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NJSACB's PED & TRT testing policies examined in detail ahead of UFC 169

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Iain Kidd scrutinizes the NJSACB's drug testing policies and standards, including TRT therapeutic use exemptions, and comes away impressed.

Benny Sieu-USA TODAY Sports

Ahead of UFC 169 in New Jersey this weekend, I reached out to the NJSACB to get some details on exactly how the widely recognized best commission in MMA handles drug testing. While the testing procedures of some commissions leave a lot to be desired, New Jersey is taking the lead in proactive improvements to testing, including testing every fighter at major events and using both blood and urine testing.

The answers below are courtesy of Nick Lembo, Commissioner Davis and the lead MMA ringside physician in New Jersey, Dr. Sherry Wulkan. I am grateful to them for taking the time out of their busy schedules to answer my questions in such detail.

Iain Kidd: On average, how many fighters are tested during a major MMA event (e.g UFC)

NJSACB: Every fighter is drug tested at a major combat sport event in New Jersey.

Iain Kidd: What methods of testing are usually employed.

NJSACB: Typically blood and urine.

Iain Kidd: Under what circumstances is extended testing (e.g blood, urine and hair) employed?

NJSACB: Some examples would be main event bouts, title fights, where competitors had a past positive test or use TRT.

Iain Kidd: What substances are tested for during each type of testing?

NJSACB: Performance enhancing drugs, prescription drugs, masking agents, diuretics and criminalized substances would be some common examples.

Iain Kidd: What testing do fighters receiving TRT TUE's undergo?

NJSACB: A letter from a Board Certified Endocrinologist stating that you stopped all hormone replacement therapy for a minimum of 8 weeks prior to repeat testing.

The letter should include copies of medical records that address the following issues:

A clearly established diagnosis of primary or secondary hypogonadism

Include the results from any relevant imaging studies

Provide results from the endocrinologist's physical examination including a description of all symptoms such as, but not limited to: incomplete sexual development, reduced sexual desire and activity, change in hair pattern, small or shrinking testes, Height loss due to vertebral compression fracture, Low bone mineral density (dexa scan), Reduced muscle bulk and strength

Provide at least three separate measurements of Baseline testosterone therapy

Samples should be taken in the morning of free or bioavailable testosterone levels.

If you have been on testosterone (T) therapy already, then the combatant should cease using testosterone therapy for at least two months, preferably three, before measuring baseline T.

Measurements must be made using an accurate method such as calculated free testosterone by equilibrium dialysis

Results should demonstrate T levels consistently below the low normal value for the reference laboratory

The obtained values must be interpreted by a Board Certified Endocrinologist in this case.

Provide LH and FSH values measured at the same time as T above. In this case, the obtained values must be interpreted by an endocrinologist.

Provide results from stimulation of the gonadal axis by hCG as applicable

Provide confirmation that you do not have any short term illness or other condition that would influence testosterone production at the time of evaluation, and that you are NOT on any medication that may affect T levels such as narcotics or corticosteroids, or androgen replacement therapy.

Provide a detailed treatment plan including how systemic T levels will be monitored to ensure maintenance of therapeutic levels. The dosage must be decided by an endocrinologist in this case. The intervals between assessments of therapeutic maintenance levels must be so stated and the results of at least two therapeutic levels submitted by an endocrinologist in this case.

Please be hereby advised that you will be subject to at least three separate drug tests prior and immediately thereafter your fight date in New Jersey, the timing and type of which is to be determined by this agency.

Iain Kidd: If a fighter has a previously failed PED test, do they have to undergo more additional scrutiny to receive a TRT TUE? Can you provide some details of this?

NJSACB: The level of scrutiny is rather high regardless of past testing history. Obviously, such history is always taken into account and studied.

Iain Kidd: When is Carbon Isotope Ratio testing employed?

