Therapeutic Use Exemption-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 WADA Prohibited List a TUE may give that Athlete the authorization to use that substance or method while competing without invoking an ADRV and applicable sanction. Applications for TUEs are evaluated by a panel of physicians, the TUE Committee (TUEC).

Criteria for Granting 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):
  • The Athlete has a clear diagnosed medical condition that requires treatment using a prohibited substance or method
  • 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
  • The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative
  • The necessity to use that substance or method is not a consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use

TUE Application Procedure

Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method.

First, check if the required medication or method you intend to take, or use is prohibited as per the WADA Prohibited List. You can also contact your National Anti-Doping Organization (NADO).

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 the substance/method 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 ICSD or relative NADO if you are having difficulties.

Then, contact ICSD doping@ciss.org to determine your competition level and TUE application requirements.

If it is determined that you are an International-Level Athlete, you must apply to 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 apply.

Please refer to the section “How to apply to ICSD for a TUE” below.

If you already have a TUE granted by your NADO:

Your NADO’s TUE is only valid at the national level, and you must submit a request for recognition to ICSD. Please refer to the section “How to submit a request for recognition of your NADO’s TUE to ICSD” below.

If you are NOT an International-Level Athlete and you have been tested by ICSD, ICSD recognizes 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 ICSD.

Retroactive TUE?

You may apply retroactively for a TUE to ICSD if:

  • You required emergency or urgent treatment of a medical condition.
  • There was insufficient time, opportunity, or other exceptional circumstances that prevented you from submitting the TUE application or having it evaluated, before getting tested.
  • You are a lower-level Athlete who is not under the jurisdiction of ICSD or NADO and was tested.
  • You tested positive after using a substance out-of-competition that is only prohibited in-competition (for example glucocorticoids).

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for the 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 Anti-Doping Rule Violation.

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.

How to Apply to ICSD for a TUE?

ICSD encourages to submission of TUE applications via ADAMS, together with the required medical information. If you do not have an ADAMS account yet, please contact doping@ciss.org to have it set up.

Otherwise, please download the ICSD’s TUE Application Form, and once duly completed and signed, send it together with the required medical file to doping@ciss.org.

Your TUE application must be submitted in legible 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 are relevant to the application

Please note that any costs incurred for the completion of TUE, are the responsibility of the Athlete. This includes any required additional medical examinations, tests, imaging studies, etc.

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 ICSD’s Checklists for TUE applications (available at the end of this page) for guidance and support.

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.

Submission of a Request for Recognition of a NADO’s TUE to ICSD?

Your request for recognition should be submitted to ICSD in writing quoting your ADAMS TUE reference number.

Keep a complete copy of the proof that your request for recognition has been sent to ICSD.

Timeframe and Deadlines

ICSD’s TUEC must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application, or request for recognition.

TUE Renewal

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 ahead of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.

Important Note

The presence (following sample collection), use, possession, or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route, or duration of administration, you should contact ICSD, as you may be required to apply for a new TUE. Some substances and dosages, e.g. insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE Application Form and would usually be accepted by the TUEC.

TUE Application Denial

A decision to deny a TUE application will include a written explanation of the reason(s) for the denial. If it is not clear to you, please contact doping@ciss.org to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us.

You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the ICSD TUEC decision. You should send the same information that you submitted to us, and on which the decision to deny the TUE was based, via a secure online method or by registered mail at:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The email address to enquire and/or send the request for review is: medical@wada-ama.org

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).

Confidentiality

All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of a TUE request, is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE and in the TUE Application Form. All members of the ICSD TUEC and any other authorized recipients of your TUE request and related information (as described in the Athlete’s Declaration) 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.

The TUE request-related information will be retained by ICSD, ICSD’s TUEC, and any other authorized 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.

Contact Information

For any further information and questions in relation to personal information practices, please contact the ICSD at doping@ciss.org and/or office@ciss.org

If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question about TUEs, please contact doping@ciss.org


The International Committee of Sports for the Deaf would like to insist on reminding how to obtain the TUE Certificate and when it should be done.

