TRT ban is largely positive, but it puts some fighters at risk

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Testosterone replacement therapy had felt like a bad joke that plagued MMA over the past year, and Nevada's ruling, which the UFC will abide by, on paper puts that era to rest. But in reality, the issue is far more complicated than the black and white viewing many have.

We have a complex set of issues here.

The first is that the Nevada Athletic Commission (NAC) made a complete ban on testosterone replacement therapy, which the UFC said they would also recognize for shows overseas that they self-regulate. The second is that hours later, the lightning rod over the last year in TRT discussions, Vitor Belfort, voluntarily pulled out of his middleweight title match on May 24 in Las Vegas, against Chris Weidman. And in doing so, put himself and his amazing high kick knockouts as the MMA equivalent to the Mark McGwire/Sammy Sosa home run battles in baseball.

Belfort arrived on the MMA scene as a 19-year-old boxing and jiu-jitsu prodigy of Carlson Gracie. At the time he was a heavyweight known as Victor Belfort Gracie, for marketing reasons, who looked like he just got out of a teenage bodybuilding contest. His fists were like Ronda Rousey's armbars with his series of one minute finishes and he was destined to be the greatest fighter the sport would ever see. He had a good career, but he never reached that level. He garnered the reputation as a head case early, then became a sympathetic figure due to the kidnapping and murder of his sister. Then, before his fights, people would be teased with the idea the "Old Vitor" was back.

He went from being unbeatable and fiercely aggressive one day, and completely passive, much smaller and less muscular, and a reasonably good fighter who couldn't hang with the top level fighters the next.

During what would be the athletic prime for most athletes, the ages between 27 and 29, the "phenom" as a teenager compiled a 2-5 record. In his last fight before turning 30, he testing positive an anabolic agent in his loss to Dan Henderson.

He then won five in a row, garnering and losing in a middleweight title shot at Anderson Silva. It was after that loss that he has said he went on testosterone replacement therapy. Since then, he's fought six times.

His lone loss was to a much bigger Jon Jones, in a fight he took on short notice as a favor to UFC, which desperately needed someone at the time. Lyoto Machida turned the fight down due to lack of preparation time. On that day, and not his fault under the circumstances, he clearly had nowhere near the stamina necessary for a championship fight. But that became the M.O. He was one of the world's greatest one-round fighters, but if you could take him to the third round, it was the equivalent of cutting Samson's hair. Only now, with the exception of Jones, nobody could get to round three since 2007.

His other five post-Silva fights consisted of five wins, all by stoppage. Four were in the first round, pulverizing Henderson, Luke Rockhold, Anthony Johnson and Yoshihiro Akiyama. The other was an early second-round knockout of Michael Bisping. At 36, with three head kick knockouts in one year, he was in the conversation for the 2013 Fighter of the Year award. And he was clearly the top contender for Weidman's crown.

Belfort's being granted an exemption for testosterone use was controversial because of his failed test. All three of his fights last year were in Brazil. Before leaving his post as the Executive Director of the Nevada State Athletic Commission, Keith Kizer, on several occasions had indicated it was unlikely Belfort would be given such an exemption in Nevada, the home base of the UFC, and where its biggest fights take place.

Thursday's meeting, which ended with the ban of exemptions altogether, was likely triggered by the fact Belfort was going to apply for an exemption, and the commission wanted distinct rules in place to guide them. They couldn't have spoken more loudly about what the answer was going to be to the request Belfort had said he was going to make for a TUE.

The armchair response is this was a great day for a sport filled with questions about the unusually high number of its athletes who had been granted exemptions. These exemptions were granted by several different athletic commissions, as well as the UFC itself when it did its self-regulated overseas shows.

Part of the reason is the unusual proportion of high profile fighters receiving these exemptions. Besides Belfort, the names included Chael Sonnen, Dan Henderson, Nate Marquardt, Forrest Griffin, Frank Mir, Antonio "Bigfoot" Silva and Quinton "Rampage" Jackson.

Keep in mind that such exemptions are allowed in other sports, but are rarely granted. There were none in all sports combined at the 2012 Olympics, and only a few over the last two decades in the NFL. But it's not so simple.

The drug testing in combat sports is woefully inadequate since, with very few exceptions, drug testing occurs only on the day of the fight. The exception is for some high-profile main events in Nevada, which have had participants get tested unannounced in training camp.

Anyone else, with even the most basic of coaching can use PEDs all through camp, and wean off to clear their system enough to test negative.

The only fighters that doesn't apply to are Belfort and his brethren, who were tested in most cases weekly throughout their camp. This was to make sure they remained within legal levels, and not spiking testosterone levels to what would be out of the realm of someone normal. In doing so, they would get competitive advantages during the toughest part of camp, due to the drugs speeding up recovery rates.

Marquardt and Silva ended up busted for levels above normal due to the enhanced testing and scrutiny fighters granted exceptions receive. Marquardt ended up pulled from a main event fight a few days before it was to take place, and was then fired by UFC.

Marquardt has since returned, signing with Strikeforce and being absorbed back into UFC when Strikeforce closed down. Silva is currently serving a suspension, from being found with levels above normal which he said was from taking a late shot right before his classic brawl with Mark Hunt in December.

Marquardt and Silva were also like Belfort in the sense they were granted TUEs after having prior test failures. Marquardt, in 2005, tested positive for Nandrolone. Silva, in 2008, tested positive for boldenone. Both, like Belfort, claimed their innocence at the time, claiming they had unwittingly taken a tainted supplement.

