TRT: The Lessons of the Hartman Case

Before Nate Marquardt cemented “Testosterone Replacement Therapy” into the mixed martial arts vocabulary; before Chael Sonnen made “hypogonadism” a relevant subject for fight fans; and before most states tested MMA fighters for performance-enhancing drugs, there was George Hartman.

A judo player and Olympic hopeful, Hartman may have been the first combat sports athlete to seek approval from a sanctioning body to use testosterone. His experience, spelled out in a 2006 arbitration decision, provides a comprehensive test case of why an athlete would seek such license and how regulators can ensure the request is for valid reasons.

“You just have to ask the right questions,” said Travis Tygart, chief executive officer of the United States Anti-Doping Agency, in a February interview on the Sherdog Radio Network’s “Rewind” program. Tygart tried the Hartman case. “And that gets to the sort of complexity of this world and what athletes and their doctors and their entourages will do to allow them to cheat to be successful.”

Hartman -- who has a 3-3 professional MMA record, including a 2007 loss to UFC middleweight C.B. Dollaway -- enjoyed success on the amateur and collegiate judo circuits, but he had trouble cutting it at the international level in his first brush with the competition there. He showed marked improvement, however, after his doctor prescribed him testosterone to treat hypogonadism, erectile dysfunction and depression.

According to the arbitration decision, Hartman began receiving testosterone shots in July 2003. Two years later, he was the No. 2-ranked judoka in the country behind Rhadi Ferguson, the 2004 Olympian who fought for Strikeforce in January. Competing at a higher weight category, Hartman won a gold medal in the Pan American Games and earned a spot on the U.S. team in the 2005 Judo World Championships.

Like Hartman, Sonnen cited hypogonadism -- a condition in which the testicles produce testosterone at an abnormally low rate -- as the reason his doctor had prescribed him testosterone. Marquardt has cited irritability, depression and sluggishness as prompting him to see a doctor.

An athlete’s testosterone production can be low for several reasons, but one explanation for a sudden, dramatic drop in testosterone levels could possibly be attributed to the use of steroids, which shut down the body’s natural testosterone production. Many causes of hypogonadism are treatable without testosterone. In Hartman’s case, Tygart said hypogonadism could not be supported as the reason his doctor detected low testosterone.

“What was put forth was this, in our opinion, fraudulent reason to provide testosterone,” Tygart said.

In March 2005, as part of the USADA’s rigorous out-of-competition testing program, Hartman provided a urine sample that was screened at a UCLA laboratory in Los Angeles. It showed the presence of exogenous testosterone, meaning that, according to the medical examiners, it came from a source outside of his body. For an athlete, that is considered a performing-enhancing substance because it can add strength and speeds recovery.

While estimates vary, most accepted normal ranges for male testosterone are between 250 and 950 nanograms per milliliter. Acceptable ranges change based on a person’s age and gender. A typical 300-milligram testosterone shot, according to testimony from a doctor in the Hartman case, will raise blood levels to 2,000 nanograms, and levels will then stay well above normal for at least three days. The arbitration decision does not specify Hartman’s levels in his failed test, though his doctor claims he had 256 nanograms per milliliter of testosterone in his blood when he prescribed him synthetic testosterone.

Facing a two-year suspension from competition for the test failure, Hartman took his case to arbitration and later applied for a therapeutic use exemption for testosterone. He argued that the Americans with Disabilities Act protects him because he had been diagnosed with hypogonadism, and that the law applies to the USADA because it is funded by federal money and thus qualifies as a public entity.

Under the act, discrimination takes place when an employer or public entity does not make a reasonable accommodation for those with a disability; the standard for a disability is an “impairment which substantially limits a major life activity.” Under the act, the United States Olympic Committee is required to encourage and provide assistance for athletes with disabilities. The law can be read to force state athletic commissions, which are public entities, to entertain therapeutic use requests. The Nevada State Athletic Commission has approved therapeutic use exemptions for three MMA fighters, executive director Keith Kizer told Sherdog.com. Kizer confirmed two of them are Dan Henderson and Todd Duffee, as first reported by the Wrestling Observer, but declined to name the third.

The Hartman arbitration case ended up hinging largely on the legitimacy of his hypogonadism diagnosis. Doctors were brought in as expert witnesses, and an independent medical analysis of Hartman was conducted. It was found that the doctor who made the hypogonadism diagnosis, Walter VanHelder, was also Hartman’s judo coach. VanHelder still runs a judo gym in Arizona that employs Hartman as a coach. The gym’s Web site promotes Hartman, who today is 37, as a fourth-degree judo black belt and “MMA expert.”

The arbitration panel found that VanHelder did not conduct several confirmatory tests in diagnosing Hartman and consistently halted the judoka’s testosterone injections at least 30 days prior to major competitions, which would give enough time for levels to normalize and allow an athlete to pass a drug test. The panel also determined that VanHelder did not run tests to confirm Hartman’s reputed erectile dysfunction, never diagnosed him with depression and testified that he did not know testosterone was a banned substance in Olympic sports -- a statement called “outlandish” in the arbitration decision.

The panel found particular fault with VanHelder’s only taking a single measurement -- in the afternoon -- of Hartman’s testosterone levels. Testosterone levels can, according to medical testimony at Hartman’s arbitration, fluctuate by as much as 20 percent in 20 minutes. Multiple tests are needed to accurately gauge one’s testosterone levels and to make any diagnosis of what may be causing a deficiency.

“I think [VanHelder] gave testosterone to a patient who had a normal testosterone level,” said Dr. Roger Johnsonbaugh, who conducted the independent medical exam of Hartman.

The panel rejected Hartman’s hypogonadism diagnosis. In doing so, it pointed out that his pituitary gland, which malfunctions in someone who is hypogonadal, was properly secreting all hormones -- such as growth, cortisol and Prolactin -- with the exception of those that would be stunted by synthetic testosterone use. VanHelder testified that something was preventing certain hormones from being produced properly in Hartman’s body and proffered that it was due to a head injury. The panel found that assessment “speculative” because no medical evidence of a head injury was submitted.

After considering the testimony of the parties, the panel determined that Hartman failed to sustain his burden of proof that he suffers from a medical disability and therefore his use of synthetic testosterone constituted a doping offense in violation of the World Anti-Doping Code. As a result, Hartman was ruled ineligible for a period of two years, and all of his competition results and awards since August 2003 were retroactively canceled.

It was during his judo exile that Hartman embarked on his mixed martial arts career.