Therapeutic Use Exemption (TUE) FAQs
What is a Therapeutic Use Exemption (TUE)?
Therapeutic Use Exemption (TUE) is special permission to use a
prohibited substance for medical reasons based on substantial medical
documentation. The USADA TUE process is consistent with the World Anti-Doping Agency International Standard for Therapeutic Use Exemptions and designed to protect the rights of clean athletes.
Do I need a Therapeutic Use Exemption?
Start here. In general a TUE is required for all prohibited substances and methods (see WADA's Prohibited List),
however the requirements vary depending on your competition status. For
athletes part of the USADA or IF National or International Registered
Testing Pool, a TUE is required for all prohibited substances or
methods. For recreational or masters level athletes also referred to as
'non-national level athletes,' USADA has special arrangements in place
that require a TUE in advance for some medications but not others. For a
thorough review of this policy, please see USADA's TUE Policy PDF. If
you are competing at an International Event (an event sanctioned by the
International Federation of your sport) you must obtain a TUE in advance
of using any prohibited substance, regardless of your competition
level. Failure to do so may results in an anti-doping rule violation.
Who do I submit my application to?
US athletes are encouraged to submit their application directly to
USADA, even though in some instances the International Federation is the
granting body for the TUE. USADA has special arrangements with the
International Federations such that we receive all TUE applications.
USADA will interact with the National and International Sporting Bodies
on behalf of the athlete.
How do I get a Therapeutic Use Exemption?
To obtain a TUE you should visit the How To Apply for a TUE page
on the USADA Website. There you will find two documents to download: 1)
an application form and 2) medical information required to justify the
use of the prohibited substance. Read both documents so that you
understand the requirements, and bring them with you to your doctor's
appointment. Your doctor should review the medical requirements for the
TUE so that he or she can supply all of the relevant information. After
completely filling in the application, submit it to USADA by fax, mail,
or email according to the instructions on the application form. We will
notify you when we receive your application. If you don't hear from us
within three days let us know- We may not have received your
What can I do to increase my chances of obtaining a Therapeutic Use Exemption?
most important aspect of a TUE application is the medical file. The
Therapeutic Use Exemption Committee will need to review any and all
relevant medical details related to the application, including patient
history, test results, how the disease/disorder/injury has been managed
over time, and any and all attempts to use non-prohibited medications
and methods. Read the application form and the medical information
requirements closely, and urge your doctor to do the same. The medical
file should be as complete as possible.
What is the Therapeutic Use Exemption Committee (TUEC)?
Therapeutic Use Exemption Committee is the group of doctors and medical
experts that review your TUE application with a focus on your medical
file, and provides the recommendation for approving or denying your TUE
application. The TUEC takes into account your entire medical file, the
anti-doping rules established by the World Anti-Doping Agency (WADA) and
USADA, and the current opinion for best medical practice. Each
anti-doping agency and International Federation has its own TUEC. Your
identity is never revealed to the TUEC.
What role does my doctor play in obtaining a Therapeutic Use Exemption?
doctor plays a crucial role in supplying the medical information
necessary for the approval of a TUE. The Therapeutic Use Exemption
Committee relies on the information supplied by your doctor to determine
if your file meets the medical criteria set by the World Anti-Doping
Who has the authority to grant Therapeutic Use Exemptions?
and the International Federations have authority to grant TUEs. The
granting body for your TUE will be determined by membership in a testing
pool, whether you compete locally, nationally, or internationally, and
the prohibited substance being applied for. USADA has mutual recognition
agreements with several International Federations. When you submit your
application to USADA we will notify you as to who is the granting
authority for your TUE. Regardless of the granting authority, all
applications from US athletes should be submitted to USADA.
What do you mean by "competition status"?
status refers to whether you compete in local, State, National, or
International Events, and whether you are a member of a testing pool
(USADA National Testing Pool, or International Federation International
Testing Pool). Knowing the competition status is used to determine who
the granting authority is for your TUE. USADA grants TUEs to all
athletes competing at or below the National Level. For athletes in an
ITP, or for athletes competing in International Events, the granting
authority is the International Federation. Regardless of the granting
authority, all US athletes should submit their TUE application to USADA.
What is a testing pool?
testing pool is a pool of athletes identified as National or
International caliber athletes by USADA or an International Federation.
USADA refers to athletes in a testing pool as NTP - National Level
athletes. Athletes who are not in a testing pool are generally referred
to as 'non-national level' athletes. You will be made aware if you are
in a testing pool. Otherwise you are a non-national level athlete.
I don't know if I'm in a testing pool. How do I find out?
are informed if they are part of a testing pool. USADA and/or the
International Federation for your sport will be able to tell you if you
belong to a Testing Pool.
What do you mean by a non-national level athlete?
non-national level athlete is an athlete who does not belong to the
USADA national testing pool (NTP). Sometimes this is also referred to as
"non-national level" athletes in USADA documentation.
I'm a recreational or masters level athlete, but I like to compete in events and races.
Why was my TUE application returned to me? Does that mean it was denied?
some instances a TUE application is returned to the athlete without
being reviewed by the TUEC. Applications are often returned because they
are not complete, or because a TUE is not required. A returned
application should not be interpreted as a denial of your TUE. If your
application is formally denied by the TUEC you will receive specific
notification of this. If your application has been returned to you
because it is incomplete, you are encouraged to resubmit it with new
I'm a recreational or masters level athlete, but I like to compete in events and races. Do I need a TUE?
You may need a TUE depending on the level at which you compete. If you
compete at events sanctioned by an International Sporting Federation,
then you need to obtain TUEs for prohibited substances along the same
lines as an athlete in a Testing Pool of the International Federation.
