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Vitor Belfort

The Nevada State Athletic Commission on Thursday set a new course for the controversy over therapeutic use exemptions for testosterone replacement therapy for mixed martial artists.

The NSAC voted unanimously to ban applications for TUEs for testosterone replacement therapy, effective immediately.

Any athlete that applies for a license to fight, whether boxing, kickboxing, or mixed martial arts, will now be unable to even apply for an exemption. If said athlete has a TUE from any other state, the commission will not recognize it.

If a fighter already had a TUE in Nevada, the fighter will now be unable to apply for a new exemption when they apply for a renewed license to fight in the state.

The commission noted that because fighter licenses terminate at the end of a calendar year, there are no licensed fighters in the state of Nevada that currently possess a therapeutic use exemption for TRT.

Several high-level fighters that are known to have fought with TRT TUEs in the past will now be unable to even apply for the exemption. Fighters such as Chael Sonnen, Dan Henderson, and Frank Mir have all fought at one time or another with a TUE.

Vitor Belfort, however, has become the lightening rod for the controversy surrounding TRT usage, primarily due to the timing of his employment of TUEs for TRT coinciding, coincidentally or not, with his career resurgence.

Belfort is sure to planted front and center once again as a result of Thursday’s commission decision, as he is slated to challenge UFC middleweight champion Chris Weidman at UFC 173 on May 24 in Las Vegas.

Belfort has yet to apply for his license for the fight, and is now unable to get a TUE for it.

UFC president Dana White has already stated that if Belfort were to be denied a TUE for the fight, and then declined to follow through with the bout, “that would be a problem.”

Upon finding out about the vote, White and the UFC issued a statement supporting the commission’s decision.

“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 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.”

The Nevada commission made its decision following a presentation from Dr. Timothy Trainor, who is the commission’s consulting physician. The commission also cited the recent urging of the Association of Ringside Physicians to ban the practice.

“Steroid use of any type, including unmerited testosterone, significantly increases the safety and health risk to combat sports athletes and their opponents,” read the ARP statement. “TRT in a combat sports athlete may also create an unfair advantage contradictory to the integrity of sport. Consequently, the Association of Ringside Physicians supports the general elimination of therapeutic use exemptions (TUE) for testosterone replacement therapy.”

Dr. Trainor pointed out that there is a legitimate medical condition called primary hypogonadism that is a diagnosis for men with low testosterone, but added that it is not at all common, and that it is fairly easy to test for if it is naturally occurring by comparing other related hormone levels via a series of blood tests.

If it is determined that there was some mitigating cause for the low testosterone level, something other than a natural occurrence of primary hypogonadism, the situation becomes much more difficult to assess. Dr. Trainor noted that head trauma, brain tumors, and performance enhancing drug use or abuse (such as steroid use) are but a few factors that could cause low levels of testosterone, but he was unaware of an effective method for pinpointing the cause.

One factor that Dr. Trainor passionately pointed to as reasoning for his suggestion to do away with applications for TRT exemptions in combat sports is his belief that performance enhancing drug use or abuse is a strong contributing factor to low levels of testosterone.

“In my opinion, medical opinion, and this is my opinion, yes, I would assume that if someone had tested positive to performance enhancing drugs or is known to have used performance enhancing drugs, I would assume that’s the cause of their low testosterone,” said Dr. Trainor.

“I certainly don’t want to reward people that have used PEDs [when] that’s what is causing their hypogonadism.  I certainly don’t want to reward them by saying here’s a testosterone exemption.”

Both Dr. Trainor and the commission seemed to be in agreement that even if a fighter’s low levels of testosterone were being caused by something other than PEDs, they might be doing a disservice to that athlete by allowing them an exemption for TRT so that they could continue to fight.

For instance, if a fighter’s low testosterone level is caused by head trauma, would it be appropriate to allow that athlete an exemption so that he could re-enter a competition where there was a likelihood of suffering further head trauma?

“Being granted a license to compete in combat sports is not a God-given right,” added commissioner Francisco Aguilar, the commission’s chairman. He also added that for the fraction of fighters that request an exemption, mitigating the issue chews up much of the commission’s limited resources and funding.

Not only did the commission unanimously approve the ban on TRT exemption applications, it was cognizant that if the Nevada commission truly wants to effect change across the sport, it would have to be proactive in reaching out to other athletic commissions so that other locations don’t become a de facto “TRT hotspot.”

“I think it is going to be incumbent upon this commission to ensure that we are proactive in reaching out to other commissions to encourage them to do the same thing,” said commissioner Pat Lundvall. “What I don’t want to see is for other commissions or different promoters to have different rules than we do.”

“That’s a good point,” added Skip Avansino, another longtime Nevada commissioner. “It certainly seems to me that we don’t want a magnet somewhere else for these things to be granted.”

To be sure, the first major domino has fallen for those that have long called for an end to legalized testosterone replacement therapy in combat sports, characterizing it as a crutch at best and outright cheating at worst.

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