Vitor Belfort was 33 years old when an Ultimate Fighting Championship doctor in Las Vegas -- whose name has faded from his memory -- diagnosed low testosterone as the cause for his feeling "tired and lethargic." The fix for the two-time champion was a testosterone-replacement therapy regimen that continues to this day.
Now 36, as he basks in a career rebirth that has him set for a spring UFC title fight, Belfort has emerged as the poster child for a practice anti-doping experts portray as, at worst, outright cheating and, at best, an unfair exploitation of a performance-enhancing-drug testing loophole: athletes competing while treated with synthetic testosterone.
Exemptions for testosterone use -- a substance banned in sports as a performance enhancer -- are being handed out at exceedingly high rates in the ever-popular combat sport of mixed martial arts, with state athletic commissions routinely granting allowances based solely on low lab values and diagnoses of hypogonadism, an "Outside the Lines" investigation has found. A major known cause of acquired hypogonadism: prior use of anabolic steroids.
In the past five years, at least 15 mixed martial artists have been issued exemptions to use testosterone, the vast majority revealed or confirmed through public records requests filed by "Outside the Lines" with the major state commissions or athletic bodies overseeing the sport. The sport itself has had more than 20,000 pro fighters over the past five years, according to record keeper mixedmartialarts.com, although fewer than 1,800 MMA combatants are under contract to the sport's dominant promoters -- Zuffa (UFC) and Bellator, which account for 11 of the fighters on TRT. Although only a small fraction, the number of exemptions still dwarfs what can be found in other sports:
• 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.
"It's a huge number," said Dr. Don Catlin, the country's leading anti-doping expert, of the MMA testosterone exemptions. "I am on the IOC committee that reviews [therapeutic-use exemptions for testosterone] requests. We essentially grant none. But in boxing and MMA there is no central control. There is no set of rules that everybody has to follow.
"There is a set of rules for each [state athletic commission], but they are kind of Mickey Mouse rules. So the route to being able to take testosterone is wide open. ... You go in and say 'I have these symptoms.' The doc says, 'Oh yeah, you got low testosterone.' You get a TUE."