Nevada’s Keith Kizer Talks PEDs, Drug Testing: Part Two

by David P. Greisman

Nevada State Athletic Commission Executive Director Keith Kizer spoke to BoxingScene.com last week about several topics related to performance-enhancing drugs and drug testing.

In part two of the interview, Kizer discusses the granting of therapeutic-use exemptions. Nevada has issued exemptions to six mixed martial artists allowing them to undergo testosterone replacement therapy. Kizer elaborates on his concerns, what testosterone levels those fighters are allowed to have, and how the commission handles those who might have previously used performance-enhancing drugs.

Part one, which can be found at this link, included Kizer speaking of how Nevada handles positive test results from tests conducted by VADA or USADA; the idea of upgrading drug testing at the state level, particularly out-of-competition testing, and what difficulties that might pose; and the criticism of Nevada’s use of a 6:1 T/E ratio

BoxingScene.com: Multiple mixed martial artists have been granted therapeutic use exemptions, or TUEs, for what would otherwise be performance-enhancing drugs. What concerns, if any, do you have about this being a slippery slope in allowing fighters to use such substances?

Kizer: “A lot. A lot. This is an area of medicine that’s had some major advances in the last few years. And it’s not just about athletes. About a month ago I was on hold with a medical office, trying to get information unrelated to anything to do with TRT [testosterone replacement therapy]. And the hold music is commercials. It was basically, ‘You may have low testosterone. Check now with your doctor. Now there’s a very easy blood test you can do to check on that. There’s all this treatment you can get for it.’

“So it’s being pushed on people like you and me, on all adult males, maybe even younger than that. One, there is some legit treatment out there, the TRT treatment being legitimate. But there’s also some unscrupulous doctors out there who see it as a goldmine. They’re going to get the 45-year-old divorcee who’s going to come in and think he’s going to look like he did when he was 25 so he can start dating again. There’s going to be firemen who get on that and then carry the extra body out of the burning building and save another life, which isn’t necessarily a bad thing.

“And there’s going to be athletes out there that can perform better, be it on the weekend softball team or in the UFC It’s a legitimate concern, even before you get to the athletic issue, because this stuff has some pretty serious side effects. And, hey, if a little bit is good, why not take a lot more? I’ve talked to people, non-athletes, who’ve had TRT issues. And it’s kind of funny how they go ‘Doc, I misplaced my vial, my medicine.’ No you didn’t. I’m not an idiot. You’re using more than you should because you want bigger biceps. Guess what? You’re going to have to wait.

“People are doing that regardless of what they do for a living, but then you throw in the additional incentive of, ‘Hey, you use this stuff, you’re going to be a better athlete, be it in weekend softball, the UFC or in Major League Baseball, and you really got an issue there. So this is very important.

“The one thing I think is sometimes lost in this is people almost act like if there wasn’t any TUEs out there, we wouldn’t have any issues with prohibited substances in sports. It makes no sense. Whether there’s a TUE or not, there’s going to be people cheating, and the same people will be cheating. The difference is with the TUE process, be it for TRT or other prohibited substances, is if someone is legitimate — and we still have the same requirements as WADA.

“We actually took their policy and I added a couple more additional safeguards. I always refer to it as the platinum standard on top of the gold standard. If you go online, you can grab their TUE standards. I basically took that, and some things I had to take out about keeping things confidential, because again I don’t have that ability.

“The other things, for example, they make you explain if you’ve ever applied for another TUE, and if so what the results were. We do that as well, but I also make these guys under oath. Have you ever used any PEDs in the past? Have you ever failed a drug test in the past? And if so, explain. There are some additional safeguards there. But other than that, we follow that to a T.

“And part of that is the athlete has a heavy burden of proving, (A) that they have a legit medical condition, (B) that this treatment is a legitimate treatment for that condition, and that (C), as part of this treatment or plan it will neither give that athlete an unfair advantage nor put him at undue risk. For example, there are some medications for ADD that can give you a cardio episode, so we wouldn’t allow it.

