There’s a lot of information to parse as it relates to Cris Cyborg’s recent potential USADA violation, so step one is to break down everything we do and don’t know so far.On December 5th, 2016, Cyborg gave a sample to USADA which came back on December 22nd apparently positive for the banned diuretic Spironolactone. We do not know if Cris disclosed her use of the medication on the disclosure form at test time.

Cris did not apply for a TUE for the spironolactone, as her reps claim her doctor--who they say works with UFC and Olympic athletes regularly-- told her she didn’t need one.

Cris claims to have started the medication the Monday after her previous fight. Cris’s team have also previously claimed that she was so dehydrated on this day that her blood was too thick to be drawn, and that her weight cut caused kidney issues.

During her weight-cut, Cris complained about being on a birth control medication containing drospirenone, which acts as a mild, potassium-sparing diuretic. It is also completely legal for use and not banned at any time by WADA. Spironolactone, which Cris is now taking, is almost chemically identical to drospirenone and the two drugs have almost identical effects as it relates to their diuretic action, though spironolactone is considered to be markedly more powerful.

Spironolactone is specifically contraindicated for use in patients with decreased kidney function (meaning it shouldn't be prescribed to those patients unless there is no alternative, which isn't the case here), so if that claim is true, the decision to start her on spironolactone is a questionable one. As it stands, Cyborg did release a list of her medical conditions from the time, and there is no mention of kidney damage or dehydration at all. Here is the list.

CID E 87.6 - Potassium deficiency

CID 87.8 - Possibly electrolyte imbalance if it’s E 87.8, but can’t be sure without identifying letter. If no identifying letter means A, then A 87.8 is viral meningitis.

CID E 44.0 - Moderate protein-energy malnutrition (weight loss)

CID N 83.2 - Retention or simple cyst of ovary. Specifically not neoplastic, congenital or polycystic ovary syndrome.

CID I 15.9 - Unspecified secondary hypertension (high blood pressure).

CID Z 73.3 - Stress (physical and mental strain).

CID E 06.3 - Autoimmune thyroiditis

Some things immediately stand out here. Specifically, as she was taking drospirenone, it should have been very difficult for her to have a potassium deficiency. This suggests that she stopped taking the drospirenone suddenly, as many of her symptoms could be explained by this.

Drospirenone has several effects; on one side are the effects on female sex hormones which allows it to act as a birth control medication, on the other are the “side effects” of the drug, which give it diuretic properties by acting on the renin-angiotensin-aldosterone system (RAAS). Among other things, this helps remove fluid from the body while retaining potassium, reduce sodium in the body, and reduce blood pressure.

If Cris suddenly stopped taking drospirenone without properly accounting for that, it’s likely she would find her potassium levels decrease, and that she would start to retain fluid and salt, and her blood pressure would increase. Three of her symptoms are, in fact, low potassium. High blood pressure and electrolyte imbalance.

As Cris split with her nutrition coach immediately after her fight, it’s unlikely she would have had accurate advice available on how to adjust her diet and lifestyle properly to ensure her body remained in homeostasis when she stopped drospirenone.

In this instance, spironolactone, as a treatment, makes sense. As spironolactone has very similar effects to drospirenone--albeit more “severe” effects, as it’s a more powerful drug--it’s reasonable to use spironolactone to treat symptoms brought on by improper discontinuation of drospirenone.

However, this only makes sense if her claims about the effect of the weight cut were untrue or exaggerated. If Cris was, in fact, badly dehydrated that Monday, and if she had kidney damage from the weight cut, then putting her on spironolactone is a potentially dangerous course of action. It should be noted that her released medical records do not support her camp’s claim that she damaged her kidneys while cutting weight.

There are some other possibilities. Spironolactone has anti-androgenic effects and is sometimes prescribed to women with polycystic ovary syndrome (PCOS). This is because one of the side effects of PCOS can be increased male sex hormones, which leads to masculinizing effects such as increased body hair, hair thinning or loss and acne. While Cris does not appear to have PCOS, she does apparently have issues with non-PCOS ovarian cysts, and it’s possible they have a similar effect. If Cris has excess testosterone caused by the cysts, spironolactone could be used to control those side effects.

As spironolactone is useful in controlling androgenic side effects, its use is popular among female anabolic steroid users. In much the same way as male steroid users take aromatase inhibitors or selective estrogen receptor modulators to avoid feminizing side effects of steroid use, female users take spironolactone to avoid masculinizing side effects.

Spironolactone is classed under WADA as a diuretic and masking agent. It doesn’t have any inherent masking properties, however diuretics can be used to dilute the amount of any banned substance in the urine and can theoretically be used to slightly reduce the detection time by flushing the substance metabolites out of the system more quickly. That being said, as spironolactone itself is banned, using it for this purpose would be foolish at best.

It’s worth noting that outside of its ability to help a fighter make weight for a fight, or its use as an adjunct in anabolic steroid use, there is no real performance enhancing benefit of spironolactone. It would not help Cris train harder, or make her stronger or faster.

Spironolactone carries a 12-month base suspension under the UFC anti-doping code. Cris has stated that her team are currently applying for a retroactive TUE. Erik Magraken wrote a breakdown of what’s required for a retroactive TUE, which you should read here.

Cris’s team laid much of the blame for the situation at the feet of her doctor for not informing her she required a TUE, which could theoretically reduce her liability and thus her suspension under the UFC anti-doping program. To do so, Cris will likely have to prove that it was reasonable for her to rely solely on her doctor for this without checking herself, and the doctor will probably have to confirm that she wrongly informed Cyborg that she didn’t require a TUE.

As a result, I expect her to receive a suspension of 12 months, potentially reduced to as low as six months, assuming there’s no evidence of any other wrongdoing, or any suggestion that her spironolactone use was concomitant with other PEDs.