Nate Marquardt, Chael Sonnen Incidents Won't Assist in Eliminating TRT Exemptions

Should mixed martial arts, and sports in general, ban hormone replacement therapy treatments for various ailments? Photo by Josh Hedges/Zuffa LLC/Zuffa LLC via Getty Images

Former UFC middleweight contender Nate Marquardt's announcement on Tuesday afternoon's edition of The MMA Hour with Ariel Helwani was a spurning moment for most mixed martial arts fans. Aburptly after the 1 PM ET start time, Marquardt was already explaining his diagnosis of low testosterone last August and the endless paperwork and testing policies he had to adhere to in order to fight professionally. Most fans ignored the reasons once the word "testosterone" came out of Marquardt's mouth, and it's hard to chastise anyone who has had enough of the performance-enhancing drug talk.

Marquardt's case is different than that of fellow contender Chael Sonnen. From the details that Marquardt's manager Lex McMahon and Nate himself provided, he had succumbed to every blood test required and provided all of the necessary paperwork needed to fight with the condition. Unfortunately, he made the grave mistake of relying on a doctor who wasn't following USADA protocols and had been red-flagged by the New Jersey Athletic Control Board when Marquardt fought Dan Miller in March. If Marquardt had found a highly-credentialed specialist, we wouldn't be talking about this right now.

The micro issue is that fighters are responsible for their own actions. Marquardt admitted that during the interview, and he took full responsibility. For fans however, the macro issue, whether or not testosterone replacement therapy, or TRT, should be banned in sports in general, is far more relevant, mainly due to the rash of high profile positives and the rise of hormone replacement therapy to allow older athletes to continue competing. Fans have expressed frustration and exhaustion from the news. Unfortunately, they'll have to get used to it.

Therapeutic use exemptions (TUEs) were created solely to allow athletes who suffered from debilitating ailments to continue to compete at a peak level in the professional and amateur sports. Glucorticosteroids, which are mostly used to relieve pain and act as an anti-inflammatory drug for athletes, are banned, yet they are used to treat allergic rhinitis, tinnitus, and colitis. Salbutamol, despite never showing proof that it can increase performance in large studies, has been used by athletes as a fat burning drug and performance enhancer. It's also banned. The list is endless, and the TUE policy is fairly open in nearly all professional sports and on the Olympic level for that reason. Various chronic illnesses and diseases can be treated with banned substances. The question is whether it is fair to effectively ban those athletes who have legitimate issues from competition.

Low testosterone and its treatment are obviously on a different plane than a person suffering from chronic asthma. Older fighters may be able to get diagnosed with low testosterone and use TRT simply because they are old. One might believe that after it was revealed that Dan Henderson was cleared by the Nevada State Athletic Commission for the therapy. TRT seems to have a broader application, so broad that it is obvious that it is being exploited. It isn't a coincidence that there is suddenly an epidemic among mixed martial arts fighters. There are fighters using it to enhance performance. The sheer number of mixed martial artists with testosterone issues does not fall in line with the overall statistics, and most of these fighters are at the upper-echelon of the sport. Draw your own conclusion.

Banning the treatment isn't going to happen however, even if there is a colossal outcry to eliminate it from the sport. Nearly all professional sports have TUE policies. Even the Olympics has a policy that will allow it. Why? Believe it or not, there are legitimate cases for it. The perfect example is American sailor Kevin Hall, who competed for the U.S. in the sailing in the 2004 Athens Olympics. He was a survivor of testicular cancer, and he produces no testosterone whatsoever. Clearly, testosterone replacement therapy is an exemption in this case.

Most fans will look at that example and say, "Come on! No testicles? That's obvious.". It is obvious. A cursory check of the nether regions would be sufficient enough to make the claim that Hall needs TRT treatment. But there are other cases of low testosterone production that require TRT treatment that aren't related to old age and performance-enhancement. They aren't as easy to diagnose by doing a hernia check however.

The most significant point surrounding the macro issue is the notion of fairness. Is it fair to ban TRT treatments when a select few require it to compete? No, it isn't. In fact, that's the very reason why TUEs exist in the first place. Life may not be fair, but in an instance in which you are competing professionally in a sport -- the commissions, committees, and oversight groups have put in place policies that ensure fairness. What's to stop an athlete from sueing an organization for banning a treatment for his specific disease over a person who uses glucorticosteroids to treat colitis? This, in a nutshell, is why TRT will never get the axe on an exemption list.

The solution to the problem is logical and clear. Instead of reviewing exemptions with one independent doctor or lab, take a page from the International Olympic Committee along with suggestions from various athletic commissions in the United States:

  • Form a panel of experts, specialists. 
  • Review each exemption with a fine-toothed comb, background check doctors, etc. 
  • Outline exact procedures to submit paperwork and a timeline. 
  • Similarly to Nevada, make these guys swear under oath with the risk of being charged with perjury. 
  • Do not allow fighters previously popped for steroid use to apply for TUE exemptions later (On a side note: Marquardt's positive in 2006 should make his TUE void in Nevada.). The assumption is that past use attributed to low testosterone levels.

In Marquardt's case, the outline was provided and a timeline was in place. Unfortunately, the other requirements are something that are not in place, at least in most states, and those points will likely never be satisfied. Why? The International Olympic Committee receives quite a bit more funding than your standard state athletic commission. They have the funds to mandate blood tests, ask three or four specialists to look over a case, and run each exemption case through a guantlet of scrutiny. State athletic commissions do not have that luxury.

As Keith Kizer stated in his interview with Mike Straka, athletes shouldn't have to choose between getting better, getting well, and competing if, in fact, they can do both without putting either themselves at unfair risk or put their opponent at an unfair advantage. Kizer has suffered the onslaught of public opinion in the past, but he's right in this context, especially when we consider true athletes who do suffer from debilitating problems. Is it fair to ban athletes with legitimate low testosterone issues? Is it fair to allow an athlete with an overly stuffy nose to take steroids, yet ban the guy who has a problem downstairs? Under the current system, it isn't, and I'm not sure I'm willing to jump on a bandwagon that crushes the hopes of a 21-year-old prospect who has had a bad run of luck with testicular cancer or a tumor in his pituitary gland.

What I am willing to jump on board with is an unified movement to increase the standards of the current policies in place. If commissions banded together, the cost could be offset by a major promotion paying for the privilege of hosting an event in a state. The problem is that if it isn't universal across North America, promotions can avoid those added costs for blood tests, etc. by heading to another state.

Ridding the sport of these excuse makers who hide behind hypogonadism and low testosterone diagnoses is also another wishful idea. As aforementioned however, it's tougher to see who is lying and who isn't. Obviously, Marquardt's history should have been a red flag. Perhaps a case-by-case magnifying glass is required. Even with that kind of oversight, there will be fighters who slip through the cracks.

Is legalization the answer? It would take all of the problems that we see with the policies above and eliminate them. I don't, however, foresee it being a solution. Perhaps the younger generation sees the benefits. We watch sports for entertainment, why not allow these guys to perform at a peak level, right? The older generation, the generation who has sat through baseball's steroid era in disgust, and a generation in power right now within the ranks that make these types of decisions isn't allowing it to happen any time soon. Furthermore, I'm not convinced anyone who has any type of power is willing to overlook brain trauma data and the scrutiny stemming from studies on concussions and steroid abuse. Legalization could solve the problems, but it's a dream at this point. 

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