U.S. Anti-Doping Agency (USADA)

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Therapeutic Use Exemptions (TUEs)
Frequently Asked Questions (FAQs)

Find answers to commonly asked questions about Therapeutic Use Exemptions and the application process.

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This will depend on your competition level (whether you are an international, national, recreational or non-competitive athlete) and the Prohibited List category of the substance/medication/method you are taking. To learn more go to the Determine if you need a TUE page of the USADA website. If you’re a Recreational/Non-competitive/Masters athlete but would like to participate in events and races sanctioned by a National Governing Body (e.g. USA Triathlon, USA Cycling, etc.) or a World Anti-Doping Code Signatory, please complete the USADA TUE Pre-Check Form.

Any athlete is encouraged to use the TUE Pre-Check found at this page. The TUE Pre-Check is an online form that allows USADA to evaluate if there is a need for a TUE based on your answers to specific questions. This helps athletes save time by determining whether a TUE is even necessary. We will respond to your TUE Pre-Check inquiry within three to five business days to let you know whether a TUE is required. If a TUE is necessary, we will direct you to specific TUE information related to your medication, so you understand what is required to submit a complete TUE application. If you’re submitting Whereabouts information to USADA or an International Federation, you can submit the TUE Pre-Check Form, but it is recommended you proceed directly to submitting a TUE application because of the potential time-sensitive nature of your application.

Please review the USADA Surgery Checklist to help determine the appropriate steps in preparing for your upcoming surgery.

Due to USADA and the NCAA having different anti-doping programs and rules, we do not recognize each other’s medical exemptions/TUEs at this time. If you are an NCAA athlete and you will be competing in an event sanctioned by a World Anti-Doping Code Signatory organization or are a member of those organizations like US National Governing Bodies, you may need to submit a TUE to USADA depending on your level of competition and the substance. If you are only competing within the NCAA and/or in NCAA sanctioned events (that are not co-sanctioned by a US National Governing Body) you will need to consult your Athletic Department Medical Staff regarding NCAA Medical Exceptions Procedures.

As soon as reasonably possible after the emergency treatment and medical situation has concluded:

  1. Collect all available medical documentation that completely outline the clinical exam, diagnosis, treatment plan, and any prohibited substances and methods administered (which may include ER admission/discharge notes, and a physician’s clinical notes detailing the treatment).
  2. Completely fill out a TUE application and write “EMERGENCY TUE” at the top of the form.
  3. Write a personal statement regarding the circumstances surrounding the events as they occurred along with any other relevant information.

Submit all three things (TUE application, medical notes, and personal statement) in accordance with any specific instructions related to your condition on the USADA TUE Application webpage to USADA.

All U.S. athletes are encouraged to submit their TUE application directly to USADA, even though in some instances, the International Federation is the review body for the TUE. If you are still unsure after your research, you can always submit your TUE application to USADA, and we will do our best to assist in determining which TUE authority is for you.

To apply for a TUE, please visit the USADA TUE Application page.

We request that athletes submit a TUE 30 days in advance of their planned use of any prohibited medication or method. Once a TUE application is received, USADA will respond within three to five business days whether the application is complete. If it is incomplete, we will send you a letter describing the deficiencies. Complete applications are sent to our TUE Committee (TUEC). The TUEC will render a decision as soon as possible and usually within no more than twenty-one (21) calendar days of receipt of a complete application (unless exceptional circumstances apply). Where a TUE application is made in a reasonable time prior to an event, the TUEC will attempt (but cannot guarantee) to issue a decision prior to an athlete’s scheduled event.

Potentially. First and foremost, we encourage athletes to consider their health first and athletic competition second. If you have a medical condition for which you have been prescribed a prohibited substance, medication, or method, consult with your medical provider. Depending on your competition level and the prohibited status of the substance, medication, or method, if you compete without a TUE, are tested, and your sample is positive for the prohibited substance, you could be at risk of having committed an anti-doping rule violation (ADRV), which may result in a sanction and public announcement. However, it may also be possible to receive a retroactive TUE depending on the circumstances.

If you compete while your TUE application is being processed, you could be at risk of an ADRV if your TUE is denied. TUEs are not guaranteed to be approved regardless of the reason or medical condition. A TUE approval prior to a competition is the safest course of action to follow.

Retroactive TUEs may be considered under any one of the following exceptions:

  1. Emergency or urgent treatment of a medical condition; or
  2. There was insufficient time, opportunity, or other exceptional circumstances that prevented submission prior to sample collection; or
  3. Due to prioritization of sports by the athlete’s NADO, the athlete was not required to get a TUE in advance; or
  4. Due to the athlete’s competitive status (not International-Level or National-Level), they are permitted to apply for a retroactive TUE; or
  5. The athlete used a substance/medication/method out-of-competition that is prohibited in-competition only.

Please call USADA directly if you have questions regarding a retroactive TUE and if it is appropriate for your specific situation.

If your TUE is approved, you will receive a certificate of approval along with an approval letter noting any conditions of the approval, as well as instructions for renewal. Please pay close attention to the conditions as, if these are not adhered to, could result in the cancellation of your TUE or denial of any TUE renewal. It is also important to be aware that if you’re competing internationally or in an International Federation (IF)-sanctioned event, that not all IFs will recognize a TUE decision issued by USADA. For this reason, it is very important you notify USADA if you intend to compete internationally. Please note “international events” can be held in the United States and not all events occurring in another country are considered “international events” for the purposes of TUEs. Finally, note the expiration date of the TUE and apply for a renewal at least 30 days in advance of the expiration date to ensure there are no gaps in your approval and you are not competing without a TUE.

Yes. While not mandatory, it would be beneficial to alert USADA of the existence of a TUE from another NADO/RADO/IF. If the TUE is approved in WADA’s database (known as ADAMS), USADA will be able to verify it. There is no need to resubmit to USADA unless we advise you otherwise.

The event organizer can help you determine if an event is a national or international-level competition. This information is often on the event website or in the registration materials. National Governing Bodies and International Federations are required by WADA to post their “sanctioned” competitions on their websites, as well. Please note, sometimes “international events” are held in the United States, and not all events occurring in another country are considered “international events” (e.g., sanctioned by the International Federation).

TUE Questions? Contact Us.

Drug Reference Line
Toll-Free Phone: (800) 233-0393
Phone: (719) 785-2080
Email: drugreference@USADA.org

Phone: (719) 785-2045
Email: tue@USADA.org

Toll-Free Phone: (800) 601-2632

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