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

Under Article 4.2 of the 2023 International Standard for Therapeutic Use Exemptions (ISTUE), the athlete must demonstrate, with supporting medical documentation reviewed by a committee of physicians, that:

1. The athlete has a diagnosed medical condition that requires treatment with the prohibited substance or method.
2. The therapeutic use will not, on the balance of probabilities, produce significant enhancement of performance beyond a return to the athlete’s normal state of health.
3. The substance or method is an indicated treatment for the condition, and there is no reasonable permitted therapeutic alternative.
4. The need for the substance or method is not a consequence of prior use, without a TUE, of a substance or method that was prohibited at the time of that use.

The 2027 ISTUE takes effect on 1 January 2027 with the 2027 WADA Code. It puts less emphasis on proof that no reasonable permitted treatment exists and more emphasis on whether the prohibited treatment is medically necessary.

Common uses

At the Summer Olympic Games from 2016 to 2022, glucocorticoids and stimulants were the substance classes most often covered by TUEs. TUEs are also granted for insulin and for testosterone replacement therapy.

Relevance to peptide users

A TUE for a prohibited peptide hormone needs the same documented medical need as any other TUE (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.