MMA Fighter’s Resurgence Clouded by Controversial Treatment

In a few months’ time, 37 year-old Vitor Belfort will have the chance to end a decade-long drought without a UFC championship. However, at the center of his late ascension into peak form lies a practice shrouded in controversy: testosterone replacement therapy.

The Nevada State Athletic Commission banned the use of testosterone replacement therapy in February. While far from being the only fighter to undergo the treatment, the ban affected Belfort more than anybody, if only temporarily. Originally scheduled to fight Chris Weidman for the middleweight title in the state three months later, Belfort had to be replaced with fellow Brazilian Lyoto Machida. He has now ended the treatment, hence his renewed opportunity. But a case like Belfort’s is only a small part of a much grander discussion.

Even with its recent ban, testosterone replacement therapy is as enigmatic as it is controversial.  Colloquially known as TRT, it is typically used to treat male hypogonadism, a disorder characterized by diminished functioning of the testes. As men near middle-age, their testosterone levels may decrease, resulting in fatigue and loss of muscle mass. The treatment reverses that loss while decreasing body fat. According to physician and podcast host Dr. Steve, if treating pathologically low testosterone levels, then theoretically, the athlete is granted no advantage when performing. Then why the motion from the NSAC?

Even if sometimes practiced for legitimate medical reasons, TRT is still perceived by many in the mixed martial arts community to be cheating. In a March 2013 interview, UFC president Dana White, a staunch opponent of the treatment, said “If you have to use TRT, you’re probably too old to be fighting…The guys that do that, that are on TRT, their training camp is a lot easier…The bangs, the injuries, all the (expletive) that goes on, they’re recovering ten times faster than the guy who’s not doing it.”

UFC Light Heavyweight champion Jon Jones fought Chael Sonnen in April of 2013. Sonnen had been granted an exemption for TRT by the Nevada State Athletic Commission, of which Jones was openly critical: “I think Chael Sonnen made tons of money when he was a young guy, and now he’s an older guy. And now just to be able to take a drug and super-enhance yourself back to where you were in your 20′s is bull.” Jones defeated Sonnen by first-round TKO.

In 2012, Sonnen insisted he needed testosterone replacement not only to compete, but to live. In December of 2013, Sonnen claimed that were he to end the treatment, he would have the testosterone levels of a 93 year-old man. Testosterone levels can indeed shift drastically if treatment is terminated. Karen Louise Herbst, an endocrinologist at the University of Arizona, reviewed Sonnen’s medical history and concluded that he did indeed need TRT to continue competing professionally.  Herbst also said Sonnen’s use of testosterone, dating back to 2008, has likely made him permanently hypogonadal. The mystery is whether Sonnen needed to undergo treatment in the first place, with Herbst stating that it was unclear whether a definitive diagnosis of hypogonadism had been made when he began. If he or any athlete did begin using TRT with normally functional testes, then performance could indeed be enhanced, according to Dr. Steve.

An 18-year veteran, Vitor Belfort, known as “The Phenom”, came up in an era where mixed martial artists, ironically, had a specialty, whether it be wrestling, boxing, Brazilian Jiu-Jitsu, etc. Belfort was a knockout artist, as his 17 wins thereby would indicate. Despite training with Carlson Gracie, under whom he earned his Brazilian jiu-jitsu black belt, he rarely showed fans that side of his repertoire, instead settling fights with his fists. In short, Belfort’s style was exciting, but somewhat predictable, until TRT. The three wins that earned him his upcoming title shot all ended in head kick knockouts, a facet previously absent from his arsenal. The wins earned him bonuses from the UFC, with the promotion anointing his win over Luke Rockhold 2013’s Knockout of the Year. Belfort was under TRT during that span.

Joe Rogan, a UFC employee since 1997, has trained in disciplines ranging from Tae Kwon Do to 10th Planet Jiu-Jitsu. In his discussion with former UFC champion Matt Serra on his podcast, The Joe Rogan Experience, Belfort’s TRT use was brought up. “TRT Vitor…when we go down over eras of the greatest, most impressive fighters, there’s going to be a part of me that is sad that TRT Vitor has to come down to an end. It’s a part of me that’s very sad,” Rogan said. With the NSAC banning TRT and Belfort thus ending the treatment, Rogan remained unsure as to whether Belfort’s testosterone levels could naturally return to the normal range. “The question is, can he at this point in time, get to a point where he’s so healthy he can actually fight, not just get to a point where he can walk around, or get to a point where can have levels high enough so he can sustain a training camp?”

Vitor Belfort, Chael Sonnen and Dan Henderson have competed at an elite level while undergoing TRT. Their ages are 37, 37 and 44, respectively. Belfort previously tested positive for elevated testosterone levels in 2006, resulting in a nine-month suspension by the NSAC. When discussing his use of TRT in the past, Henderson said “I’ve been on it for six years, I’d be getting sick and laying on the couch more without it.” Shortly before being suspended, Belfort fought Henderson, losing a three-round decision. They fought again in November of 2013, with “TRT Vitor” becoming the first and only fighter to knock Henderson out in 42 career fights.

When comparing “pre-TRT Vitor” to “TRT Vitor”, the latter looks like the far superior fighter. At an age where most professional athletes retire from their respective sports, Belfort is handily disposing of top-level competition. But with Herbst confirming that Chael Sonnen has developed a dependency on the treatment, the question is whether Belfort will be able to reclaim his newfound form without it.

In May of this year, the fighter himself said he feels “like an animal” sans the treatment. He went on to say that he will be at a disadvantage in future fights. “My hormone stays at 200 today and the normal range is from 300 to 800. (TRT) raised my levels to a normal range according to the commission. My hormone was at the same level of my opponents’, so they are in advantage now,” Belfort said. Belfort passed his last random drug test. Between his and Dr. Steve’s statements, Belfort did not have an advantage in his last three victories. But to the trained eyes of Joe Rogan, Dana White and Jon Jones, testosterone replacement therapy does much more than level the playing field.

Belfort will fight Chris Weidman for the middleweight title on February 28th at UFC 184 in Los Angeles.

The photo at the top shows Vitor Belfort during his stint on TRT (left) and before said stint (right) Below is a video of Vitor Belfort (on TRT) defeating Luke Rockhold, as well as an ESPN post-fight discussion:

In this video, Dana White defends his stance on TRT. The physiology of the treatment is also explained by endocrinologist Dr. Margaret Wierman:

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