If you've been following sites like MMAmania.com for any amount of time, then you've probably read more than your share of articles about the controversial role of testosterone replacement therapy (TRT) in mixed martial arts (MMA).
However, for the vast majority of sports fans who don't have any interest in our wonderful world of face punching, this controversy has largely flown under the radar.
Until now that is.
In a recent ESPN "Outside the Lines" investigative report, investigative journalist Mike Fish took a closer look at TRT in MMA. What he found didn't exactly paint the sport -- or its leading promotion Ultimate Fighting Championship (UFC) -- in a flattering light.
According to the report, a minimum of 15 MMA fighters have been issued therapeutic use exemptions (TUE) for testosterone over the past five years. Of these 15 fighters using athletic commission sanctioned testosterone, 11 of them are current or past employees of either UFC or its competitor, Bellator MMA.
This may not seem like an exuberantly high number of TUE-holding fighters on first blush, but when one compares these numbers to other major sports, well, then the case for MMA having a testosterone problem becomes undeniable.
Per the ESPN article:
• The International Olympic Committee did not issue a single testosterone exemption for the 2012 London Olympics, which featured 5,892 male athletes.
• The U.S. Anti-Doping Agency issued one testosterone exemption last year among the thousands of elite-level athletes under its jurisdiction.
• Major League Baseball has issued six exemptions to athletes over the past six seasons -- an average of 1,200 players populate its rosters each season.
• National Football League officials say testosterone exemptions are "very rare" and only a "handful" have been issued since 1990. Nearly 2,000 players circulate through rosters each season.
• No pro boxer is known to have had an exemption issued through a state athletic commission, and Nevada officials said they have never even received an application.
As for the often repeated "hypogonadism" excuse many fighters on TRT use to justify their use?
According to Dr. Richard Auchus, an endocrinologist and University of Michigan professor of internal medicine interviewed for the ESPN piece, it is a condition that occurs in just 0.1 percent of adults in their thirties.
While the above data make MMA look bad enough to the outside world, elsewhere in the report TRT poster boy Vitor Belfort makes a claim that, if true, could be far worse for the sport's image.
According to Belfort, "a UFC doctor" -- whose name "The Phenom" conveniently enough, claims he can't remember -- got him on TRT back in 2011.
What's more, according to the ESPN report, Belfort wasn't the only one:
Belfort volunteered that it was a "UFC doctor" who started his testosterone regimen in 2011 -- similar to a 2012 claim by Quinton "Rampage" Jackson, who said a UFC doctor referred him to an age-management specialist. Sources also told "Outside the Lines" that the UFC encouraged heavyweight Roy "Big Country" Nelson to see a doctor about TRT, although he eventually opted not to after having lab work done in 2010. Nelson declined multiple interview requests for this story.
"Outside the Lines" also obtained a 2010 letter to Dr. Jeff Davidson, a UFC medical consultant and former Nevada commission ringside doctor, from a Las Vegas physician thanking him for his referral of MMA fighter Todd Duffee. The doctor prescribed Testosterone Cypionate for the then 24-year-old, whose "extreme fatigue" was diagnosed as caused by "secondary hypogonadism."
Also, a doctor for Chael Sonnen wrote Davidson regarding the middleweight's TRT regime in 2010 -- a year before there is a record of his having formally applied with a state regulator for an exemption. Dr. Mark Czarnecki apologized for the handwritten letter, noting "apparently Dana needs the information ASAP." "Dana" is presumed to be UFC president White, and the letter details Sonnen's use of testosterone since a 2008 diagnosis of hypogonadism.
In a later instance, anti-aging specialist Dr. John Pierce wrote in 2012 advising Davidson and Greg Hendrick, then director of event operations for UFC, that fighter Frank Mir had been diagnosed with hypogonadism and had already started on a regimen of Testosterone Cypionate. That was 10 weeks before Pierce wrote the Nevada commission about the diagnosis and start of care, according to commission records obtained by "Outside the Lines."
A doctor in the employ of the world's leading MMA organization actively pushing synthetic testosterone on its fighters?
Not a good look, to put it mildly.
Perhaps the most shocking tidbit above is the allegation someone, evidently a doctor, under the employ of UFC recommended Roy Nelson of all people get on TRT. Over the past few years Nelson has been outspoken in his opposition to performance enhancing drug use, which raises the question whether the alleged recommendation he go on TRT back in 2010 had anything to do with the development of "Big Country's" vehement anti-drug stance.
UFC declined to participate in the ESPN article, but rest assured it won't be long before UFC President Dana White -- who once called TRT "cheating" -- responds to the above revelations in some form or another.