Treatment or Advantage? The 2014 Ban on Testosterone Exemptions in MMA

Timeline

1. 2006Vitor Belfort tests positive for an anabolic steroid after a bout in Nevada.
2. 2013Belfort receives TRT exemptions for three fights in Brazil.
3. Feb 7, 2014A random NSAC test finds Belfort's testosterone above the therapeutic range (disclosed in June).
4. Feb 27, 2014The NSAC unanimously bans TRT exemptions, effective immediately; the UFC backs the ruling.
5. Feb 28, 2014Belfort is replaced in his May title fight; Brazil's MMA commission says it will also ban TRT.
6. Jun 10–11, 2014Chael Sonnen is removed from UFC 175 after a failed test and retires.
7. Jul 23, 2014The NSAC suspends Sonnen for two years.

The ethical issues

• Balancing legitimate medical need against the risk of performance enhancement.
• Whether exemptions rewarded past steroid use that may have caused low testosterone.
• Fairness to clean opponents in a combat sport where advantages can cause injury.
• Fighters' health when an approved treatment is withdrawn suddenly.
• Whether regulators with limited budgets can monitor exemptions effectively.

Stakeholders

Stakeholder	Interests & obligations
Fighters with TRT exemptions	Continuing treatment and careers.
Opponents	A fair and safe fight against an unenhanced competitor.
Athletic commissions	Protecting fighter safety and the integrity of bouts with limited resources.
UFC	The credibility of its events and the health of its business.
Fighters with genuine medical conditions	Access to treatment without being excluded from competition.
Fans	Fair, clean fights.

The case

Background

Testosterone drives muscle growth and recovery, which is why synthetic testosterone is banned in most sports. But some men have medical conditions that leave them with abnormally low levels, and anti-doping systems allow a therapeutic use exemption (TUE) when treatment is medically necessary. In mixed martial arts in the early 2010s, testosterone replacement therapy (TRT) exemptions became common among prominent fighters, and controversial. In February 2014, Nevada ended them, and the UFC followed. The case asks whether a blanket ban was a fair answer to an exemption system that was hard to police.

The rules and governance

In the United States, combat sports are regulated by state athletic commissions, which license fighters, conduct drug tests and grant exemptions. The Nevada State Athletic Commission (NSAC), which oversees many major UFC events in Las Vegas, is among the most influential.^[4] Where no commission exists, such as at some events abroad, the UFC regulates its own events and generally follows Nevada’s rules.^[1][4][5]

Exemption standards varied. New Jersey’s commission, for example, followed strict guidelines that the Association of Boxing Commissions based on International Olympic Committee policy.^[8] Today, the World Anti-Doping Agency’s guidance for physicians says testosterone exemptions “should only be approved for hypogonadism,” meaning an organic cause such as a structural or genetic defect, and “should not be approved for low testosterone due to functional states.” Its list of functional causes includes aging and the use of “natural or synthetic androgens,” meaning prior steroid use.^[2]

The TRT era

FOX Sports reported that at least 15 major fighters had legally used TRT in various states and countries.^[4] MMA Fighting listed Dan Henderson, Chael Sonnen, Frank Mir, Forrest Griffin and Quinton Jackson among those who had received exemptions from state commissions.^[3]

The most scrutinized case was Vitor Belfort, a middleweight contender. Belfort tested positive for the anabolic steroid 4-hydroxytestosterone after a bout in Nevada in 2006. He later received TRT exemptions for three fights in Brazil, all of which he won by knockout, and defended the treatment, saying he would be at a disadvantage without it.^[6] Belfort was scheduled to challenge champion Chris Weidman in Las Vegas in May 2014, and his expected exemption application in Nevada was widely anticipated.^[6]

The UFC had begun its own random testing of fighters using TRT in 2013 to check that they were not abusing the therapy.^[5] Testing itself had limits. FOX Sports explained that under the testing procedures then in use, synthetic testosterone would generally be flagged only if a fighter’s testosterone-to-epitestosterone ratio exceeded Nevada’s 6:1 cutoff, which would trigger a more expensive carbon isotope ratio test that could distinguish natural from synthetic testosterone, a test that was rarely used because of its cost.^[4]

At NSAC meetings, consulting physician Dr. Timothy Trainor explained that prior use of performance-enhancing drugs is a main cause of hypogonadism.^[4] He estimated that less than one percent of the general population has primary hypogonadism, and said past steroid abuse can produce results resembling it, so exemptions could end up going to athletes who had “shut down their systems” with performance-enhancing drugs.^[3]