“And in that regard, under WADA as well as under ours, just because you have the ability to get a TUE doesn’t mean you get the drug of your choice. If there’s other less performance enhancing or other less dangerous drugs out there to treat you, that’s what you have to take. Sometimes as an athlete you have to give up certain abilities or certain rights because of the sport. It might be that as a schoolteacher you can take a drug for your condition, but as an athlete you got to take a different drug for your condition.

A”ll that comes into play, and it’s pretty intense. And one thing, too is confusing, is I see some people say MMA is the only sport that allows TUEs like that. That’s not true. WADA’s given out TUEs for TRT. I don’t know how many of the national federations have, because that stuff’s kept confidential.

“Again with us, going to your slippery slope issue, it’s all public. Once a TUE is granted, it’s public. And the athletes need to know that. Another deterrent for them is if you vary from your TUE, you lose it, and you can get popped like you would for any other prohibited substance use.”

BoxingScene.com: How many TUEs have been granted in Nevada now?

Kizer: “Six. [Mixed martial artists] Forrest Griffin, Chael Sonnen, Frank Mir, Dan Henderson (who is still on TRT and will be competing on Sept. 1), Shane Roller (who is no longer on TRT) and Todd Duffee.”

BoxingScene.com: All mixed martial artists?

Kizer: “I don’t know why that’s the case. Some of those guys also do kickboxing, but as far as boxing goes, we haven’t had any requests for boxers. I’m not sure. The weight classes are much wider in MMA. I’m not sure if that has any effect, because supposedly weight cutting is a cause sometime of hypogonadism. Obviously the head trauma, which is also a possible cause, comes into play in both sports.

“Or it might just be that MMA fighters as a whole usually come from a background where perhaps they’d have greater access to medical care where a boxer may not, on average. We’ll see as it goes forward. It’s not just going to be a matter of athletes. Men in general, I think it’s very safe to assume, there are more on TRT this year than last year, by a lot, and a lot more than the year before, by a lot.  It’s not just going to be an issue with athletics, but with athletes of course we have the additional concern of it being for performance enhancing, especially in a contact sport.”

BoxingScene.com: What testosterone level would they then be allowed to have under a TUE?

Kizer: “First off, to be eligible — we’ve had to turn down some people because, luckily for them, they weren’t below normal. Low-normal, like with WADA, is not sufficient. They have to be below normal. So in the first place, without the TRT, you have to be below normal, usually about 350 — this is total testosterone. In the cases we’ve had, they’re all probably going to average about 200 in the six cases. In one case, he was below 100. That’s the first step.

“Then there’s other things you have to show and prove, including that it can’t be due to prior usage of steroids, which is hard to prove or disprove. That’s one reason why they’re under oath, which is important because, as you know, Marion Jones didn’t go away because of a failed drug test. She went away for lying under oath. That’s another safeguard and procedural issue that comes into play.

“Then once you’re on it, once you get your approval, we test you. In fact, we test them several times. I do both the blood and urine. The urine’s really to find out, to make sure it wasn’t a ruse for something else, so I’m testing for steroids, for diuretics and masking agents. But the more important thing is the blood. We test for the total testosterone, free testosterone, the LH, the FSH, the hematocrit and the hemoglobin.

“The average range is between the 350 and 1150. Some places uses 400 and 1200 as the range. It’s a pretty wide range. The [T/E] ratio is not really the issue. You check the urine, and the T/E ratio kind of is a benchmark on whether someone may be using synthetic testosterone or not. It’s really more of a telltale sign. If someone’s over 6:1, it’s pretty safe to assume that they’re using synthetic testosterone.

“If they’re above 4:1, it’s probably a pretty good sign that they’re using synthetic testosterone. Usually with TRT, sometimes people on TRT are still below normal, are still below 250 or 260, but they’re not 150 or 50. But I’d say on average with the TRT, these athletes when we test them probably average about 400 or 500.”

BoxingScene.com: What’s the highest level they’d be allowed to have?

