Therapeutic Use Exemptions

What is a Therapeutic Use Exemption?

Athletes may have illnesses or conditions that require them to take medications or undergo procedures. If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List, a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. Applications for TUEs are evaluated by a panel of physicians, the TUE Committee (TUEC).

A TUE is a certificate granted for a set prohibited substance, in certain dosage, with a limited period of validity. An application for a TUE must be based on a documented medical condition and diagnosis, and the TUE will only be granted under strict criteria as outlined in the International Standard for Therapeutic Use Exemptions (ISTUE).

Athletes must absolutely avoid taking a medication containing a prohibited substance without a valid TUE.

All of the four following criteria must be met for obtaining a TUE (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2):

  • The athlete has a clear diagnosed medical condition which requires treatment using a prohibited substance or method;
  • The therapeutic use of the substance will not, on the balance of probabilities, produce significant enhancement of performance beyond the athlete’s normal state of health;
  • The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative;
  • The necessity to use that substance or method is not a consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.

For a TUE to be granted, all four of the above criteria must be met. All TUE applications are reviewed by a panel of experts called the TUE Committee (TUEC).

Who should apply for a TUE?

Athletes participating in The World Games are subject to the IWGA TUE Application Process. They need a TUE to take a prohibited substance or use a prohibited method. Athletes should verify with their International Federation to know to whom they need to apply and how they can apply retroactively.

If the athlete participating in The World Games already has a valid TUE granted by their National Anti-Doping Organisation or International Federation, IWGA will recognise it.

If the athlete does not already have a TUE granted by their NADO or IF, the athlete must apply directly to IWGA for a TUE as soon as possible – but no later than 30 days before The World Games (deadline is 5 June 2022) using the IWGA TUE Application Form. A TUE granted by IWGA for a specific event is effective for that event only. For example, a TUE granted to an athlete for The World Games 2022 is only valid from 5 to 18 July 2022 and is not valid for any other event, such as World Championships or future editions of The World Games.

Can I Get a Retroactive TUE?

You may only apply retroactively for a TUE to IWGA if:

  • You required emergency or urgent treatment of a medical condition.
  • There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application, or having it evaluated, before getting tested.
  • You tested positive after using a substance Out-of-Competition that is only prohibited In-Competition (for example glucocorticoids).

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for a therapeutic use of a prohibited substance or method, if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE.

This unique retroactive TUE will only be granted with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the IWGA’s decision).

Important note:

Using a prohibited substance or method without a TUE could result in an Anti-Doping Rule Violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

How to apply for a TUE

A Therapeutic Use Exemption must always be approved prior to the start of the treatment. In emergency or exceptional cases, a retroactive TUE may be granted. 

Athletes participating in The World Games may obtain a valid TUE granted by their National Anti-Doping Organisation or International Federation.

Upon arrival at The World Games, it is possible to ask the TUE Committee for emergency TUEs. If an athlete is not sure of where they should apply for a TUE, they should contact the respective International Federation.

Please download the IWGA's TUE Application Form, and once duly completed and signed, send it together with the required medical file to the IWGA TUE Committee.

Your TUE application must be submitted in legible capital letters or typing.

The medical file must include:
- A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible);
- The results of all examinations, laboratory investigations and imaging studies relevant to the application.

Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support, and Medical Information to Support the Decisions of TUECs for guidance on specific common medical conditions, treatments, substances, etc.

Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.

What if my TUE application is denied?

A decision to deny a TUE application will include a written explanation of the reason(s) for the denial. If it is not clear to you, please contact the IWGA TUE Committee to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us.

You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the IWGA TUEC decision. You should send the same information that you submitted to us, and on which the decision to deny the TUE was based on, via a secure on-line method or by registered mail at:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7

The email address to enquire and/or send the request for review is: [email protected]

It should be noted that WADA is not obliged to proceed with a request for a review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).


All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of a TUE request, is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the TUE process and in the IWGA TUE Application Form.

All members of the TUEC and any other authorised recipients of the TUE request and related information  (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.

Contact information

For any further information and questions in relation to IWGA's personal information practices, please contact IWGA Executive Committee Member Volker Bernardi.