WHAT IS a TUE?
Deaf Athletes, like all people, may have illnesses or conditions that require them to take a particular medication/substance or undergo certain procedures/methods. For Athletes, the substance or method may appear on WADA’s List of Prohibited Substances and Methods (List). In such instance, they may be granted a TUE, which gives them permission to take a substance or use a method.

Please keep in mind: the athlete should obtain the permission as well as the TUE Certificate before starting to use the prohibited method or substance.

WHICH ATHLETES CAN APPLY FOR A TUE?
All athletes that compete in sport at the International Level (as defined by the International Committee of Sports for the Deaf) or the National Level (as defined by each National Anti-Doping Organization) can apply for a TUE.

Please keep in mind: A TUE granted by an Athlete’s National Anti-Doping Organization that meets ISTUE (International Standard for Therapeutic Use Exemptions) criteria must be recognized by the International Committee of Sports for the Deaf. This option accelerates the process of obtaining a new TUE.

WHAT ARE THE CRITERIA FOR GRANTING A TUE?
The criteria for granting a TUE are as follows:
1. The athlete would experience significant health problems without taking the prohibited substance or method;
2. The therapeutic use of the substance would not produce significant enhancement of performance;
3. There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method;
4. The requirement to use that substance or method is not due to the prior use of the substance or method without a TUE, which was prohibited at the time of use.

For the TUE to be granted, all four criteria must be met.

WHAT ARE THE CRITERIA FOR DOCUMENTATION?
The following supporting documents must be attached to the completed TUE application form:
A statement by an appropriately qualified physician, attesting to the Athlete’s diagnosis and need to Use the Prohibited Substance or Prohibited Method in question for Therapeutic reasons;
A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible) and the results of all examinations, Laboratory investigations and imaging studies relevant to the application.

Please keep in mind: A summary that explains the diagnosis and key elements of the clinical exams, medical tests and treatment plan as well as all forms are required to be submitted in English or French.

WHAT HAPPENS WHEN AN ATHLETE IS GRANTED A TUE?
TUE is granted for a specific method or a substance with a defined dosage and route of administration. They are also granted for a specific period and do expire. The athlete must comply with all the treatment conditions outlined in the TUE application. Material changes to the treatment require a new application and TUEC review.

Please keep in mind: Once a TUE has been granted by an Anti-Doping Organization, it will inform WADA, which then has the opportunity to review the decision. If the decision does not conform to the ISTUE, WADA may reverse it and deny the TUE.

TUE Application Form

Therapeutic Use Exemptions Frequently Asked Questions

At-a-Glance - Therapeutic Use Exemptions

Series of Therapeutic Use Exemption (TUE) Checklists, which provide guidance and support to athletes, their physicians, and National Deaf Sports Federations during the TUE application process.

These Checklists are based on the Medical Information to Support the Decisions of TUECs documents, which were developed by WADA and external medical specialists primarily for TUECs. The Checklists – which cover the most commonly seen conditions – list the requirements for completing the TUE Application Form, including the medical evidence that must be submitted along with it.

International Committee of Sports for the Deaf strongly urges all NDSF to use these Checklists in their interactions with athletes and applying physicians.

TUE Checklist - ADHD

TUE Checklist - Adrenal Insufficiency

TUE Checklist - Anaplylaxis

TUE Checklist - Asthma

TUE Checklist - Cardiovascular Conditions

TUE Checklist - Diabetes

TUE Checklist - Female Infertility

TUE Checklist - Growth Hormone Deficiency

TUE Checklist - IBD

TUE Checklist - Intrinsic Sleep Disorders

TUE Checklist - IV Infusion

TUE Checklist - Kidney Failure and Kidney Transplantation

TUE Checklist - Male Hypogonadism

TUE Checklist - Musculoskeletal Conditions

TUE Checklist - Pain Management

TUE Checklist - PCOS

TUE Checklist - Renal Transplantation

TUE Checklist - Sinusitis Rhinosinusitis

TUE Checklist - Transgender Athletes