If you want to give Dr. Don Catlin a laugh, ask him what he thinks of the use of therapeutic-use exemptions (TUEs) for testosterone in the sport of mixed martial arts. Ask the 73-year-old anti-doping pioneer and International Olympic Committee member if he thinks there’s ever a situation where pro fighters -- even those in their 40s -- should be given permission to use testosterone, and then sit back and listen to his low chuckling response.



"That’s a joke," Catlin laughed. "Forget it. It’s a joke."



Catlin should know. The founder of the UCLA Olympic Analytical Lab, Catlin is responsible for developing such ground-breaking anti-doping innovations as the carbon isotope ratio test, which has been used to catch Olympic medalists using testosterone or a precursor. He also identified and developed a test for "The Clear" -- the designer steroid at the center of the BALCO investigation in 2003.



In addition to that expertise, Catlin also sits on the medical commission for the IOC that’s responsible for reviewing TUE applications from Olympic athletes, so he knows exactly what the process should look like when it’s being overseen by trained professionals -- which isn’t what’s happening right now in MMA, he said.

"What we do in the IOC, is we have specialists all over the world who all they do for us is conduct examinations for athletes who claim to be low on testosterone," said Catlin. "The levels of testosterone in men vary all over the place. Unless this particular person we send them to, and the people they send the data to for examination say so, we don’t give them [a TUE]. I think in all the years I’ve done it, we’ve given two. One was a kid who didn’t have any testicles because he had a terrible accident ten years ago or something. It just doesn’t happen."



And yet, in MMA it does happen. Fighters like Dan Henderson and Nate Marquardt, among others, have successfully applied for and received permission to use testosterone. Plenty more are rumored to be using it without an exemption, and in Catlin’s experience it’s the "preferred" performance-enhancing drug for athletes, in part because of the difficulty of detecting it.



"They like testosterone because they can use a form of testosterone that’s short-acting. It’s on and off in a day or two," he said. "Stanozolol is pretty good, but that has complications, including some liver troubles. Testosterone doesn’t have those kind of troubles, but you take it for life."



To even effectively catch testosterone users, you need a carbon isotope ratio test, which Catlin said most athletic commissions either don’t do, or don’t follow up on. And to dependably catch any athlete who’s doping in any way, you need the element of surprise and enough resources to make the most of it.



According to its critics, drug testing in MMA currently has neither, which is also why the sport has a serious drug problem that it isn’t even close to solving. Exactly how it should go about addressing that issue is a complicated answer, and one where a lot depends on who you’re asking.



It’s the Testing, Stupid



Last month Zuffa announced that, as of Jan. 1, 2012, all incoming fighters would be drug tested prior to completing their contracts with either the UFC or Strikeforce.



"We already work closely with athletic commissions to protect our athletes and now we're taking it one step further," UFC CEO Lorenzo Fertitta said in the press release announcing the move. "We're going to test any potential UFC or STRIKEFORCE fighter before finalizing their contract. This shows that we don't want performance-enhancing drugs in our sport."



The timing of the announcement was curious enough. It came about a week after Strikeforce 145-pound women’s champ Cristiane "Cyborg" Santos tested positive for the steroid stanozolol in California, and mere hours after it was announced that former Strikeforce light heavyweight champ Mo Lawal had tested positive for drostanolone in Nevada.



Those results might show that fight night drug testing isn’t wholly useless, but neither it nor the new-signee tests are sufficient, according to former NSAC ringside physician and current president of the Voluntary Anti-Doping Association (VADA), Dr. Margaret Goodman.



"The smart fighter, the fighter who plans ahead, can probably pass the tests that are done by the athletic commissions every time," said Goodman, a Las Vegas-based neurologist. "I think it’s great to do tests on new fighters before they sign with Zuffa, but again, that’s giving them some notice. ...True unannounced testing gives the athlete about an hour’s notice. That’s the way we do it with VADA, that’s how it’s done with the Olympic program, and that’s the way it should be done. It’s the only way to really do an unannounced program."



