10 Things You Need to Know About Therapeutic Use Exemptions (TUEs)
1. Understanding Therapeutic Use Exemptions (TUEs)
A Therapeutic Use Exemption (TUE) permits an athlete to use a prohibited substance or method for legitimate medical reasons without facing sanctions for a positive doping test. This exemption ensures that athletes with genuine health conditions can compete fairly. For example, an athlete with asthma may require inhaled corticosteroids, which are on the World Anti-Doping Agency’s (WADA) Prohibited List.
2. Eligibility Criteria for Applying for a TUE
Any athlete with a documented medical condition requiring treatment with a substance or method on the prohibited list can apply for a TUE. This includes both amateur and professional athletes subject to anti-doping rules. For instance, a weightlifter diagnosed with hypogonadism may need testosterone replacement therapy, necessitating a TUE.
3. The Application Process for a TUE
To apply for a TUE, an athlete must submit an application to their relevant Anti-Doping Organization (ADO) or International Federation (IF). The application should include comprehensive medical evidence supporting the need for the prohibited substance or method. For example, an athlete with Attention Deficit Hyperactivity Disorder (ADHD) requiring stimulant medication must provide diagnostic reports and treatment history.
4. Required Information in a TUE Application
A complete TUE application must contain:
• Detailed Medical History: Including past and present medical conditions.
• Diagnosis: Confirmed by a qualified physician, with evidence from relevant tests.
• Medical Examinations and Tests: Lab results, imaging studies, or other diagnostic procedures that support the diagnosis.
• Treatment Plan: A clear outline of the medication or method, dosage, frequency, and duration.
• Justification: Explanation of why the prohibited substance is necessary and why permitted alternatives are ineffective or contraindicated.
For example, a diabetic athlete applying to use insulin must provide blood glucose monitoring records and HbA1c levels.
5. Timing for TUE Application Submission
Ideally, athletes should apply for a TUE before starting treatment with a prohibited substance or method. This preemptive approach avoids potential anti-doping violations. In cases requiring immediate medical attention—such as emergency surgery or acute infections—a retroactive TUE may be considered. Athletes are advised to submit applications as soon as possible in such scenarios.
6. Processing Time for TUE Applications
Processing times vary but typically take up to 21 days after submitting all required documentation. It’s advisable to apply well in advance of competitions to ensure approval. Delays can occur if applications are incomplete or if additional information is requested. For instance, an athlete planning to compete internationally should consider the processing time to avoid disqualification.
7. Outcome if a TUE Application is Denied
If a TUE application is denied, athletes have the right to appeal the decision to an independent TUE appeal body, such as WADA. The appeal must be lodged within a specified timeframe, and additional medical evidence may be required. For example, an athlete denied a TUE for beta-blockers may provide further cardiology reports to support the appeal.
8. Validity and Expiration of a TUE
TUEs are granted for a specific period, depending on the medical condition and treatment plan. Short-term conditions may warrant a TUE valid for a few months, while chronic conditions might receive longer durations. Athletes must reapply before expiration if continued use is necessary. For example, an athlete with rheumatoid arthritis may need annual renewals of their TUE for anti-inflammatory medications.
9. Disclosure Obligations During Doping Control
Athletes must declare all medications and substances used, including those covered by a TUE, on the doping control form during testing. Providing proof of an approved TUE when requested ensures transparency and helps avoid potential sanctions. For instance, if a prohibited diuretic is detected, but the athlete has a valid TUE for hypertension management, they may be exempt from penalties.
10. Possibility of Retroactive TUE Approval
Retroactive TUEs are granted under specific circumstances, such as emergencies or acute medical conditions requiring immediate treatment. Athletes must apply as soon as possible and provide comprehensive medical evidence justifying the urgency. For example, an athlete treated with prohibited corticosteroids during emergency surgery can seek a retroactive TUE to legitimize the necessary medical intervention.
11. Identifying Substances or Methods Requiring a TUE
Any substance or method listed on WADA’s Prohibited List requires a TUE for therapeutic use. This includes certain stimulants, hormones, and even some over-the-counter medications like pseudoephedrine. Athletes should consult the latest Prohibited List and their team physician to determine if their medication necessitates a TUE. For instance, treatments for narcolepsy often involve stimulants that are prohibited without exemption.
12. Confidentiality of Medical Information
All medical information submitted in a TUE application is treated with strict confidentiality. It’s used solely for evaluating the application and is accessible only to authorized personnel within the ADO or IF. This ensures athletes’ privacy is respected while maintaining the integrity of the anti-doping process.
13. Criteria for Granting a TUE
The following criteria must be met for a TUE to be granted:
• Medical Necessity: A clear medical condition requiring treatment with a prohibited substance.
• No Reasonable Alternative: No permitted therapeutic alternatives are effective.
• No Performance Enhancement: The substance doesn’t enhance performance beyond normal health levels.
• Not Due to Prior Doping: The medical condition isn’t a result of prior use of prohibited substances.
For example, an athlete cannot receive a TUE for hormone therapy if the deficiency is due to previous anabolic steroid abuse.
14. Determining if Your Medication Requires a TUE
To ascertain if a medication requires a TUE:
• Consult the Prohibited List: Review the most recent WADA Prohibited List.
• Seek Professional Advice: Speak with your team doctor or a sports medicine specialist.
• Contact Your ADO: They can provide guidance on substances and methods.
For instance, certain asthma inhalers contain prohibited beta-2 agonists; verifying this information helps in applying for a TUE if necessary.
Examples:
• Example of Medical Necessity: An athlete with Type 1 Diabetes Mellitus requires insulin therapy, which is a prohibited substance under peptide hormones. A TUE allows them to manage their condition without facing anti-doping violations.
• Alternative Therapies Ineffective: In cases of severe ADHD, stimulant medications like methylphenidate may be the only effective treatment. If non-stimulant alternatives fail to control symptoms, a TUE for the stimulant may be justified.
• No Performance Enhancement Beyond Normal Health: The goal is to restore normal physiological function. For example, thyroid hormone replacement in hypothyroidism aims to achieve normal thyroid levels, not to enhance metabolic rate beyond normal.
• Avoiding Prior Doping Consequences: An athlete with hypogonadism resulting from anabolic steroid abuse would not be granted a TUE for testosterone replacement, as the condition is a consequence of prior doping.