NJSACB: Testosterone levels vary from person to person, but drug monitoring organizations in sport look at the relative amounts of testosterone and an isomer (natural variation) of testosterone called epitestosterone collected in urine samples. The natural testosterone to epitestosterone ratio is usually 1:1, and rarely exceeds 4:1 in the healthy adult male population. If the ratio exceeds 4:1, or varies significantly from prior tests done on an individual, the lab will conduct an isotope ratio mass spectrometry (IRMS) test to determine whether or not the testosterone came from outside the body. This test relies on the concept that endogenous testosterone (testosterone manufactured by the body) has more carbon 13 than does pharmaceutical testosterone.

Iain Kidd: Do you have a rough cost estimate for the different types of testing the NJSACB employs?

NJSACB: It can cost up to $15,000 for each fighter.

Iain Kidd: How often/under what circumstances is random testing employed by the NJSACB?

NJSACB: Random testing is conducted routinely based upon circumstances that would not be prudent to disclose.

Iain Kidd: Are there any forms of testing the NJSACB currently does not undertake for any reason that you would like to employ in an ideal world?

NJSACB: No, the NJSACB has an extensive, comprehensive, and flexible drug testing program that attempts to adapt to changing national and international policies when those policies changes are applicable to the sports the state regulates.

Iain Kidd: Do you feel olympic style year-round random testing is a feasible goal for MMA in the next 5-10 years?

NJSACB: A year- round, Olympic-style random drug testing program would be very difficult to implement without a federal mandate and without the full cooperation of larger promotions and coaches. I do believe that "out of season" testing of individuals, as well as the implementation of a "biological passport" system, would, in part, assist in the promulgation of equity and fairness in combat sports.

What is a "biological passport"?

Each individual has his/her own "biological fingerprint". For example, an individual should have the same ratio of testosterone to epitestosterone throughout his adulthood. Variations in that ratio would warrant further testing.

There is very little to be critical of in regards to the NJSACB's testing policy. Sure, in a perfect world every fighter would be tested randomly leading up to a fight the same way fighters who receive TRT TUEs are, but the truth of the matter is that the cost of doing that makes it wildly impractical at this point in time.

At up to $15,000 per fighter, a full card of 24 fighters could cost the commission $360,000. That's a figure that commissions simply can't afford to spend regularly. If the NJSACB was to apply this standard to the UFC, it would be expected to apply it to other events in the interests of fairness. Considering the number of combat sport events New Jersey hosts each year, it becomes apparent why this is simply not a realistic prospect.

The fact the NJSACB test both blood and urine regularly is a big step forward from most commissions, which tend to only utilize urine testing, I assume because it's significantly cheaper than blood testing.

CIR testing only being employed on suspicious samples creates a small gap for fighters who are micro dosing with testosterone, but hearing that the NJSACB will keep a fighters testosterone levels on record and use CIR testing if their ratio changes is again a step up from most commissions, which will only employ CIR testing when the T:E ratio is above their accepted limit.

As you can see from the provided answers, getting a TRT TUE isn't as simple as finding a doctor willing to prescribe it for you. The NJSACB policies for granting a TRT TUE, and then the increased scrutiny and testing applied to fighters who receive it, make it a poor option for a fighter trying to gain an unfair advantage. The truth is that if you want to cheat, applying for a TRT TUE is a really good way to get caught, and the system seems to have been set up with that in mind.

In Frank Mir's case, he has been, and will continue to be monitored via blood, hair and urine testing well prior to the event, near the event, pre bout, after the bout, and well after the competition date. The NJSACB examined the records he provided when he received a TRT TUE in Nevada and Wisconsin, and he was required to be seen by a board certified endocrinologist. It doesn't get much more thorough than that.

The fact the policy makers at NJSACB are in favor of out of season testing and biological passports bodes well for drug testing in MMA going forward. I strongly hope that in the next few years the resources needed to pull this off become available.

If more commissions were willing and/or able to use an identical testing policy and structure to that of the NJSACB, I strongly believe the incidence of PED usage in our sport would be cut significantly. The current testing regimen isn't perfect, but it's the best we have in MMA at the moment, and our sport would be healthier if other states treated PED testing the same way New Jersey does.