The ban

On February 27, 2014, the NSAC voted unanimously to ban TRT exemptions, effective immediately, across boxing, kickboxing and MMA. The ban applied to future applicants and to fighters who had received exemptions in the past, including from Nevada.^[3][4] Commissioner Skip Avansino proposed the motion; FOX Sports reported he said the commission’s budget was not enough to monitor users and that the system was being gamed.^[4]

Commissioner Bill Brady explained his support: “There is always a person there fighting on the other side who isn’t asking for anything, who is going to be tested, who is going to be tested randomly, and is clean.” He added, “we have an obligation to the fighter who doesn’t want an exemption and is clean.”^[3] Chairman Francisco Aguilar said TRT “gives people an unfair advantage” and urged other commissions to follow.^[3]

Minutes later, the UFC said it “fully supports” the decision. “We believe our athletes should compete based on their natural abilities and on an even playing field,” UFC president Dana White said, adding that the UFC would honor the ruling in international markets where it oversees regulation.^[1] White told MMA Fighting, “Couldn’t wait for that garbage to go away.”^[5]

Immediate effects

Belfort had agreed to a random NSAC test in early February while in Las Vegas for an awards show, but its results had not been released when the ban was announced.^[6] He said he would drop TRT and not apply for a Nevada license in time for May, though he later said the UFC had decided to replace him. Lyoto Machida took his place against Weidman.^[6] In June, Belfort disclosed that a random NSAC test on February 7, 2014, had found his testosterone “above the therapeutic range,” which he attributed to his prescribed dose the day before; he said later tests were normal or below normal.^[9]

Other regulators split. Brazil’s MMA commission said it would ban TRT, but only after Henderson’s March 23 fight, for which his exemption still stood.^[7] New Jersey’s counsel said the state was not ready for a full ban. He said New Jersey had granted only one initial TRT exemption among 4,930 MMA contestants since 2008, later revoked after that fighter failed a required monitoring test, had honored two exemptions from other jurisdictions after further testing and endocrinologist documentation, and had refused more than a dozen applicants. He pointed to rare legitimate cases, such as a soldier who “suffered testicular malfunction from an IED explosion” or testicular cancer survivors.^[8]

FOX Sports noted another concern: doctors said stopping TRT should be supervised and could have serious medical consequences, and the NSAC made no recommendation about fighters who had held exemptions.^[4]

Aftermath

In June 2014, Chael Sonnen was removed from UFC 175 after testing positive for anastrozole and clomiphene. He said he used them to help transition off TRT and to address fertility. “I want to stay within the rules, and I don’t fully understand them, and I have to put my health first,” he said, before announcing his retirement.^[10] A second test found human growth hormone, EPO, hCG and anastrozole. Sonnen said he wanted a dialogue “about how fighters who transition off [testosterone replacement therapy] can avoid violating any rules.”^[11] In July the NSAC suspended him for two years and required him to pay the commission doctor’s expenses and help educate fighters. One commissioner had wanted a lifetime ban. Sonnen said he felt “tremendous regret and embarrassment.”^[12]

The core dilemma

A medical exemption system is fair in principle: athletes with genuine conditions should not be excluded. But in MMA, regulators struggled to tell genuine cases from those caused by past steroid use, and they lacked resources to monitor users. A blanket ban protected clean opponents and was easy to enforce, but it excluded any fighter with a genuine need and ended treatment abruptly.

Competing values

• Medical need vs. competitive fairness: treatment for some versus a level field for all.
• Individual circumstances vs. enforceable rules: case-by-case judgment versus bright lines.
• Fighter health vs. fighter safety: the health of treated fighters versus the safety of opponents.
• Reliance vs. reform: fighters relied on exemptions that were revoked overnight.

Strongest arguments

For the ban: Commissioners said exemptions gave an unfair advantage and burdened clean opponents.^[3] Prior steroid use can cause the very condition exemptions treat.^[2][3][4] The commission could not afford adequate monitoring.^[4] Belfort’s elevated February test showed how hard therapeutic levels were to control.^[9]

Against a blanket ban: Genuine organic hypogonadism exists, and WADA’s framework permits exemptions for it.^[2] New Jersey’s strict approach granted very few exemptions without banning them outright.^[8] Abrupt withdrawal raised health concerns, and Sonnen’s case showed how a transition could lead to violations.^[4][10][11]

Applying the frameworks

Justice & fairness (Rawls)

Behind a veil of ignorance, a fighter would not know whether they would have a genuine medical condition or face an opponent with an exemption. Rawls would favor rules that protect the fair opportunity of every fighter. That supports strict limits, but arguably also a narrow path for genuine organic conditions.

