California putting temporary hold on approving TRT exemptions

USA TODAY Sports

The California State Athletic Commission (CDSAC) will not be approving any new exemptions for testosterone replacement therapy (TRT) until its new policy on the subject becomes law. The time frame, according to CSAC Executive Director Andy Foster, could be anywhere between two months and one year. The few with exemptions already in place will be allowed to continue.

For a relatively short period of time, the California State Athletic Commission is not going to be approving of any therapeutic use exemptions for testosterone, or as it's often called, TRT (testosterone replacement therapy).

According to Andy Foster, the Executive Director of the commission, the issue is not banning TRT usage in the state at all, but simply waiting for the approval of a policy on the issue already written by commission members Dr. Van Buren Lemons and Martha Shen Urquidez.

"The policy is pretty much done," he said.

As far as when the policy will be enacted, it could be anywhere from two months to one year. "It depends on whether we can get a 60 day emergency rule put into place," said Foster. "If not, it could take 90 days, or perhaps almost a year."

At this point, this may have no effect on UFC, which has no announced events scheduled in the state at this time. Bellator has two dates scheduled, one in September and another in November.

At the commission's Monday hearing, Department of Consumer Affairs lawyer Michael Santiago argued that until the regulation is approved and on the books, the commission shouldn't be approving fighters to be allowed to use a banned substance (testosterone) without a policy in writing.

In theory, once someone goes on TRT it shuts down their own production of testosterone. That could create the need for it for the rest of their life, thus becoming a touchy situation. Foster said that athletes who have been approved for TRT in the state will be grandfathered in as long as their current license is active if they are to fight during the time frame before the new regulations are in place. He also said the number of fighters who fall into this category is tiny.

The belief is that California has approved less than five exemptions for MMA fighters, although Foster would not state a number. "We really don't have that many," he said. "We been getting a big increase in applications. We mostly turn them down. We've been getting a lot of calls about it."

"The commission's concern is we were starting to see an increase in these types of applications," said Foster. "We can't disclose who is asking, but I think it's important we develop a policy so that everyone understands what's required."

Many have complained use of artificial testosterone, which has an anabolic effect, is a performance enhancer. Those in favor will argue it just takes athletes who have a medical issue that would make them lethargic and decrease their athletic performance and simply gets them back to normal. Those on TRT have to be regularly tested and come in at what would be normal levels of testosterone for a natural athlete.

UFC President Dana White has suggested at points that if a fighter needs such therapy because their body is producing low levels of testosterone, maybe they should consider retiring. Still, UFC when it regulates itself outside the U.S., has approved of usage for a number of fighters, although White has said they will be tested heavily over the weeks leading to the fight to make sure they aren't spiking levels high to get to performance enhancing levels while in training camp.
But it's not that simple. There is the ethical question regarding how to handle athletes who have low testosterone because they've lowered their bodies ability to produce the hormone because of prior use of anabolic steroids. The new California policy specifically excludes fighters who have used steroids to damage their systems from being approved, but it's impossible to tell with certainty what the cause is of the problems.

Many fighters who don't use steroids have complained it allows people to cheat when they are young, and then after they've damaged themselves, continue cheating. There is also the question of allowing athletes who previously used steroids and built up power, speed and muscle mass on the drug, if it allows them to regain much of those increases that they never would have obtained naturally. And there is also the question as to using TRT and stacking it with Human Growth Hormone (HGH), a banned substance that is not tested for in MMA because current testing procedures are primitive and expensive, creates a situation that increases gains of the HGH alone.

Foster, who admitted not being an expert on the subject, said he turned it over to Dr. Lemons and commissioner Urquidez to produce the policy.

"The main thing I got from it, is that it has to be if you're going to be allowed to take this stuff, it has to be that your body can't produce testosterone anymore," he said. "A lot of these guys can produce some, just not enough."

New Rule 303.1, covering TUEs, states that five criteria must be met for approval.

1) The licensee would experience a significant impairment to their health without the treatment
2) The TUE would produce no performance enhancement past the point of someone with normal health
3) Either other treatment for the problem has been tried or no reasonable alternative exists
4) The necessity for use is not a consequence of prior non-therapeutic use of any illegal substance
5) The condition is not so severe that with the substance, the participant is not put at a higher level of risk of injury from participating in a combat sport with the use of the substance.

For approval, it requires a number of tests, including those showing lower than healthy levels of testosterone and an exam from an endocrinologist. The athlete must also submit a number of tests for a six-month period prior to a fight showing a blood serum testosterone level under 1,100 ng/dL, which is the high end of normal range. Two tests above that range within a six-month period of competition will result in the fighter being removed from competition, although they will be evaluated on a case-by-case basis.

In UFC history, Nate Marquardt is believed to be the only fighter disqualified from a fight because his levels were shown in pre-fight testing to be above allowable limits. He was fired by UFC at the time, although he is now back in the organization, and claims to no longer be using TRT.

What has made the therapy controversial is the success of some of the fighters who have been revealed to be approved for TRT in other jurisdictions. Vitor Belfort is the most controversial because he has a failed steroid test in his past. He has been on a tear of late at 36 years old, and is arguably next in line for a shot at the middleweight title, with consecutive knockouts of Michael Bisping and Luke Rockhold.

Dan Henderson, who has been on the therapy dating back to at least early 2007, headlines Saturday's UFC 161, at the age of 42. Henderson has produced a number of tests showing, even with therapy, a lower than average blood serum testosterone level. However, critics will note that since he was approved in Nevada, Henderson has five knockouts in his last 11 fights, after the age of 36, battling top level competition in every fight during that period. Prior to that time, he had seven knockouts in 26 fights against a generally lower level of competition.

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