Therapeutic Use Exemption (TUE)

International Standard for Therapeutic Use Exemption (ISTUE)

The International Standard for Therapeutic Use Exemptions (ISTUE) is a mandatory International Standard developed as part of the World Anti-Doping Program.

The purpose of the ISTUE is to establish

the conditions that must be satisfied in order for a Therapeutic Use Exemption (or TUE) to be granted, permitting the presence of a Prohibited Substance in an Athlete’s Sample or the Athlete’s Use or Attempted Use, Possession and/or Administration or Attempted Administration of a Prohibited Substance or Prohibited Method for therapeutic reasons;
the responsibilities imposed on Anti-Doping Organisations (ADO) in making and communicating TUE decisions;
the process for an Athlete to apply for a TUE;
the process for an Athlete to get a TUE granted by one ADO recognised by another ADO;
the process for WADA to review TUE decisions; and
the strict confidentiality provisions that apply to the TUE process.

WADA Therapeutic Use Exemption Guidelines

This TUE Guidelines document takes ADOs through the lifecycle of the TUE, starting with the criteria for granting a TUE.

The Guidelines bring forward key ADO responsibilities, including support of Athletes making TUE applications, recognition of TUEs, and communication of TUE decisions. Confidentiality provisions and WADA’s role in the review of TUE decisions are also addressed.

These Guidelines are not mandatory, but are intended to give clarity and additional guidance to Code Article 4.4 and the ISTUE, each of which is mandatory.

Therapeutic Use Exemption Process

What is TUE?

Athletes may have illnesses or conditions that require them to take medications or undergo procedures. If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List , a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. Applications for TUEs are evaluated by a panel of physicians the TUE Committee (TUEC).

Why the need for TUE?

If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List, a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. Applications for TUEs are evaluated by a panel of physicians (TUE Committee).

Who should apply for TUE?

Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method. You should verify with your NADO to know to whom you need to apply and if you can apply retroactively. For an athlete to be granted a TUE, All of the four following criteria must be met (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2):

a. The athlete has a clear diagnosed medical condition, which requires treatment using a prohibited substance or method;

b. The therapeutic use of the substance will not, on the balance of probabilities, produce significant enhancement of performance beyond the athlete’s normal state of health;

c. The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative;

d. The necessity to use that substance or method is not the consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.

When should one apply?

For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition.

Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method. You should verify with your NADO to know to whom you need to apply and if you can apply retroactively.

First, check if the required medication or method you intend to take or use is prohibited as per the WADA Prohibited List.

You have a responsibility to inform your physician(s) that you are an Athlete bound to anti-doping rules. You and your physician(s) should check the Prohibited List for whatever substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives, if there are none, apply for a TUE. Remember athletes have the ultimate responsibility. Contact your NADO if you are having difficulties.

Then, contact your NADO to determine your competition level and TUE application requirements.

How to apply to your NADO for a TUE?

Option 1: Only through ADAMS

You must exclusively submit your TUE application, including the required medical file, via ADAMS. If you do not have an ADAMS account yet, please contact your NADO to have your account set up.

Option 2: through ADAMS or paper format/electronic TUE form

Athletes are encouraged to submit TUE applications via ADAMS, together with the required medical file. If you do not have an ADAMS account yet, please contact your NADO to have it set up.

Otherwise, you can download the SEARADO’s TUE Application Form , and once duly completed and signed, send it together with the required medical file to mingkai@searado.com.

Your TUE application must be submitted in a legible form using capital letters or typing.

The medical file must include:

A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible),
The results of all examinations, laboratory investigations and imaging studies relevant to the application.

Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support during the TUE application process, and TUE Physician Guidelines for guidance on specific common medical conditions, treatments, substances, etc.

Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.