Testosterone is a hormone that helps build muscle and strength, while epitestosterone is a similar substance that doesn’t really affect performance. Anabolic steroids increase testosterone levels in the body, which can lead to increased muscle mass and strength. 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. In the past five years, at least 15 mixed martial artists have been issued exemptions to use testosterone, the vast majority revealed or confirmed through public records requests filed by "Outside the Lines" with the major state commissions or athletic bodies overseeing the sport. Vitor Belfort used TRT to address low testosterone levels, which he claimed were due to previous injuries and the physical toll of a long fighting career.
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. "There is a set of rules for each state athletic commission, but they are kind of Mickey Mouse rules. So the route to being able to take testosterone is wide open. ... You go in and say 'I have these symptoms.' The doc says, 'Oh yeah, you got low testosterone.' You get a TUE." His use of TRT, along with other fighters', prompted the UFC and athletic commissions to increase scrutiny and ultimately ban TRT to ensure a level playing field. The era of TRT Vitor highlighted the need for stricter regulations around hormone therapies in sports.
They were about the ethics of hormone therapy in sports, the long-term health impacts, and what should be allowed in the spirit of fair competition. Others, including some doctors and sports regulators, raised concerns about the health risks of using synthetic hormones, especially for a sport as physically intense as MMA. As he aged and continued fighting, Belfort turned to TRT to address his declining testosterone levels, which can be a natural effect of aging and the physical demands of a long fighting career. The therapy, which involves administering synthetic testosterone, aims to bring hormone levels back to a healthy range. Ultimately, each method offers unique advantages and considerations, and fighters must carefully balance these to achieve peak performance while maintaining overall health and adhering to sports regulations.
In addition, Olympic wrestling and other international combat sports organizations have also noted the UFC’s policy changes. The UFC’s stance on TRT and its eventual ban had a ripple effect in combat sports. This led to extensive media coverage and increased scrutiny, which eventually resulted in TRT being banned across the UFC and most athletic commissions that regulate MMA. Wrestlers use strength, stamina, and physical endurance to perform in the ring, but the outcome of matches is predetermined, which changes how some organizations view TRT.
Some experts suggest that TRT might be acceptable if it is used solely to bring an athlete’s testosterone levels up to a normal range, rather than to boost levels beyond what is typical. TRT’s future in sports depends on how organizations weigh these ethical and medical factors. This leads to cases where fighters misuse or overuse testosterone to gain benefits, unknowingly putting their health at risk. Many people see TRT as similar to performance-enhancing drugs (PEDs), which are banned in most sports. For example, if one athlete takes TRT to boost testosterone levels, is that an advantage over those who don’t?
These organizations provided strict rules, requiring athletes to submit blood tests before each fight. Those against TRT felt it was a shortcut that bypassed the natural limitations of age and physical wear and tear. When some fighters use TRT, opponents without TRT may feel they are at a disadvantage.
The use of Testosterone Replacement Therapy (TRT) in sports, particularly in mixed martial arts (MMA), has sparked significant debate about whether it provides an unfair advantage to athletes. TRT’s initial acceptance gave some fighters a way to extend their careers, but as its use spread, the line between medical treatment and performance enhancement became blurred. For Belfort and other fighters who relied on TRT, this decision meant they could no longer use testosterone legally, drastically affecting their training and performance.
With a performance like that, I would think I was on steroids, too," Adesanya said. He cast aside the negative opinions as par for the course for those who want to take away from his performance. That was 10 weeks before Pierce wrote the Nevada commission about the diagnosis and start of care, according to commission records obtained by "Outside the Lines." Yet Belfort, who is training for a late May title fight with middleweight champion  Chris Weidman at UFC 173 in Las Vegas, looms ominously over a sport maneuvering through the TRT conundrum. We receive commissions from certain products purchased through links served on our site.
However, critics argue that TRT gives these athletes an unfair advantage over fighters who compete without hormone therapy. As fighters age, their testosterone levels often decrease, leading to less power and endurance. In boxing, testosterone levels play a significant role in a fighter’s strength, aggression, and stamina. For several years, MMA was one of the few sports where athletes could use TRT with a medical exemption.

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