The presence of a Prohibited Substance or its Metabolites or Markers and / or the Use or Attempted Use, Possession, Administration or Attempt to Administer a Prohibited Substance or a Prohibited Method will not be considered an anti-doping rule violation if it is consistent with the provisions of a TUE issued in accordance with the International Standard for Therapeutic Use Exemptions.

The TUE is thus an official document authorizing an athlete, as part of a treatment, to use a substance on the prohibited list.
In this context, a TUE is a document authorizing an athlete for proven medical reasons to use a substance or method normally prohibited appearing on the prohibited list maintained and published by the World Anti-Doping Agency.
Applications are reviewed by a Therapeutic Use Exemption Committee (TUEC).


  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.

An athlete who requires the use of a Prohibited Substance or Prohibited Method for Therapeutic Reasons must obtain a TUE before using or possessing the substance or method in question.

An athlete may not obtain a retroactive authorization for the use of a prohibited substance or a prohibited method for therapeutic purposes (retroactive TUE) unless:

  1. there is a medical emergency or treatment of an acute illness; or
  2. due to other exceptional circumstances, there has not been sufficient time or opportunity for the athlete to submit, or for the TUEC to consider, an application for a TUE prior to the sample collection;
  3. the applicable rules required the athlete or allowed the athlete to submit a retroactive TUE Application;
  4. WADA and the Anti-Doping Organization with which the retroactive TUE application is or would be submitted consider that a retroactive TUE must be granted in the name of fairness.

All athletes participating in competitions, whatever their level, are affected by the TUE application.


If you are a national or lower level athlete, you must submit your TUE Application to your NADO. However, if the NADO considers that the athlete is below the national-level and therefore refuses to consider the application, the athlete should keep that correspondence and nevertheless collect all the medical information and be ready to present the documentation should there be a need.

If you are an international level athlete or if you are entered in an international event for which a TUE issued by your IF is required, you must submit your TUE Application to your IF, which is responsible for accepting applications and granting TUEs.

If you already have a NADO TUE, it is not valid at the international level unless recognized by your governing IF or by a MEO. If you already have a TUE from your NADO and are participating in an IF or international event, check if this IF or MEO automatically recognize your TUE as per ISTUE article. If the International Federation considers that the TUE does not meet these criteria and therefore refuses to recognize the TUE, the International Federation must immediately inform the athlete and his National Anti-Doping Organization, by stating the reasons. The athlete or National Anti-Doping Organization shall have 21 days from such notification to submit the matter to WADA for review. If the matter is submitted to WADA for review, the TUE issued by the National Anti-Doping Organization will remain valid for national level competition checks and out-of-competition testing (but is not valid for controls of international level competitions) pending the decision of WADA. If the matter is not submitted to WADA for review, the TUE will cease to be valid in all cases upon expiry of the 21-day review period.

If an International Federation chooses to control an athlete who is not an international athlete, it is required to recognize a TUE issued to that athlete by his National Anti-Doping Organization.
An organization responsible for major events may require athletes to turn to it for a TUE if they wish to use a prohibited substance or prohibited method in connection with the event. In that case:
The MEO must provide for a procedure allowing the athlete to apply for a TUE if the athlete does not yet have one. If the TUE is granted, it is only valid for this event. If the athlete already has a TUE issued by his National Anti-Doping Organization or International Federation and this TUE fulfills the criteria set out in the International Standard for Therapeutic Use Exemptions, the MEO is required to recognize it. If the MEO considers that the TUE does not meet these criteria and therefore refuses to recognize it, it must immediately inform the athlete, by stating its reasons.

If the MEO takes the decision not to recognize or not to issue a TUE, the athlete may appeal exclusively to an independent body established or designated for that purpose by the organization responsible for major events. If the athlete does not appeal (or his / her appeal is rejected), he / she is not allowed to use the substance / method in question in connection with the event, but any TUE issued by his / her National Anti-Doping Organization or its international federation for this substance or method remains valid outside the said event.