Care ethics

Care ethics focuses on relationships and vulnerability. It highlights the opponent who absorbs blows from a possibly enhanced fighter, and also the fighters left to manage the medical effects of stopping treatment without guidance. A caring regulator would plan the transition, not just the ban.

Rights-based

Fighters have a right to medical treatment and a right to compete safely. A rights-based view asks whether a blanket ban unjustly removes the first right for a few to protect the second for many, and whether revoking existing exemptions without process respected fighters’ reliance on them.

Walk it through: the Simple Decision Model

1. Spot the issue: Whether to keep, tighten or end TRT exemptions.
2. Gather facts: Medical causes of low testosterone, prior steroid use, testing costs and capacity.
3. Test options: Keep exemptions; adopt strict organic-only criteria; ban outright; ban with transition support.
4. Check codes and law: Commission rules, ABC guidelines and WADA standards.
5. Decide and document: Explain the medical and fairness reasons.
6. Communicate and follow up: Give fighters guidance on stopping treatment safely and coordinate with other commissions.

What’s settled and what’s contested

• Settled: The NSAC banned TRT exemptions on February 27, 2014; the UFC backed the ban; Belfort was replaced; Sonnen failed two tests and was suspended.^{[1][3][6][10][11][12]}
• Contested: whether a blanket ban was better than strict criteria; how regulators should handle genuine medical cases; whether fighters received adequate support in transitioning.^[2][4][8]

Why this case matters

Therapeutic exemptions remain one of the hardest problems in anti-doping. The TRT ban shows how regulators weigh medical need, fairness, safety and their own capacity to enforce rules, and how a clear rule can solve one problem while creating others.

See also: The UFC-USADA Split: Who Should Run a Promoter’s Drug Testing?.

Key terms

Therapeutic use exemption (TUE)

Advance permission for an athlete to use a medically necessary substance that would otherwise be prohibited.

Equalizer vs. enhancer

Whether a technology or adaptation restores a level field (adaptation) or gives an advantage beyond it (augmentation).

Fair play

Integrity put into practice: respecting both the written rules and the spirit of competition.

Duty of care

The responsibility of coaches, organizations and institutions to protect the health, safety and well-being of those in their charge. It is not a license for total control.

Paternalism (hard and soft)

Restricting someone’s choices for their own good. Hard paternalism overrides competent, informed adults; soft paternalism steps in when information or autonomy is compromised.

Sanction certainty

The principle that the likelihood of being caught and punished deters misconduct more than the severity of the punishment.

Definitions from the Ethics Cases glossary.

Discussion questions

1. Should an athlete with a genuine medical condition be allowed to use a banned substance to compete? Under what conditions?
2. Was it fair for Nevada to revoke exemptions it had already granted?
3. Should past steroid users ever be eligible for a testosterone exemption?
4. Does the risk of injury in combat sports justify stricter rules than in other sports?
5. What should regulators do to protect fighters' health when they ban a treatment?

Sources

1. UFC Supports NSAC Ruling — UFC
2. TUE Physician Guidelines: Male Hypogonadism, Version 8.1 (October 2023) — World Anti-Doping Agency
3. Nevada State Athletic Commission bans TRT, urges fellow athletic commissions to follow — MMA Fighting
4. Nevada commission bans TRT exemptions, urges other states to follow — FOX Sports
5. Dana White says UFC will no longer allow TRT, 'couldn't wait for that garbage to go away' — MMA Fighting
6. Vitor Belfort to end TRT program — ESPN
7. Brazilian MMA Commission Follows Nevada's Lead, Will Ban TRT After Henderson-'Shogun' — Sherdog
8. New Jersey commission not ready to ban TRT, but reviewing Nevada's decision — MMA Fighting
9. Vitor Belfort admits he failed random February 7 drug test with elevated levels of testosterone — MMA Fighting
10. Sonnen Retires at 37 — UFC
11. Chael Sonnen tested positive in June — ESPN
12. Sonnen Suspended Two Years by NSAC — UFC