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LAS VEGAS -- When UFC middleweight Vitor Belfort applies for a fighter’s license in Nevada on Wednesday, he will do so under unique circumstances. The Nevada State Athletic Commission has no precedence regarding certain details of Belfort’s application -- nor is it likely to face these details again as they pertain to testosterone replacement therapy, which is now effectively banned in combat sports. On Feb. 7, Belfort, 37, submitted to a random urine test at the NSAC’s request while he was in Las Vegas to attend an MMA awards show. As an unlicensed fighter within the state, Belfort could have declined the test, but he agreed to it. He was expected to file an application with the NSAC around that time for a then-proposed UFC fight in May. The results of that urinalysis were kept private under medical law until early June, when Belfort released a public statement admitting he tested positive for a high testosterone level and published corresponding lab reports to prove it.  The initial urine test collected by the NSAC, which Belfort did not publish, showed the Brazilian’s testosterone-to-epitestosterone ratio to be 14:1. The NSAC considers a positive test to be anything above 4:1.
There is a common misunderstanding in terms of that ratio, however. In Belfort’s case, that number means very little. In February, Belfort’s lawyer Neal Tabachnick said the NSAC results were “not relevant.” Technically, he was correct. At the time Belfort took the test on Feb. 7, he was on TRT, which was controversial but legal if approved. Belfort had received the necessary approval to use TRT prior to three fights in 2013, all of which took place in Brazil. It was no secret Belfort was on TRT when he took the urine test in Nevada, and since he wasn’t licensed in the state, he had no legal obligation to stop. He was expected to apply for a therapeutic use exemption for that title fight in May. The NSAC made that a moot point on Feb. 27, however, when it banned TRT. A medical patient on TRT is expected to produce an elevated T/E ratio. That ratio does not necessarily indicate a high serum testosterone level in the blood. It only strongly indicates the presence of synthetic testosterone. In other words, the random test conducted by the NSAC did not medically prove Belfort’s testosterone levels were above normal. They merely confirmed he was using synthetic testosterone. Again, everyone knew that already. “Typically, you can say a 6:1 ratio proves PED [performance-enhancing drug] use,” said Dr. Timothy Trainor, consulting physician to the NSAC. “But when it comes to ‘Joe Smith,’ who is a TRT patient, the T/E ratio is a useless, meaningless test.” Why would the NSAC request Belfort to produce a "useless and meaningless test" in the first place? The answer is it probably shouldn’t have. In random tests taken since Belfort’s case, the NSAC has ordered blood and urine tests, which in the case of Chael Sonnen produced positive results for several banned substances. Belfort apparently underwent a voluntary blood test on Feb. 7 -- which is not a useless, meaningless test in terms of determining actual levels of testosterone in the blood. Belfort submitted the results of that test as part of his application. Results showed Belfort’s testosterone level was at 1,472 nanograms per deciliter. According to the Phoenix-based LabCorp that analyzed the test, a normal range of testosterone should fall between 348 and 1197 ng/dL. Essentially Belfort willingly submitted a self-incriminating blood test. “That is absolutely, 100 percent correct,” Trainor said. After the initial urine test, which produced the T/E ratio, the NSAC requested additional blood and urine tests from Belfort over an extended period of time. The blood tests showed a substantial drop in Belfort’s serum testosterone level, to as low as 142 ng/dL on May 29. The urine tests showed his T/E ratio returned to a far more normal 2:1. Both indicated he had stopped taking TRT. “I wrote a letter to the NSAC after reviewing his tests that stated, ‘This looks good,’” Trainor said. “The urine tests look like he was taking TRT and then he stopped.” What does all this mean in terms of Belfort receiving a license Wednesday? The NSAC has a “failed” urine test from Feb. 7 that it conducted, but the test doesn’t mean much for the reasons stated above. The results prove Belfort was on testosterone, but he had approval from the Brazilian athletic commission to do so. The NSAC has the blood test that shows Belfort’s levels were spiked above normal ranges on Feb. 7, but there is no precedent on how to handle that, so it would have to set one. Does an unlicensed fighter with a testosterone level approximately 300 ng/dL above normal deserve a suspension? If yes, how long? According to Trainor, the information provided is not enough to come to any kind of conclusion regarding Belfort’s “abuse” or lack thereof of TRT. He did say, however, that every fighter who had previously received an exemption for TRT in Nevada had been monitored by the commission and never tested above normal ranges. “Anyone who received an exemption from our state was overseen and always come back within normal range,” Trainor said. “In theory, Belfort should have been able to keep his at a normal range if he had a competent doctor.” UFC president Dana White stated last week that the promotion will book Belfort for a title fight against Chris Weidman, as long as Belfort receives a license in Nevada. White added that the fight does not have to take place in Nevada and that Brazil will be considered.
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