News came out last week that UFC fighter George Sullivan is facing a second suspension from breaking UFC anti-doping rules. He was originally suspended for one year in 2016, after admitting to using a product that contained a banned substance.
This time around, he failed an out-of-competition test weeks before he was due to return from his original suspension. Sullivan claimed the test failure was down to a misunderstanding about a fertility pill he had been prescribed.
Hey guys it's a misunderstanding about a fertility pill I started taking 3 weeks ago to try and have a baby. dr Morgan...Posted by George Sullivan on Thursday, January 26, 2017
‘Hey guys it's a misunderstanding about a fertility pill I started taking 3 weeks ago to try and have a baby. dr Morgan is Sending in all of his paper work tomorrow to clear this up. I'm sad that it came to this my dr and I are shocked and we will clear this up. I have all the documents to prove it. I love my wife and starting a family is everything to us ! God bless’
Since then, he has gone on Twitter to claim that he is applying for a TUE:
Sent all the paper work to Usada to show why we need this medication. Trying to get tue approval— George Sullivan (@Sullivan_UFC) January 28, 2017
‘Sent all the paper work to Usada to show why we need this medication. Trying to get tue approval’
He then stated that he has nothing to hide and the drug in question is clomiphene, the same substance Jon Jones and Brock Lesnar received one year suspensions for taking:
@Sunkist1207 yes I have nothing to hide it's clomiphene— George Sullivan (@Sullivan_UFC) January 28, 2017
‘yes I have nothing to hide it's clomiphene’
USADA separately confirmed to Bloody Elbow that, as per Mr. Sullivan’s tweet, clomiphene is indeed the substance he tested positive for.
Clomiphene is licensed by the FDA as a fertility treatment for women, but is not currently licensed as a fertility treatment for men. Despite this, clomiphene is sometimes used as an off-label treatment for fertility issues in men.
Clomiphene also has a couple different uses as a performance enhancing drug. It has traditionally been used as part of “post-cycle therapy” by people who have been using anabolic steroids. Use of anabolic steroids can suppress the body’s natural production of testosterone. To try to mitigate this, steroid users would take clomiphene at the end of a cycle of anabolic steroids to help the body produce testosterone again.
This boost to testosterone production doesn’t only occur in people with low testosterone, though. Studies have shown that even in young, healthy individuals, clomiphene can double testosterone production. It does this by suppressing estrogen’s action in the pituitary, which causes more luteinizing hormone to be produced. This luteinizing hormone then stimulates the body’s leydig cells, which secrete testosterone and related steroid hormones.
Clomiphene is becoming increasingly popular as a treatment for low testosterone in men, in place of testosterone injections or creams, though as with male fertility, clomiphene is not licensed by the FDA for this purpose.
Sullivan’s attempt to apply for a retroactive therapeutic use exemption seems unlikely to succeed.
USADA provides the following guidance regarding retroactive therapeutic use exemptions:
'An application for a TUE will only be considered for retroactive approval where:
a. Emergency treatment or treatment of an acute medical condition was necessary; or
b. Due to other exceptional circumstances, there was insufficient time or opportunity for the Athlete to submit, or for the TUEC to consider, an application for the TUE prior to Sample collection; or
c. It is agreed, by WADA and by the Anti-Doping Organization to whom the application for a retroactive TUE is or would be made, that fairness requires the grant of a retroactive TUE.'
In Sullivan’s case, the clomiphene was not used as an emergency treatment or to treat an acute medical condition. Infertility would almost certainly be considered a chronic, ongoing medical condition, not a sudden, acute condition. As a result, there was also ample time for Sullivan to apply for a TUE.
The fact clomiphene isn’t licensed by the FDA for use as a male fertility treatment will also likely count against Sullivan. These factors, combined with the fact that clomiphene could potentially significantly enhance performance, lead me to believe there is very little chance Sullivan will receive a retroactive TUE.
USADA typically do not reveal the outcome of TUE applications unless the athlete discloses that information first.