Athlete’s Therapeutic Use Exemption Process


As an athlete, you may have an illness or medical condition that requires a particular medication. If the medication or method you are required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency (WADA) Prohibited List, a TUE may give you the authorisation to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. A TUE allows you to use the medication or method as it will not afford your competitive advantage in your sport but rather ensure you can compete in a proper state of health.


The TUE must meet all of the following four criteria to be granted. For more details, please refer to the International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2:

  • The prohibited substance or prohibited method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence;
  • The therapeutic use of the prohibited substance or method will not produce any additional enhancement of performance beyond a return to the athlete’s normal state of health following the treatment;
  • The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonably permitted therapeutic alternative; and
  • The necessity for using the prohibited substance or method is not a consequence of prior use (without a TUE) of a prohibited substance or method at the time of use.

Follow these steps to find out if you need a TUE, and where and when to apply for it.

Step 1: Check if the medication or method you intend to use is on the Prohibited List

You have the responsibility to inform your physician that you are an athlete bound to anti-doping rules. You and your physician should check the Prohibited List for the substance/method you are prescribed. Apart from that, you can make additional checks in several ways:

  • Check medication labels. Some medications only contain a full ingredient list on the box rather than on the bottle;
  • Check the active ingredients it contains. Note that ingredients can be different in the same product when purchased in different countries, so you will need to check the list each time;
  • Go to the Prohibited List and check to see if any of the medication’s active ingredients appear;
  • Make sure you also check the dose of the medication you are taking;
  • Use a “check your medication” online tool or ask your National Anti-Doping Organisation (NADO) if it has one. Find information on specific online drug references here or contact your NADO or reach out to the ICSD Anti-Doping Commission (ADC) at if you have any difficulties.

If the substance/method is prohibited, discuss non-prohibited alternatives with your physician. If there are none, apply for a TUE.

Step 2: Contact your National Deaf Sports Federation (NDSF) or ICSD ADC at to determine your competition level and TUE application requirements.

You are an International-Level Athlete if you meet the following criteria:

  • You are an athlete selected to represent your country in the Summer and Winter Deaflympics, World Deaf Youth Summer and Winter Games;
  • You are an athlete entered by a NDSF to participate in an ICSD-sanctioned event;
  • You are included in the ICSD Registered Testing Pool (RTP) or Testing Pool (TP).

If it is determined you are an International-Level Athlete, you must apply to the ICSD in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.

For substances prohibited In-Competition only, you should apply for a TUE at least 30 days before your next competition unless one of the exceptions on retroactive TUEs applies.

If you already have a TUE granted by your NADO, such a TUE is only valid at the national level and you must submit a request for recognition to the ICSD ADC in writing quoting your Anti-Doping Administration & Management System (ADAMS) TUE reference number. Please keep a complete copy of the proof that your request for recognition has been sent to the ICSD.

If you are not an International-Level Athlete and you have been tested by ICSD, in this case, ICSD’s TUE Commission (TUEC) recognises a valid TUE granted by your NADO (i.e., it satisfies the ISTUE criteria for granting a TUE), unless you are required to apply for recognition of the TUE because you are competing in an international event.

If you are not a National-Level Athlete as defined by your NADO and you have been tested by ICSD, you must apply for a retroactive TUE to the ICSD.


You may only apply retroactively for a TUE to ICSD if:

  • Emergency or urgent treatment of a medical condition was necessary.
  • There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting, or for the ICSD TUEC to consider, an application for the TUE prior to sample collection.
  • You are not an International-Level Athlete or National-Level Athlete who is not under the jurisdiction of the ICSD or NADO and were tested.
  • You tested positive after using a substance Out-of-Competition that is only prohibited In-Competition.

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for therapeutic use of a prohibited substance or method if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE.

This unique retroactive TUE will only be granted with the prior approval of WADA, and WADA may, in its absolute discretion, agree with or reject the ICSD’s decision.

Important note: Using a prohibited substance or method without a TUE could result in an ADRV.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.