The problem with the low testosterone is that in the vast majority of cases that athletes in their 20s and 30s develop this problem, it is due to taking anabolic steroids, which mess with your endocrine system and limit your ability to produce testosterone. There can be other reasons, but they are rare.

But it's impossible to prove the cause of low testosterone, only diagnose that it's a legitimate medical issue. Or doctors or athletes working together in a competitive sport can find ways to create such a diagnosis, such as creating an environment for a low reading by staying up late and drinking a lot of alcohol, or testing right after getting off a steroid cycle. The commissions can put in safeguards to see through the latter, and a number of athletes that have applied have been turned down. But ultimately, there is no way to know the cause of the issue. In a perfect world, those who had the problem from prior steroid use should be up a creek, while the small percentage who had a legitimate medical issue should be treated differently. The problem is, by being sympathetic to the latter you are risking rewarding the former.

Thus the door may have been opened to former steroid cheats who are able to use this loophole to get a career second wind.

In a nutshell, the whole TRT controversy was based on the idea that many of those applying had burned through their system by taking steroids. In doing so, were able to build more muscle mass than they could have naturally. In going on TRT, even in putting their body into normal levels, were able to regain that steroid-built mass due to muscle memory, and in a sense, cheat at the other end after the damage they had caused themselves from prior use. In addition, there are unanswered questions regarding the combination of using artificial testosterone combined with Growth Hormone, another illegal drug that is virtually impossible to detect and is used with impunity by high-level athletes, and the synergistic combination of the two drugs magnifying the effects of each.

TRT was supposed to be limited to those with medical need, not in the sense they couldn't fight as well without it, but that it was a health risk to not be on it. And once you get on it, because it further shuts down the natural production by the body, the very thing that in theory forced you onto it in the first place, you have to remain on it for life.

Yet, Marquardt and Shane Roller both claimed to have given it up because of the controversy of their names being linked to it.

And now, Belfort is saying he will abide by the commission rules and get off it himself, but there isn't enough time before May 24, so is pulling out of his title fight and not requesting a Nevada license. He has since changed his tune in a released statement. This comes three weeks after he was given a surprise test by the Nevada commission, the results of which have not been released.

There are two factors here. One is the physical. Belfort would have to wean himself off the therapy and wait for his body to normalize. The second is mental. In both boxing and MMA, there are whispers about fighters coming off steroids after being caught. Very often, in their next fight, besides a change in muscle tone, there is the deeper mental reaction, a loss of aggressiveness and confidence, a killer to a fighter in a championship situation. Thus, this may have been one of the least surprising championship pullouts in history.

If Belfort can get off the therapy and lead a normal life, let alone fight, he should have never been approved for it in the first place. In his case, with his prior test failure, it made no sense he was granted such an exemption to begin with.

The Nevada commission's decision, based largely on the testimony of Dr. Timothy Trainor, followed the lead of The Association of Ringside Physicians, who recommended a similar policy of banning such exemptions from combat sports in January.

But there are key issues ignored in this outright banning.

If there were athletes who followed all protocols, had legitimate medical need, and been granted an exemption, their careers and health are being kicked to the curb by the same agencies that are supposed to be protecting those things from happening.

By now banning such exemptions, the fighters are put in a position to either retire from the sport, or both risk the health issues that come from low testosterone and the potential health risks of competing in a combat sport while having dangerously low levels in their system and with weak production.

As controversial as this would have been to most, it would have been a much fairer situation to have banned TUE's from this point forward, but grandfather in those who have received exemptions in the past rather than put them in a position to either have to retire or face greatly enhance health risks both in and out of competition. If anyone had a legitimate need, the commissions, by allowing such therapy in the past, created a rule and a deal to, in theory, put them in a position of lifetime need. I would not advocate that include fighters who had prior positive steroid tests, so this grant would only apply to a few active fighters, Sonnen, Henderson, Jackson and Mir, all of whom are near the end of their careers anyway.

There is also the case of Silva, who suffers from acromegaly. It's disease that, combined with the surgery to remove the tumor on his pituitary gland that caused his affliction, is medically proven to greatly lower testosterone. Because of his disease, it is a significant health risk for him to have low testosterone, having nothing to do with being a fighter.

What compounds the Silva dilemma is he's got not just one, but two test failures on his record. But he's left with a series of alternatives, none of which are good. He can either retire, he can cheat to avoid severe health problems, or he can continue his career and take very serious health risks in doing so.

Whatever ruling the Nevada commission would have made, or statement the ARP would have made, had they addressed the specific issues of Silva and the other fighters would be one thing. By making a blanket ruling that is absolutely valid in the majority of instances, but without considering the exceptions, or likely even giving a moment of thought to these issues, concerns me a lot.

Because of how high profile Belfort is, this seems like a huge step against PED use in MMA. In reality, it's a ruling that affects very few fighters, and will lead to significant risks to at least some of those few in question.

A far more important discussion would be addressing the much more massive issue of fighters who use the lack of testing to cheat with almost impunity. But for commissions, that becomes a financial issue. This ruling costs nothing and actually saves the commission some money in not having to test the few applicants on a regular basis.

Essentially, they put a Band-Aid on a cancer. But it was a positive step, because approvals seemed like they were being issued with far too much leniency.

It makes everyone feel better, though, particularly those who felt Belfort never should have gotten his exemption due to his past. In his case, the feeling is, justice was served a little late, He was served up on a silver platter, publicly humbled, and had to walk out on his championship opportunity.

For others, it's not quite so simple.

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