It’s also costly. When boxers Andre Berto and Victor Ortiz agreed to be the first two fighters to have their bout subject to VADA testing, the organization subjected them to an array of tests that will end up costing "about $6,000 per fighter," Goodman said.



"That’s expensive, I know. But the bottom line is, if you’re going to do the testing, then do the testing. If you’re not going to do it and really look for the drugs that fighters are using, then don’t do it at all."



While Goodman’s dollar figure sounds high to Catlin, who said he could fund a testing program "for a year with that kind of money," he agreed that state commissions don’t have the resources to effectively run a testing program. Individual organizations like the UFC, which declined requests for comment on this story, can’t be left to police themselves, he said.



"When it comes to control and state athletic commissions, that’s not the way to go. They don’t have the resources, and more than that, they don’t have the know-how. They don’t know what a positive for testosterone is, and they don’t know what to do about it. That’s why I have zero or little faith in them. They’d be better off pooling together than being separate groups. The UFC should put money in, but they can’t control it. That’s the trouble they have now. ...They have a new UFC testing program that I’ve read about, and the UFC is very excited about it. That’s good. But what are they doing? What are they testing for? I can’t tell you. You cannot have the sport itself tied to the testing. That doesn’t work. You have to have an independent body that is not subject to all the in-house pressures."



Nevada vs. the World



Nevada State Athletic Commission executive director Keith Kizer is used to criticisms of everything from his agency’s approach to drug-testing to its punishment of those athletes who are caught using. Since Las Vegas is still the fight capital of the world in the eyes of many boxing and MMA fans, the spotlight falls on Kizer’s commission more often than most.



Kizer is willing to accept some of that criticism, but when he hears the NSAC being judged by the standards of international organizations like the IOC, he can’t help but feel that it’s "a bit of an apples to oranges comparison," he said.



"To me, it’s not the funding so much as the lack of other resources. We’re just one state. We’re one state, in one country, so obviously we’re going to have less ability than a national or international agency."



Not only is the state of Nevada tasked with keeping tabs on fighters all over the globe, he said, but they don’t get adequate notice of which fighters will fall under their jurisdiction. The IOC knows well in advance who has qualified for Olympic events, and who should be subject to out-of-competition testing, but the NSAC doesn’t have that luxury.



"Tell me who’s going to be fighting on the [UFC] card here [in Las Vegas] on July 7," Kizer said. "I don’t think even Dana [White] and [UFC matchmaker] Joe [Silva] can tell me that right now."



Even when the organization does attempt to conduct out-of-competition testing, as it did before the Alistair Overeem-Brock Lesnar bout in December, it runs up against problems that most state agencies aren’t equipped to deal with. When it struggled to get Overeem to submit the appropriate sample in a timely fashion, Kizer said, "the issue...wasn’t that he was in Utah, it was that he was in Holland."



In that case, Overeem’s sample came in weeks after his camp was informed that he needed to take an out-of-competition test, but the former Strikeforce heavyweight champ was granted a conditional license anyway, following a hearing that the NSAC took undue criticism for, according to Kizer.



"What could we have done differently there? ...I guess you could just say that if there’s anything less than absolute, 100 percent compliance then we’re just going to say no as a matter of course. I don’t know if that’s fair either, though."



It’s a similar situation with the therapeutic-use exemptions for testosterone, Kizer said. The NSAC doesn’t take quite as hardline a stance on it as Catlin and IOC medical commission, he admitted, but it’s not as if TUEs are handed out frequently, either.



"I think there’s an impression among the general public that everybody’s getting exemptions for [testosterone replacement therapy]. I can’t speak for other states, but for us it’s probably about one a year asking and it’s 50/50 whether they’ll get approved. To even ask you’ve got to be able to prove that your testosterone is below normal -- not just low -- but below normal. Then you have to have a note from your doctor detailing your treatment plan, what the underlying cause is, showing that it’s not going to put you at undue risk or give you an unfair advantage, and then our doctor talks to their doctor."