ICSD ADC encourages TUE applications to be submitted via ADAMS, together with the required medical information. If you do not have an ADAMS account yet, please contact your NADO or ICSD at to have it set up.

Otherwise, please download the ICSD TUE Application Form, and once duly completed and signed, send it together with the required medical file to ICSD ADC.

The TUE application will be only considered when submitted in legible capital letters or typing with a clearly stated diagnosis and alongside the following supporting medical evidence:

  • Comprehensive medical history and the results of all relevant examinations, laboratory investigations and imaging studies;
  • Copies of original reports, letters and specialist reviews;
  • Detailed summary of any alternative medications tried, including names, and dosages;
  • Duration of use, and effects, or clinical justification from the prescribing doctor that confirms that in their opinion there are no other permitted alternatives that exist to treat the medical condition.

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

Any costs incurred in making the TUE application and in supplementing it as required by the ICSD TUEC are the responsibility of the athlete.

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

You should keep a complete copy of the TUE Application Form, and all materials and information submitted in support of that application, and proof that it has been sent.


A panel of physicians, called the ICSD TUEC, review TUE applications. Applications will be approved if the conditions set by ISTUE are satisfied.

In normal circumstances, a decision from the ICSD TUEC should be completed within 21 days of receipt of a complete application, or request for recognition.

You will be notified regarding the decision of the TUEC in writing. The TUEC will issue a Certificate that will specify the prohibited substance or method, route of administration, dose, and expiry date. Athletes must comply with all the treatment conditions in their granted TUE Certificate.

You are strongly advised not to use any prohibited substance without a valid TUE. Athletes should also verify if the substance or method they are using is legal in the specific country or state where they compete or plan to compete. For example, cannabis or opioids are illegal in various countries. There may be severe legal consequences for transgressing those rules regardless of whether one was granted a TUE.


Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information well in advance of the expiry date so that there is sufficient time for a decision to be made before your current TUE expires.

Important note: Presence, use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, in the event that, after your TUE is granted, you require a materially different dosage, frequency, route or duration of administration, you should contact ICSD ADC as you may be required to apply for a new TUE.


You will be informed about the TUE decision, which will include an explanation of the reasons for the denial of the application. If it is not clear to you, please contact the ICSD ADC to understand exactly why the TUE was denied. The application may simply not be legible or incomplete. In such cases, you should resubmit your application with the required information completed.

If the application was denied because the ICSD TUEC considered that you did not fulfil all criteria for granting a TUE, you and/or your NADO can submit a request to WADA via registered mail or secure online method to to review the decision no later than 21 days after notification of the ICSD TUEC decision. You should send the same information that you submitted to ICSD and on which the decision to deny the TUE was based on to WADA.

It should be noted that WADA is not obliged to proceed with a request for a review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).


You or your NADO have 21 days from the date of decision to refer the matter to WADA for review. The email address to enquire or send the request for review is:

Alternatively, you may send to:

WADA Medical Department

World Anti-Doping Agency

Stock Exchange Tower

800 Place Victoria (Suite 1700)

P.O. Box 120

Montreal (Quebec) H4Z 1B7


The same information that was provided to your NADO should be submitted to WADA. Please use a secure online method unless sending by registered mail.

Pending WADA’s decision, your NADO TUE remains valid for national-level Competition and Out-Of-Competition Testing only.

If the matter is not referred to WADA for review, your NADO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.


All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE process, and in the ICSD TUE Application Form. All members of the ICSD TUEC and any other authorised recipients of your TUE request and related information are subject to a professional or contractual confidentiality obligation.

Please review the terms of the Athlete’s Declaration carefully. In particular, note that should you wish to revoke the right of the ICSD’s TUEC to obtain the information related to your TUE in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval (or recognition) being granted.

Your TUE request-related information will be retained by ICSD and any other authorised recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information (ISPPPI).


For any further information and questions in relation to which organisation you should apply for a TUE, or as to the recognition process, or any other question about TUE, please contact at


International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Checklists for TUE Applications

WADA Guidelines for the International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Anti-Doping Education and Learning (ADEL)