If you compete at a National level or below, then the requirements for
TUEs vary based upon the medication. To determine if you need a TUE,
visit the TUE page on USADA's website, and consult USADA's policy on
TUEs PDF. Please note, sometimes "international events" are held in the
United States, and not all events occurring in another country are
considered "International Events" for the purposes of TUEs.
My TUE was approved by USADA- why do I need to submit another TUE application to my International Federation?
athletes who compete at the National Level or below need only obtain a
TUE from USADA. When such an athlete wishes to compete at an event
sanctioned by the International Federation (whether in the US or
abroad), a new TUE application may need to be submitted to the
International Federation. USADA has mutual recognition agreements in
place with many International Federations, and thus some IF's recognize
the TUE issued by USADA. However, in order to protect the athlete in the
event of testing, it is important to ensure that the International
Federation will recognize the TUE that USADA has issued. You should
check with your International Federation to determine their TUE
requirements, and you should notify USADA immediately if you intend to
compete at an International Event. We can help you if a new TUE process
needs to be initiated.
Why does it matter so much if I plan to compete at International Events?
all International Federations will recognize a TUE issued by USADA for
an International Event. For this reason, it is very important that you
notify USADA if you intend to compete Internationally. Please note,
sometimes "international Events" are held in the United States, and not
all events occurring in another country are considered "International
Events" for the purposes of TUEs.
I'm not sure if the event I plan on competing in is local, National, or International- how do I find out?
National and International Governing Bodies for your sport can help you
determine if an event is considered to be National or International
Level. Please note, sometimes "international Events" are held in the
United States, and not all events occurring in another country are
considered "International Events" for the purposes of TUEs.
My doctor prescribed a medication for me for emergency use- what should I do?
you are prescribed a prohibited substance for an emergency, you should
file an emergency TUE. The process is essentially the same- you should
download the relevant forms from the TUE page and submit them as a
matter of urgency. Make sure to write EMERGENCY TUE at the top of the
form so that we know to expedite processing. It is understood that in
some instances not all medical information can be obtained quickly. You
should make your best effort to submit a medical file that is as
complete as possible, and submit the TUE application as soon as
I’ve had asthma all my life, what asthma medications require a TUE?
You can check the prohibited or not-prohibited status of medication by visiting www.globaldro.com.
My TUE application was denied, but I really need my medication. What are my options?
the first instance you should contact USADA to determine exactly why
the TUE was denied if it is not made clear in the denial letter.
Sometimes there may be a critical piece of information that was
overlooked or not provided, or new relevant information or test results
may be available that would allow the TUE to be approved. You should
investigate whether there is scope for resubmission of your application.
Failing this, you may appeal the decision to the World Anti-Doping
Agency. Information regarding the appeal process is available on the
How can I find out the clearance time of the medication I am taking?
Predicting the time it takes for a medication to clear completely from your system is complicated and can vary greatly and is unique between individuals and to each medication. For this reason, USADA cannot predict urine and/or blood clearance times for athletes. You will need to talk with your physician and/or pharmacist about the average time it takes the body to clear a particular medication, and whether there are any known factors that might affect how your body might process that medication. Once you have that information, you will need to decide for yourself whether the “clearance time” estimated by your physician or pharmacist is sufficient for you to compete. If you are not certain that the medication will have cleared by the time you compete you are encouraged to apply for a TUE.
Do I need a TUE for an upcoming surgery?
If you are planning a surgery your first step is to look up all medications that you will be given (or that will be administered) during or after your surgery on www.GlobalDRO.com. For general anesthesia, it is common for more than one medication to be used. There may be cases when it is not possible to find out in advance of what medications you will receive (such as in an emergency) and sometimes the anesthesiologist will change his or her mind during the surgery about the most appropriate medication to use. In all cases, request a copy of the surgical notes in order to find out which medications were administered and submit an emergency TUE if necessary. Please review the USADA surgery checklist before a planned visit or emergency visit to the hospital.
Do I need a TUE (Medical Exception for Banned Substances) for NCAA-sanctioned events?
The NCAA has different rules and regulations compared with USADA, thus please contact the appropriate person at your institution or NCAA to discuss your medication and if this medication is on the NCAA Banned Drug List. You may need to obtain a Medical Exception for Banned Substances with NCAA for this medication. Please note, if you are competing in NCAA events and competitions sanctioned by the governing body for your sport, you may need a TUE with USADA for the competitions with your national governing body and may also need a Medical Exception for Banned Substances with your institution or NCAA. The application and review processes are completely separate.
The beta-2-agonist inhaler I am prescribed for asthma has a threshold listed for the inhaler dose, but not my nebulizer dose. What is the maximum amount of the nebulizer I can use?
The beta-2-agonists used for the treatment of asthma that have a limited dose or threshold set by WADA include inhaled salbutamol (maximum 1600 micrograms over 24 hours), inhaled formoterol (maximum delivered dose 54 micrograms over 24 hours) and salmeterol when taken by inhalation in accordance with the manufacturers’ recommended therapeutic regimen. These include the isomers when available, such as levalbuterol (Xopenex®)and arformoterol (Brovana®). The threshold for the presence in urine of salbutamol is 1000 ng/mL and formoterol is 40 ng/mL.
When used as a nebulized treatment, the dose used is more than that listed for the inhalers. This is because a nebulizer device does not deliver that full amount into your lungs. Instead, only a fraction of that dose is inhaled. The amount you take per treatment is dependent on both the nebulizer device you use and the way in which that medical device nebulizes the specific drug.
USADA does not maintain a list of all nebulizer devices or the percentage of drug each administers. As the athlete, you should contact the manufacturer of the nebulizer device and ask what percentage of the drug you are using is administered with each dose. If the amount inhaled is higher than the dose allowed by WADA, submit a Therapeutic Use Exemption for the use of your nebulizer and related inhalers.