Last updated on: 5/10/2021 | Author:

Should Therapeutic Use Exemptions (TUE) Be Allowed for Injured or Ill Athletes?

General Reference (not clearly pro or con)

WADA, in an undated FAQ, “Therapeutic Use Exemption,” accessed on Apr. 26, 2021 and available at, stated:

“Athletes, like all people, may have illnesses or conditions that require them to take particular medications or undergo procedures. If the medication or method an athlete requires to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medicine or method. TUEs are granted according the International Standard for TUEs (ISTUE), a document outlining the conditions, the stakeholder responsibilities and the TUE process…

The criteria are:

–The athlete would experience significant health problems without taking the prohibited substance or method;
–The therapeutic use of the substance would not produce significant enhancement of performance;
–There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method;
–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.”

Apr. 26, 2021

Lisa Rapaport, journalist, in a Mar. 3, 2020 article, “Sports Doctors May Accidentally Prescribe Banned Steroids,” available at, stated:

“Sports physicians routinely prescribe corticosteroids to athletes for conditions like inflammation, asthma and allergies, but not all of them know which forms of these drugs are banned under anti-doping rules, a study suggests.

The survey of 603 physicians from 30 countries found that four in five prescribe oral corticosteroids to athletes, one of the forms prohibited during competition by the World Anti-Doping Agency (WADA).

While 73% of physicians knew athletes needed a medical exemption to use oral corticosteroids just before or during competition, far fewer knew exemptions were also required for other forms of these drugs including intravenous injections, ointments, creams and inhaled medicines.”

Mar. 3, 2020

Ian Boardley, PhD, Senior Lecturer in Sport, Exercise and Rehabilitation Sciences at the University of Birmingham, in a undated article, “Therapeutic Use Exemptions – Legalised Doping or Medical Necessity?,” accessed on Apr. 26, 2021 and available at, stated:

“The existence of the TUE system creates a situation whereby doping substances can be used legally but not necessarily ethically. This is a particular issue if those involved, such as athletes, managers and team doctors, lack the objectivity to recognise when they may be crossing ethical boundaries when applying for TUEs. This means it is essential that any system sanctioning the use of prohibited substances for medical reasons is sufficiently robust that it does not rely on those applying for TUEs making the distinction between ethical and unethical use of prohibited substances. Whether the current TUE system is suitably robust is a major issue for anti-doping, and one that is being debated extensively at present.”

Apr. 26, 2021

The USADA, in an undated explainer, “Therapeutic Use Exemptions (TUEs),” accessed on Apr. 26, 2021 and available at, stated:

“In some situations, an athlete may have an illness or condition that requires the use of medication listed on the World Anti-Doping Agency’s Prohibited List. USADA can grant a Therapeutic Use Exemption (TUE) in these situations in compliance with the World Anti-Doping Agency International Standard for TUEs. The TUE application process is thorough and designed to balance the need to provide athletes access to critical medication while protecting the rights of clean athletes to complete on a level playing field.

Apr. 26, 2021

The NCAA, in a June 23, 2020 statement, “Medical Exceptions Procedures,” available at, stated:

“The NCAA list of banned drug classes (NCAA Bylaw 31.2.3) is composed of substances that are generally purported to be performance enhancing and/or potentially harmful to the health and safety of the student-athlete.

The NCAA recognizes that some banned substances are used for legitimate medical purposes. Accordingly, the NCAA allows exception to be made for those student-athletes with a documented medical history demonstrating the need for treatment with a banned medication. Exceptions may be granted for substances included in the following classes of banned drugs: anabolic agents*, stimulants, beta blockers, diuretics, anti-estrogens*, beta-2 agonists, peptide hormone* and narcotics* … No medical exception review is available for substances in the class of cannabinoids.”

June 23, 2020

PRO (yes)


Annie A Garner, PhD, Assistant Professor of Psychology at Saint Louis University, et al., in a Mar. 2018 study, “The Use of Stimulant Medication to Treat Attention-Deficit/Hyperactivity Disorder in Elite Athletes: A Performance and Health Perspective,” available at, stated:

“The use of stimulants as a treatment for attention-deficit/hyperactivity disorder (ADHD) among elite athletes is a controversial area with some arguing that stimulant use should not be permitted because it offers an advantage to athletes (fair play perspective). Guided by an integrated model of athletic performance, we address common concerns raised about stimulant use in sports from our perspective, which we coined the ‘performance and health perspective,’ highlighting relevant research and pointing to gaps in empirical research that should be addressed before bans on use of stimulants for athletes with ADHD are considered. The current article posits that a stimulant ban for athletes with ADHD does not necessarily facilitate fair play, ensure safety, or align with existing policies of large governing bodies. Instead, we recommend that stimulant medication be allowed in high-level sport, following proper diagnosis by a trained professional and a cardiac assessment to confirm no underlying heart conditions. Athletes with ADHD approved to use stimulant medication should be monitored by a health care professional, physically reevaluated and reassessed for ADHD as clinically appropriate and as indicated by relevant sports governing bodies. This performance and health perspective is consistent with that of multiple sport governing bodies who offer therapeutic use.”

Mar. 2018


A user with alias Lord Montcalm, in a June 13, 2018 SB Nation Bless You Boys fan post, “Players Should Be Allowed to Use PEDs to Rehab Injuries,” available at stated

“Baseball fans are rightly hostile toward steroid use in the game, but there is a massive difference between using performance enhancing drugs to hit a baseball farther, and using them to heal. Anything that’s available to my grandmother to manage the aging process should be available medically to Miguel Cabrera to full recover.

Baseball is littered with great players who had a horrific injury and were never able to fully recover. How many guys can you think of where the story was, “Yeah, he got hurt and was just never the same again”? The game is full of cases like this. It’s sad…

Now, I get that this is a slippery slope and one that needs to be monitored carefully. But in this day and age there must be a happy medium between “Brady Anderson hitting 51 home runs” and “All Stars never really healing from career-altering injuries because they can’t get the right care.”

My solution: MLB should appoint a committee of respected doctors and former athletic trainers to review special cases. If players need to use a steroid to heal, they should have to apply to the committee for permission. If the doctors vote to let them use a drug that’s on the banned substance list because it’s required medically for therapy, then the player is allowed to do so without penalty. If the player is unable to persuade a super majority of the committee that this is what they need for their care, then no dice.”

June 13, 2018

CON (no)


Paul Dimeo, PhD, Senior Lecturer of Health Sciences and Sport at the University of Stirling, and Verner Møller, PhD, Professor of Sports Science at Aarhus University, in a Dec. 18, 2017 article, “Elite Sport: Time to Scrap the Therapeutic Exemption System of Banned Medicines,” available at, stated:

“There are many ways in which an unscrupulous and determined athlete can exploit the TUE process. An obvious strategy is to find a doctor willing to bend the rules and write prescriptions for unnecessary medicines. Another might be to fake an illness or manipulate the results of diagnostic tests.

There is some research to show this may happening in practice. For example, in a large Danish study, 51% of respondents believed that athletes in their sport where being allowed unnecessary TUEs.

In November, Shane Sutton, the former Team Sky coach said that TUEs were part of their “marginal gains” performance strategy. The leading athletics coach, Alberto Salazar, who was until recently British distance runner Mo Farah’s coach, obtained TUEs for his group of elite athletes, and upon investigation it was revealed that some of their medical records were altered.

There is a clear difference between the letter of the law and the spirit of the law, but in a highly competitive context like sport, managers will follow the letter of the law to avoid punishment while trying to gain as much advantage as possible…

And if WADA aims to ensure a level playing field, promote the health of athletes and foster a consistent, coherent and transparent approach, then perhaps the only way forward is to prevent the abuse of TUEs is by removing them completely.

The global sports community needs to be serious about clean sport, and such a drastic solution might be necessary. Those who suffer illness might not get to compete to the same extent, but athletes would have to accept that fairness and health are good principles to follow, and accept their fate much like athletes who miss out due to broken bones or concussion.

This might sound brutal and inhumane, and WADA might look for ways to soften the blow for those athletes in genuine need, but at the very least, we need to recognise the complex and sometimes hidden problems in the current approach, and seek ways to solve them.”

Dec. 18, 2017


Vladimir Putin, PhD, LLB, President of Russia, as quoted in an Oct. 11, 2016 article by Ben Rumsby, “Vladimir Putin calls for athletes with therapeutic use exemptions to be banned from competing against those who do not,” available at, stated:

“We need to understand what to do about [TUEs]. Otherwise, we could soon face all records and victories going only to people who are ill with, let’s say, chronic illnesses. Maybe they can be put in a special category, or their achievements, points, seconds and honours can be considered in a special way.”

Oct. 11, 2016