Applicants are then asked whether they’ve ever failed a test for performance-enhancing drugs, whether they’ve ever used them either in this sport or others, and what other treatments they might have tried. Even then, applications are ultimately denied as often as they’re approved, Kizer said.



"I’d say in the...almost six years that I’ve been [executive director] we’ve definitely had less than a handful of guys get approved and less than a handful be denied. It’s probably been about the same amount, like three [approved] and three [denied]. There’s also been requests for [exemptions for] ADHD drugs. I know there’s one where the doctor said no and one where he said yes. And that’s about it. Usually it’s something like an asthma inhaler or cold medicine."



When Kizer hears people like Catlin or Goodman criticizing the NSAC’s testing procedures, he’s wary of people who may be trying to drum up business for their own drug-testing organizations, he said -- a problem that a state-run agency doesn’t have.



"All our information is public. Fight night testing goes through Quest Labs -- that’s not a secret," Kizer said. "They do two different tests," including one for "steroids, diuretics, and masking agents" and one for drugs of abuse like marijuana, cocaine, and amphetamines. The NSAC uses the same prohibited substances list as the World Anti-Doping Agency (WADA), Kizer said, and the list is freely available to athletes and the public.



"I had [former UFC heavyweight champion] Josh Barnett ask me once, ‘Where do I get a list?’ Well, here you go. WADA-AMA.org, the list of prohibited substances. Look it up. We actually have that codified in our regulations as well as on our website."



The Cheaters and the Cheated



If there’s one thing that almost all parties in the debate agree on, it’s that something has to be done. In a combat sport like MMA, the risks that come with performance-enhancing drugs are simply too great to ignore, according to orthopedic surgeon and MMA Junkie columnist Dr. Johnny Benjamin.



"It’s one thing if a baseball player is taking performance-enhancing drugs and crushing a baseball out of the park, but it’s a whole other thing if a fighter’s taking them and crushing their opponent with super-physiological ability," said Benjamin.



It’s a sentiment the NSAC’s Kizer has been echoing for years, and one the executive director is glad to see is gaining some traction, he said.



"This isn’t just about cheating. This is about perhaps killing someone," Kizer said. "..And yet, there are still people doing steroids in MMA and boxing, people who, if you went to them and said, ‘Hey, I could put some brass knuckles in your gloves and guarantee you no one will find out about it,’ they’d tell you to get the eff away from them. And yet they’ll take steroids."



As Kizer sees it, PEDs are not just a risk to the fighter who’s competing against an abuser of them, but also to the fighter who feels compelled to get on them just to even the odds.



"Steroids are illegal because of the damage they do to the person taking it. You don’t want to have another person who doesn’t want to take it feel like they have to in order to compete. I think there’s been a lot of athletes over the years who have taken steroids not because they want an unfair advantage, but because they want a level playing field."



And yet, not all banned substances are created equal. Some may pose serious risks to users and those who compete against them, but others, like marijuana, seem to present no such danger, at least according to onlookers like Dr. Benjamin.



"I think one place where an arbitrary line has been drawn is with marijuana use," said Benjamin, who noted that fighting under the influence of the drug would be dangerous for combatants and make brain injuries harder to diagnose, "but if someone smokes marijuana several days before competition, obviously it’s not still active in their system. They’re no longer high or under the influence, but they still have metabolites, and are likely to fail a urine test. That’s a very gray area to me."



Even Catlin said that while he’s not "a fan of a great deal of marijuana testing," there is "some rationale to it" with sports like MMA and boxing.



"Generally though, it’s a recreational drug, and I don’t think drug testing in sport should be used to control recreation," said Catlin.



Fighters like Nick Diaz, who has a prescription for medical marijuana in his home state of California, could make "a very legitimate argument" for a medical exemption, according to Benjamin, who said he’s "waiting for the first person to disclose that on their pre-fight paperwork, and see what the athletic commission in the responsible jurisdiction does."



