When the Nevada State Athletic Commission (NSAC) put an end to its therapeutic use exemption (TUE) program for Testosterone Replacement Therapy (TRT), a domino was tipped over that started a chain reaction that will alter the landscape of mixed martial arts (MMA) for better and for worse.

The move by the NSAC was not only bold but also controversial in that the TUE program was viewed by many as being a means of controlling performance-enhancing drugs by allowing a controlled legal avenue in an effort to curb illegal supplementation. It must be noted, though, that TRT is essentially illegal in every other professional sport; in fact, testosterone was one of the many substances Lance Armstrong was using to cheat his way to seven Tour de France wins. Even so, testosterone was being allowed in MMA because there are legitimate reasons why TRT is medically necessary for MMA athletes. There are documented peer-reviewed studies showing that traumatic brain injury (TBI) is a cause for low testosterone. Veterans Affairs hospitals across the country have been dealing with treating veterans for Low-T due to TBI. The science shows that damage to the endocrine system through TBI is not only possible but also fairly common, so it is no wonder that more and more MMA fighters are coming in with Low-T every day due to the nature of their chosen profession.

So the idea that fighters could apply for a TUE to allow for the legal use of TRT while training for a fight was a novel one, albeit one that drew criticism to MMA and the Ultimate Fighting Championship (UFC) in particular. While MMA may be getting major prime time television coverage and acceptance, there are those who still disparage the sport as being barbaric and criticize its legitimacy when TRT is allowed.

The Nevada ban has led California and Brazil to ban TRT, which will effectively remove TRT as a viable treatment option for fighters in the UFC, if not across the board. This should be considered a good thing in that the sport cannot be accused of allowing fighters to get a competitive edge through hormone replacement therapy. If Anderson Silva was allowed to use steroids and human growth hormone to heal his broken leg, should Vitor Belfort and Chael Sonnen be allowed to use TRT? Especially if there has been alleged steroid abuse in their pasts? TRT will mean that an entire generation of aging fighters will likely be forced to retire. At 44 years old, Dan Henderson perhaps has the best claim to needing TRT in that he is at an age where Low-T is an issue and he has certainly sustained prior TBI in his career. Without TRT, he will likely be unable to compete at a meaningful level. The day Hendo hangs up the gloves will be a sad one and fans across the globe would all love to see the icon go out on his own terms as opposed to being hamstrung by a lack of TRT.

In the coming months, we will see a rash of fighters who are forced out of competition by the TRT ban. We will also see even more fighters get suspensions for continuing the practice illicitly; and this is perhaps the most troubling aspect of this historic turn. Fighters who cannot afford to quit fighting but need TRT to compete at the highest level are going to seek out illicit means of getting TRT and other PEDs. The argument is akin to outlawing abortion: make it illegal and it will still happen in back alleys and result in people getting hurt. It is true; banning TRT won

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