When the news came out on Wednesday that Vitor Belfort had been given a testosterone use exemption for using the drug as therapy before his Jan. 19 victory over Michael Bisping in Sao Paulo, Brazil, it was the most controversial public revelation of an issuance thus far.

It has always been whispered, and in some cases even shouted, that the increasing volume of testosterone use exemptions in MMA has been due to the number of athletes whose systems have been damaged by previous steroid use. But since the current testing procedures likely catch only a small percentage of users, when names publicly come out that have been approved for TRT, there has almost never been any tangible proof the athlete in question had used steroids in the past.

But in the case of Belfort, there was such proof with a previously failed steroid test in Nevada and a subsequent suspension.

Still, the news wasn't surprising at all. Rumors abounded around the time of UFC 152, when it came out that one of the fighters was given an exemption, but the name was never released. Belfort's own beat-around-the bush answer when asked about rumors of such use before the fight three weeks ago in an ESPN.com interview only served to heighten the suspicion. For those following the story, when he took off his shirt before the Bisping fight, it was almost like thumbing the nose in the face of those concerned about the direction and future of the sport.

In theory, the idea of medical testosterone replacement therapy is to take someone who, for whatever reason, has damaged their system to the extent that it no longer produces a healthy amount of testosterone, and gets them back to average levels and not the top allowable levels. There are legitimate medical uses for such therapy, including among men who were heavy steroid users for years. The question is not whether they should be allowed to use the drug in question for their health, but whether they truly need it since athletes have been conning doctors on this subject for years, and more so, should be allowed to compete in a sport that involves physical damage to the opponent while on it.

Then there is the sticky point. A very small percentage of men under the age of 40 naturally produce low enough levels of testosterone that it can be deemed unhealthy. Testosterone replacement therapy has gotten far more coverage in MMA than almost any other sport. Perhaps because the media in that sport is either more concerned, or has its head buried less in the sand than those in other sports. But there are guidelines in most sports very similar to those used by the UFC and the various state athletic commissions.

For Bisping, three of his five career losses have been to fighters that it has publicly come out were using TRT, Dan Henderson in 2009, Chael Sonnen in 2012, and Belfort. They were the three most important fights of his career, as in each case, the winner was to be in line for a middleweight championship match. There is no guarantee he would have won any, let alone all of those fights, if the opponent wasn't using. But it is impossible not to consider the possibility in every case.

In his case, the losses have cost him literally millions of dollars.

Bisping was in England shooting a movie after the Belfort fight, and returned home to Southern California inundated with interview requests. The irony of this case is, long before Bisping signed for this fight, he was one of the company's most outspoken critics of TRT. Plus, nobody had made him aware before the fight that he would be going against someone approved for the drug. But the reality is, while never confirmed, it is also impossible that Bisping didn't go into the fight without a fairly strong suspicion that was the case.

Still, he lost, decisively and didn't want to come across as a crybaby, nor did he want to dwell on the loss when he has another fight coming up.

On Friday night, he released a statement on his web site:

As I said right after the fight, I lost because I made a mistake and Vitor took advantage of it. It sucks. I don't like it, but that was the result. I lost. Bottom line. Over the past couple years, and even right before the fight, I have made my views on TRT very, very clear. I don’t feel that I need to go into depth about it again right now. All I have to add, about this specific instance, is that it is very disappointing that someone who was caught cheating with testosterone in the past, now gets to use testosterone legally. A well known side effect of steroids is that it reduces testosterone, so I don't understand how it would make sense to then grant someone an exemption to then increase testosterone. All that being said, I am not here to make excuses or cry over spilled milk. I fight in the best organization in the world, The UFC, and am very excited to work and earn a title fight, the right way. That process starts by whooping Alan Belcher's ass at UFC 159 on Saturday, April 27th, live on PPV. Thanks everyone for their support – can’t wait to spend some time with British UFC fans in London next week and I will be back, better than ever.

The idea that it's not fair to not allow exemptions, or is necessary, is contradicted in of all places by the pro wrestling company World Wrestling Entertainment. The company, which had its own long-term history of issues with steroids, allowed its performers use of TRT when it restarted its drug testing program in 2006. But it has since all but banned usage. This came after the death of Chris Benoit, whose endocrine system was damaged, likely from nearly two decades of steroid use. Upon his death, a suicide, after he had murdered both his wife and young son in a well-publicized case, it was discovered in his autopsy that he had roughly five times the amount of testosterone in his system as he should have had taking to get him back to normal. It was all legally prescribed to him by what is known in that profession as a "mark doctor," someone who prescribes to celebrities what they want.

It would be incredibly naive to believe the "mark doctor" types that were prevalent in pro wrestling, as well as in football and likely numerous other sports, don't exist in MMA, particularly for top tier fighters or some of the most successful camps. And therein lies the problem. We've already seen the embarrassing testimony of doctors for Chael Sonnen and Alistair Overeem at commission meetings, so to simply accept that because someone got a prescription that everything is kosher is beyond naive.

In the case of WWE, the company made the decision going forward to allow TRT for men under contract who had similar system damage, but would no longer allow it for any new performers, or grant future exemptions. If a cosmetic-based business, where their jobs are to not damage their opponent, can do such a thing, then one questions why a business where the prime objective is to physically damage an opponent in a fight, can't protect its clean athletes to the same level.

There are a number of problems in MMA regarding the use. The first is whether it gives a participant an unfair advantage. The idea that getting one back to normal limits should be no more of a competitive advantage in theory than knee surgery that allows someone to get back strength and functionality in that joint. But in fact, that may not be the case.

Nate Marquardt, the only other fighter that it has publicly come out is on TRT who has a failed steroid test in his past, was given an exemption by the state of New Jersey for his 2011 fight with Dan Miller. In getting his exemption, he had to agree to follow up testing.

Prior to his next fight, scheduled against Rick Story in Pennsylvania, he was surprised with a test by New Jersey, which showed him significantly over the top limit of allowable testosterone. The idea of such therapy should only get you to normal levels, not well above top levels, or more than double average levels. He couldn't even get a reading under the top limit days later after stopping usage, and was not allowed to fight. But in his case, it was a fluke that he was caught. Pennsylvania, the state he was fighting in, was not going to test him until after the fight.

There is likely a percentage of fighters who would need this therapy to function that did not develop hypogonadism, the clinical name for a body that produces low testosterone and that never used steroids. The ethical question surrounding Belfort, as well as Marquardt, is should this be allowed for damage one has done by previous steroid use. The problem is, it is virtually impossible to prove what caused the problem, or to say without question it was steroid use.

Where Belfort is a lighting rod is that his long career in the sport has shown him having marked physical changes.

He went from a nearly 230-pound teenage heavyweight who looked almost like a competitive bodybuilder to a very normal looking 185-pounder over the course of his career. Then, for the Jan. 19 fight with Bisping, he was noticeably more muscular than he had been in years, to the point professional fighters on twitter were outright making accusations from the moment he took his shirt off before the fight started.

There would be a lot less talk if a fighter on TRT showed up looking similar to other fighters as opposed to looking like one perceives a steroid abuser to look. When the opposite happens, questions naturally arise.