According to Kizer, it hasn’t happened yet, at least not in Nevada. If it did, he said, the commission would take the same steps it takes in any other request for an exemption, including examining the medical issue that the banned substance purports to treat, and asking if there’s a non-prohibited substance that can offer the same or similar treatment.



But when it comes to serious issues affecting the sport, few in MMA would say that the focus needs to be on stamping out recreational drug use. It’s the performance-enhancing kind that has fighters talking among themselves, said Dr. Goodman, and it’s something of an open secret in fight gyms everywhere.



"After having spoken to 75 to 100 MMA athletes, I hear the same story. They’re all aware of other fighters using performance-enhancing substances, whether it’s steroids or testosterone or Human Growth Hormone or blood doping, I hear these stories all the time. In trying to put the [VADA] program together, I had to talk to as many [MMA] fighters and boxers and trainers, and it’s something I hear over and over again."



What few people agree is on what to do about it, and who should foot the bill. Those with a stake in the game, like Goodman, say the UFC and other organizations should hire a third party like VADA to do their testing. Those involved with state commissions, like Kizer, argue that commissions are doing a lot with the funding and resources they’ve been given, even if they don’t always get credit for it.



"There are going to be athletes in every sport that think they can beat the test," said Kizer. "Look at the Olympics. That’s the weird thing I find with some of the public, and not just in MMA, but people will say that because some guy got caught it shows that athletes aren’t concerned about the tests, that the tests must not work because the guy got away with it. Well, wait a second. He got caught. It doesn’t mean the test is foolproof, but it shows the test is actually pretty damn good. Every Olympics they catch somebody."



When the UFC travels outside of athletic commission jurisdiction, it acts as its own commission, conducting its own testing, much as it will for new signees. That’s a laudable effort, according to Catlin, but it’s not nearly enough.



"When I read that Dana [White] is running a new testing program, on one hand I kind of snicker, but then I say, okay, they’re trying. They’re putting words out there that make sense to me. Whether those words are backed by policies or not, I wouldn’t know. But you’ve got to start somewhere. The fact is, though, you can hire a testing agency that will find exactly what you want: nothing."



Anti-doping experts like Catlin and Goodman insist that the only reasonable solution is to empower some third-party, independent agency to conduct the testing, and for promoters like Zuffa to fund it, at least in part, but without having any influence over its findings. Any sports organization that does its own testing, according to Catlin, can never be fully trusted to report accurate, unbiased results, no matter how well-intentioned it might be.



"They need to clean it up. They know that, and they generally want to. At the same time, it’s the fox guarding the henhouse. They need a program. They want one, otherwise society would be all over them. They have a program, but is it the one they need to really clean it up? No."



Fans of the sport who also carry the burden of a certain amount of medical knowledge, such as Dr. Benjamin, still look to Zuffa and the UFC to do what’s necessary to help the sport get clean -- or at least cleaner.



"As many times as Dana White has said that the UFC is now a first-tier professional sporting organization, commensurate with NFL, NHL, Major League Baseball, the NBA -- one thing you notice about all those organizations is that they do their own testing," said Benjamin. "They don’t leave it to anyone else and say, hey, we’re not responsible. [Zuffa] wouldn’t really have to do much themselves except pay the bill. As they move more mainstream with these FOX contracts and things like that, at some point they’re going to have realize that that’s part of doing business on the level that they’re on, and then go ahead and write the check."



Writing checks is one thing the UFC seems willing to do. It’s giving up control of the process that might be more difficult. But just as White and Fertitta brag about running "toward regulation" after purchasing the UFC, Goodman said, they should also embrace improved drug testing as part of their quest for mainstream acceptance.



"They’ve done such a great job at promoting the sport, advancing the sport -- and I love the sport -- but I think this is something they could do that would really set them apart, safety-wise. It wouldn’t be that difficult to do, and it should be done. It has to be done."