three letters would become almost inseparable from TRT in the minds of fight fans. Together, they popped up everywhere, among fighters young and old.

Former UFC light heavyweight champion Forrest Griffin applied for and received an exemption allowing him to use synthetic testosterone. So did former heavyweight champion Frank Mir. Heavyweight Todd Duffee had reportedly received his exemption at the age of 24. And former PRIDE FC champion Dan Henderson had very quietly been on it longer than any other documented case, stretching all the way back to 2007.

According to an ESPN report published just days before the Nevada commission voted to ban TRT, at least 15 MMA fighters had received TUEs for testosterone. What’s more, the UFC had even begun issuing those exemptions itself for events it operated in countries without athletic commissions.

As former UFC light heavyweight champion Quinton Jackson would later claim, the UFC referred him to a doctor specifically for the purposes of procuring a testosterone prescription prior to his fight at UFC 144 in Japan.

It wasn’t just the UFC, either. Strikeforce and Bellator both had fighters with testosterone TUEs. So did smaller regional promotions. In the span of a couple years, there seemed to be an epidemic of hypogonadism sweeping through the ranks of MMA. It was positively shocking how many seemingly healthy and fit professional athletes were actually suffering from this very rare condition.

Or, as Dr. Don Catlin of the UCLA Olympic Analytic Lab put it: “It’s just a farce that is perpetuated in MMA. It is doping. It is cheating. It is both.”

Catlin, who helped develop the carbon-isotope ratio test to screen for the presence of synthetic testosterone, was one of the strongest voices against TRT in MMA. In interview after interview, he pointed out that synthetic testosterone was a powerful performance-enhancer, even a preferred one for sports like MMA, with the ability to give a fighter a clear advantage over an opponent.

Beyond that, actual hypogonadism requiring testosterone use was also exceptionally rare. As a member of the committee that reviewed TUE applications for Olympic athletes, Catlin was fond of pointing out that he could only recall one person in 20 years who had received permission to use testosterone, “and that was for someone who had no testicles.”

According to several doctors and scientists who weighed in over the years, the most likely culprit for low testosterone among pro fighters (assuming it was a condition that existed at all) was prior steroid use. That had the potential to shut down the body’s ability to produce testosterone naturally, sometimes for years.

And if a fighter had essentially given himself this condition, likely through prior doping, should state athletic commissions really be sanctioning further doping as a remedy? Wasn’t that not only rewarding cheaters, but punishing the clean fighters who had to compete against them?

Vitor Belfort.

Enter Vitor Belfort.

While there were many TRT cases that seemed highly suspect, it was the former UFC champion Belfort who came to embody a particular cross-section of thorny issues related to the practice.

For starters, there was his failed drug test for a fight in Nevada in 2006. He was known to have doped illegally and been caught, which would likely prevent him from getting an exemption for testosterone use from the Nevada commission, according to Kizer.

But then, what if he didn’t fight in Nevada? There were plenty of other places where commissions either didn’t exist, or functionally didn’t matter.

Belfort reportedly began using TRT in 2011 at the urging of a “UFC doctor,” but he remained cagey about when reporters asked him to confirm that he was using testosterone. Then in 2012 he accepted a short-notice fight against UFC light heavyweight champion Jon Jones at UFC 152 in Toronto, where he showed up looking visibly bulkier and more muscular than he had in recent outings.

A Deadspin report would later document that Belfort was not only on TRT at the time, but potentially abusing it even beyond the allowable parameters.

Just weeks before the fight, UFC officials accidentally emailed Belfort’s lab results to a somewhat random assortment of managers, trainers, and fighters. The results showed that Belfort’s testosterone levels were well above the “normal” range for a man his age, and the UFC knew about it prior to his fight with Jones.

Belfort was allowed to fight at UFC 152 anyway. He wound up losing via fourth-round submission, but not before he managed to catch Jones in an armbar that nearly seriously injured him. Afterwards, Belfort not only went back to middleweight, but also back to Brazil, where he could compete far away from the prying eyes of U.S. state athletic commissions.

What followed was one of the most impressive years of Belfort’s career. He fought three times in 2013, all in Brazil. He ended all three fights with spectacular knockouts, sporting a physique like a cartoon superhero in the process.

But with each win, the focus on his TRT use intensified. So too did the questions being lobbed at UFC officials about why they were so content to keep Belfort confined to Brazil.

The UFC had attempted a delicate dance on the subject of TRT up until this point. At times, UFC President Dana White was opposed to it, calling it “junk” one month, then praising it as “sport science” that was “absolutely fair” the next. As long as fighters didn’t abuse it, he said, the practice should be allowed.

But Belfort’s 2012 lab results suggested he was abusing it, and still the UFC allowed him to fight. By allowing him to fight only in Brazil, where the newly created local commission took a very liberal stance on allowing TUEs, the UFC appeared to be enabling Belfort’s testosterone use, if not outright encouraging it.

Around this same time, as pressure on the UFC intensified over the issue, the rhetoric coming from UFC officials began to change. White claimed that TRT “ruined” fighters, even after supporting it just months earlier. When the Association of Ringside Physicians called for a ban on TRT in early 2014, White voiced his support for that idea.

Antonio Silva vs. Mark Hunt in December 2013 at Brisbane Entertainment Centre.

Meanwhile, an instant classic of a heavyweight fight between Mark Hunt and Antonio Silva in Australia was marred by Silva’s elevated testosterone levels after he received a TUE that he allegedly abused. Increasingly, TRT was casting its shadow of doubt and controversy over the entire sport. You could hardly be a fan of MMA and not have an opinion on it.

Then, just months before Belfort was set to apply for a TRT exemption in Nevada prior to a UFC middleweight title fight against Chris Weidman, the state’s athletic commission voted unanimously to ban the practice altogether, instantly reversing its own years-long policy.

“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,” NSAC chairman Bill Brady said at the time. “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.”

And how did the UFC president White feel after years of waffling back and forth on the issue?

“(I’m) pumped!” White told reporter Ariel Helwani via text message. “Couldn’t wait for that garbage to go away.”

And all at once, the sanctioned use of synthetic testosterone did go away. It was so easy you almost couldn’t help but wonder why it had taken so long.

“Today in MMA History” is an MMAjunkie series created in association with MMA History Today, the social media outlet dedicated to reliving “a daily journey through our sport’s history.”

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