Sometimes lost in the contentious discussion around fighters receiving a Therapeutic Use Exemption for Testosterone Replacement Therapy is that some fighters unequivocally need it for medical reasons. While many fans are cynical over Vitor Belfort's use of TRT, the case of Antonio “Bigfoot” is another matter.

Silva engaged in a battle for the ages with Mark Hunt at UFN 33, but tested positive for elevated levels of testosterone afterwards. Although he had been granted a TUE, he let his levels get too high, so the fight was declared a no contest, Silva was suspended for nine months, and he was denied his Fight of the Night bonus.

Silva's manager Alex Davis appeared recently on The MMA Hour and explained that Silva's case is a medical necessity.

“This is one of the guys that really have authentic technical reasons to be on TRT,” said Davis as transcribed by MMA Fighting. “He has acromegaly. His pituitary gland overproduces GH (growth hormone) and that unbalances all his other hormones.”

“When I started managing him, he was actually lactating. He has extreme low testosterone. He has extremely low testosterone, so he has a real reason to be on TRT.”

“I didn’t really take part on the TRT process. There was a miscommunication between him and his doctor. If I was in the middle of it maybe we would have avoided it. I didn’t realize I needed to be involved.”

“He took the instructions wrong, but he did not try to cheat. What happened was, there was a miscommunication with the doctor and he ended up taking injections at the wrong time. He was taking a month then started taking a week. He took one a week before the fight and one at the week of the fight, which wasn’t supposed to. It got mixed up.”