Kizer: “If they’re above normal, there’s a major problem. But even if they’re close to that, I would have an issue. If they’re over 1,000, even though it might still be normal, but then there’s the issue of is the doctor being overly aggressive. Again, ‘If a little bit’s okay, why not use a lot?’ That’s a lot of people with a lot of different prescription drugs that might say that. If your doctor gives you a prescription and says ‘Take one pill a day to help you with your condition,’ and you take four, there’s a problem. You’ve violated your prescription, and your doctor’s probably not going to be very happy.

“The same thing comes into play here, but even more so because we’re talking about a combat sport. So if I had a situation where a fighter came back and his blood level was 1,000 or 900 or 800 even, is his treatment too aggressive? I tell these athletes, I say ‘Look, we’ll tell you what too much is but we don’t know what too little is. So you better talk to your doctor and say look, doctor, I need to be conservative here, because if I fail the test, if I go above it, I’m the one getting suspended, not you.’

“The last few we’ve had — Frank Mir, Chael Sonnen and Forrest Griffin were the three this year — we test them basically on fight night or within a couple hours after the fight, and their levels were extremely low, and very low in the month leading up to the fight. All that stuff comes into play.  It’s really hard, because the normal range is wide, between 350 and 1150, or 400 to 1200 depending on which lab you’re using.

“Even the 1:1 [T/E]ratio, I think, is misunderstood. But again, a normal male can be 5:1 and be completely legitimate, so you got to be careful when you’re talking a certain number as opposed to a certain range. So that comes into play. But that’s something we’ll really look at.  It might be a situation where we tested you and you were 800. You better be careful, because if your next test is 1,200, you’re not going to be fighting next week. So maybe you need to talk to your dodctorr and get that down to 500.

“800 by itself is not a violation. It’s something that puts him really close to it and they need to be careful That turned out to be a situation where they’re getting some build-up there, their next test might be a failure and they’re not fighting or maybe even worse than that. For the most parts these athletes have been, kind of a trial and error situation.

“I can tell you, at least dealing with these guys, part of the key is getting to a reputable doctor, not somebody who’s saying ‘More is more. Don’t you want to look even better? Don’t you want to be even stronger?’ Well, he’s not the guy who’s going to be suspended for a year.

“I can tell you, the UFC has done a very good job getting these guys to reputable doctors who’ve been very conservative in their treatment, but not too conservative. Sometimes when we’ve done these blood tests on fighters who just fought under a TRT, their testosterone level is still below normal.”

BoxingScene.com: You mentioned that fighters are asked under oath whether they’ve taken PEDs before. The need for a TUE might arise from previous PED use. Does previous PED use, if they were to admit it, disqualify them from being able to get a TUE from Nevada? Or what about if they’ve been caught using PEDs illegally before?

Kizer: “On the second question, no, being caught before by itself isn’t necessarily [going to], but it makes it a lot harder to get it. But there could be a situation where someone used before but it wasn’t the cause of his hypogonadism. But that’s going to make the fighter and, even more accurately, his doctor jump through additional hoops get. If they can meet it, great, if they can’t, they can’t. As far as it being a result of that, I would not grant one. Now whether they could appeal that to the full commission remains to be seen. We’ve never had that situation before, but I would not be in favor of a TUE for TRT with that.

“I guess could there be a situation where — I’ve had someone ask me, ‘What if a guy, when he was 17, did something stupid, took some steroids for his high school football team. Here is now 10 years later and he’s been totally clean. He was a stupid kid back then, peer pressure or a coach was pushing it on a kid back then, which unfortunately some high school football coaches probably do. Here he is now 10 years later, 12 years later, 20 years later, and he’s always been a model athlete, a model licensee, never done anything since then, but unfortunately it’s caused hypogonadism for him. Isn’t that person deserving of a healthy body again? It’s treatment that’s not going to give him an unfair advantage or put him at undue risk. It’s 100 percent legit. He can prove all this stuff.’

“That’s a pretty good argument. But my initial reaction is ‘Sorry, no,’ but he’d at least have the ability to make that argument to the full commission. That’s something they’d at least listen to. Whether or not they’d grant it remains to be seen.”

David P. Greisman is a member of the Boxing Writers Association of America. Follow David on Twitter @fightingwords2 or send questions/comments via email at fightingwords1@gmail.com