Therapeutic Use Exemption (TUE)

A therapeutic use exemption is the mechanism by which an athlete with a genuine clinical need may use a substance or method that is otherwise prohibited in sport. It is granted by a national anti-doping organisation, an international federation or a major event organiser, assessed by a panel of physicians against the criteria in the World Anti-Doping Agency's international standard, and recorded so that a subsequent adverse analytical finding can be reconciled against it. It is an authorisation, not a defence assembled afterwards, although retroactive applications are provided for in emergency treatment and a few other defined situations.

Four criteria must all be satisfied. The athlete would experience significant health impairment if the substance were withheld; the therapeutic use is highly unlikely to produce any additional performance enhancement beyond a return to normal health; there is no reasonable permitted therapeutic alternative; and the necessity is not a consequence of prior use, without an exemption, of a substance that was prohibited at the time. The second and fourth criteria carry most of the weight in practice.

For the peptide field the operative example is growth hormone. Documented adult growth hormone deficiency, established by stimulation testing against defined diagnostic criteria, can support an exemption. Age-related decline in the growth hormone axis, or a low reading on a single random sample, cannot, because the second criterion asks whether treatment restores normal health rather than exceeds it.

The misconception encountered most often is that a prescription is itself an exemption. It is not: a lawful prescription from a treating physician has no anti-doping standing whatever until the relevant body grants the exemption, and the burden of proof sits entirely with the athlete.