Therapeutic use exemptions (TUE) in sport

What a TUE is

WADA describes a TUE as permission to use a medicine or method that would otherwise break anti-doping rules, because the athlete needs it to treat an illness or medical condition ^[1]. Before taking any medicine, WADA says, an athlete has to check its status on the List or with their anti-doping organisation; if it is prohibited, the TUE process applies ^[1].

The starting point is the Prohibited List, which WADA publishes and which takes effect on 1 January each year ^[1][2]. WADA points out that it includes medicines people may not link with doping, such as insulin for diabetes and some blood pressure medicines, as well as methods such as intravenous use ^[1]. The article on peptides and the Prohibited List looks at the List itself; this one is about the exemption process.

The four conditions

WADA lists four criteria, and an application has to meet all of them ^[1]:

• The substance or method is needed to treat a medical condition that has been diagnosed and is backed by clinical evidence.
• On the balance of probabilities, using it will not improve performance beyond what returning to the athlete’s normal health would be expected to bring.
• It is an indicated treatment for that condition, and there is no reasonable permitted alternative.
• The need for it is not caused, wholly or partly, by earlier use of a prohibited substance or method without a TUE.

Where to apply

Athletes do not send TUE applications to WADA. WADA writes the rules, audits decisions and hears certain reviews, but applications go to an anti-doping organisation ^[1]. National-level athletes apply to their national anti-doping organisation (NADO); international-level athletes apply to their international federation, such as FIFA or UCI. Major event organisers, such as the International Olympic Committee, can also grant TUEs, valid for their event only ^[1].

Each anti-doping organisation decides how it defines national and international level, and some have their own rules, so WADA advises athletes to contact their organisation first; an athlete unsure of their level can ask their NADO ^[1]. A TUE can be submitted to only one organisation ^[1].

When to apply and who fills it in

WADA asks athletes to apply as soon as possible after a prohibited substance or route of administration is prescribed. If the substance is prohibited only in competition, the application should go in at least 30 days before the event ^[1].

The treating physician completes the form and supplies the supporting medical information, but WADA is clear that the athlete is responsible for making sure a complete application with enough medical detail to confirm the diagnosis reaches the organisation ^[1]. Forms can be filed through WADA’s ADAMS system or on an electronic or paper form, and WADA publishes TUE Checklists of the medical evidence an application needs, which athletes can take to their doctor’s appointment ^[1].

Decisions, conditions and appeals

A TUE committee at the anti-doping organisation reviews the application and must decide within 21 days of receiving a complete file ^[1]. If it is granted, the certificate sets out the dose, frequency, route and duration. Any change to those, such as a different dose or route, has to be reported to the organisation that granted it. Every TUE has an expiry date; continuing treatment after that needs a new application ^[1].

If a TUE is refused, the organisation explains why ^[1]. The routes of appeal depend on who decided:

What WADA itself does

WADA describes a two-part role. It facilitates the WADA TUE Committee, an independent group of three physicians that reviews TUEs granted by anti-doping organisations when necessary, and it can review a federation’s refusal at the athlete’s request ^[1].

WADA is not obliged to review every case, but it must review some, such as when a federation and a NADO disagree about the status of a TUE ^[1]. Outside a review request, WADA does not accept TUE applications directly from athletes ^[1].

Retroactive TUEs

A retroactive TUE is applied for after the substance or method has already been used. At least one of five conditions in the International Standard for TUEs must apply ^[1]:

• The athlete needed emergency or urgent treatment.
• There was not enough time, opportunity or other exceptional circumstance to apply, or to have the application evaluated, before being tested.
• National rules did not allow or require the athlete to apply in advance.
• The athlete was a lower-level athlete not under the jurisdiction of a federation or NADO when tested.
• The athlete tested positive after using, out of competition, a substance prohibited only in competition, such as a glucocorticoid.
• In exceptional circumstances, a retroactive TUE can also be granted when refusing it would be manifestly unfair. Meeting a condition only opens the door: the application is still judged against the four criteria ^[1].

An example: glucocorticoids and the competition window

WADA’s answers on glucocorticoids show how timing works. All glucocorticoids are prohibited in competition when given by injection, by mouth (including under the tongue or against the cheek) or rectally, and the in-competition period starts at 11:59 pm on the day before the event ^[2]. Given by those routes in that period, they need a TUE ^[2].

If a glucocorticoid is given out of competition but the event falls within the washout period WADA publishes, the doctor should document the history, examination, diagnosis, investigations, medicine name, dose, route and duration at the time. If a test is then positive, a retroactive TUE is submitted with that documentation ^[2]. Intravenous infusions follow a similar logic: emergency treatment comes first, and a retroactive TUE follows as soon as reasonable ^[2].

Moving up a level and competing abroad

• When an athlete becomes subject to a federation’s or event organiser’s rules, an existing TUE must be recognised at the new level, so a fresh application is not always needed ^[1].
• Some federations and event organisers recognise certain TUEs automatically, so WADA suggests checking their websites first; without automatic recognition, the athlete requests recognition through ADAMS or as the organisation specifies ^[1].
• A national TUE is valid for national-level events worldwide and does not need recognition by other national organisations; an athlete an international federation treats as international level needs that federation’s TUE or its recognition ^[1].
• A TUE granted by an event organiser is valid only for that event, and a NADO or federation TUE is not valid at the event unless the organiser recognises it ^[1].

Confidentiality, the 2027 rules and keeping records

WADA says everything in a TUE application, including the medical details, is handled under strict medical confidentiality. Committee physicians and other experts must be bound by confidentiality agreements, and anti-doping staff sign them too ^[1].

The rules themselves are about to change: the 2027 World Anti-Doping Code and International Standards, including a new International Standard for Therapeutic Use Exemptions, were approved in December 2025 and come into force on 1 January 2027 ^[3]. This article describes the process as WADA presented it on 20 October 2026; your anti-doping organisation can tell you what changes for you.

At a doping control, WADA advises declaring medicines and supplements taken in the past 7 days, and blood transfusions in the past 3 months if blood is collected ^[1]. A dated record of each dose, with who prescribed it, makes that easier.