Therapeutic use exemption

A therapeutic use exemption (TUE) is a formal authorisation under the WADA Code permitting an athlete to use an otherwise prohibited substance for a documented medical condition without committing an anti-doping rule violation.

Approval criteria

To be granted a TUE, the athlete must demonstrate, with supporting medical documentation reviewed by an independent committee of physicians, that:

1. The substance is necessary to treat an acute or chronic medical condition such that without it the athlete would experience a significant impairment of health.
2. The therapeutic use is unlikely to produce any additional enhancement of performance beyond the anticipated return to a normal state of health.
3. There is no reasonable permitted alternative.
4. The need for the substance is not the consequence of prior non-medical use of a prohibited substance.

Common uses

TUEs are granted most frequently for stimulants used to treat ADHD, glucocorticoids for inflammatory conditions, insulin for type-1 diabetes, and occasionally for hormone replacement therapy following documented endogenous deficiency.

Relevance to peptide users

TUEs are granted for peptide hormones only rarely and only for severe documented deficiency (for example, recombinant growth hormone for adult GH deficiency). A TUE is specific to one athlete and one substance and does not change the prohibited status of the substance for others.