Along with exemptions, several MMA fighters and officials also described to "Outside the Lines" widespread use of performance-enhancing substances in the sport. One top contender labeled PED use in the sport "rampant," and a prominent state athletic commission chairman matter-of-factly acknowledged: "We got some doping going on in MMA."
A few state commissions where MMA fights occur less frequently acknowledged they don't test for PEDs or don't require fighters to reveal whether they are being treated with testosterone. Nor, apparently, does any state -- including Nevada, arguably the most influential commission and a model for other regulators -- require notice in a bout agreement of an individual having an exemption to use testosterone, so an opponent is left to learn through the rumor mill, if at all.
Drug testing in MMA is confined to postfight by the state athletic commissions that test for performance-enhancing substances, with Nevada believed to be the only commission attempting out-of-competition testing. The UFC also does some of its own testing, although officials declined comment and little is known about the program. By comparison, major pro leagues such as the NFL and MLB -- in part as a result of urging from Congress -- engage in far more rigorous programs that include testing at the start of camp or spring training as well as year-round, random testing.
"Outside the Lines" found the average age of the MMA fighters when granted their first testosterone exemption was 32 -- the youngest 24. The majority enjoyed exemptions from multiple states, and, in some instances, fighters were found to have simply informed a commission they were on TRT rather than filing a formal application to compete while being treated with testosterone.
U.S. and international anti-doping agencies insist therapeutic-use exemptions for testosterone should be rare and permitted only in dire medical cases such as testicular cancer and Hodgkin's disease, as is the norm in most major sports. The international standard for an exemption specifically states that "low-normal" levels of a hormone isn't justification for granting approval, also noting the same of isolated symptoms such as fatigue, slow recovery from exercise and decreased libido.
Dr. Richard Auchus, a leading endocrinologist and University of Michigan professor of internal medicine, described the incidence of low testosterone or what is known as hypogonadism in healthy 30-year-olds as "vanishingly small" -- or well less than 0.1 percent.
"What people have to understand is a [testosterone exemption] is granted for a disease, not for a [low] lab value," said Auchus, a consultant to USADA. "If you say idiopathic hypogonadotropic hypogonadism, meaning 'I don't know why you have it, but you have low testosterone production and there is nothing wrong with your testes' -- well, that can happen because you are taking exogenous androgen [steroids]. That doesn't cut it."
The issue, said Catlin, is that synthetic testosterone remains one of the favorite drugs to enhance performance. Anti-doping leaders thus fear testosterone exemptions might be used by athletes to dope under the disguise of legitimate medical need.
"It's just a farce that is perpetuated in MMA," said Catlin, who developed the test used to differentiate an individual's natural testosterone from the synthetic version. "It is doping. It is cheating. It is both."