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Anti-doping - TUE
THERAPEUTIC USE EXEMPTIONS (TUEs)
TUE application form
Athletes may have an illness or medical condition that requires a particular medication or procedure. If this medication or procedure contains a banned substance or involves the use of a banned method (one that appears on the WADA Prohibited List), the athlete may need to apply for a Therapeutic Use Exemption (TUE). A TUE gives the athlete an exemption to possess/use the substance or method, while competing in sport.
IMPORTANT: It is the athlete’s responsibility to find out if any medication or method they want to use is prohibited (see the WADA Prohibited List).
An athlete also has a responsibility to inform their physician(s) that they are an athlete bound by anti-doping rules, and to ask if the treatment being prescribed involves a banned substance or method. If a banned substance or method is involved, the physician should first assess if there are any reasonable alternatives that are not banned. If there are no such alternatives, the athlete must apply for a TUE.
For more information about TUEs read: At-a-Glance: Therapeutic Use Exemptions.
IPC's Role in the TUE Process
The IPC operates both as a Major Event Organisation (MEO) and an International Federation (IF) under the World Anti-Doping Code.
As the MEO for the Paralympic Games, the IPC manages the TUE process for all participating athletes.
The IPC functions as an IF for the World Para sports listed below:
| World Para Athletics | World Shooting Para Sport |
| World Para Ice Hockey | World Para Swimming |
| World Para Powerlifting |
Where to Apply for a TUE
Where (and when) an athlete must apply for a TUE depends on their status as a national or international level athlete.
National Level Athletes
National Level Athletes must apply to their National Anti-Doping Organisation (NADO) for a TUE. Athletes should contact their NADO for advice if unsure of their status and about the application process.
International Level Athletes
International-Level Athletes must apply to their IF for a TUE. Accordingly, the IPC receives and processes TUE applications from International-Level Athletes for the World Para Sports for which the IPC acts as the IF.
Each of the sports publishes annually a list which outlines who is considered an International Level Athlete - click on the links above to go to the sport specific Anti-Doping page where the International-Level Athlete criteria are published.
Athletes who are included on the International-Level Athletes list must apply to the IPC for a TUE: tue@paralympic.org
If an athlete does not meet the IPC's International-Level Athlete criteria, they should contact their NADO to confirm their status and requirements regarding TUEs.
Athletes who are neither National nor International Level Athletes are not required to apply for a TUE unless they return a positive test. In this situation, a retroactive application must still meet all the requirements for approval.
The IPC's MEO role for the Paralympic Games
For the Paralympic Games the IPC manages the TUE application and recognition process for all participating athletes.
All athletes must apply to the IPC for a TUE (or for recognition of an existing TUE) if they wish to use a prohibited substance or method in connection with the Paralympic Games.
TUE Application Process
Athletes are required to submit a completed and signed TUE application form to the IPC. TUE applications can be submitted via ADAMS or by email to: tue@paralympic.org
The 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;
• Copies of original reports, letters and specialist reviews;
• A detailed summary of any alternative medications tried (including names, dosages, duration of use, and effects) or clinical justification from the prescribing doctor that confirms that in their opinion there are no other reasonable permitted alternatives that exist to treat the medical condition.
Any cost incurred for the completion of a TUE application is at the responsibility of the athlete, including any required additional medical examinations, tests and imaging studies.
Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission. For any questions around the TUE application please contact tue@paralympic.org
To assist the athlete and their doctor in providing the correct medical documentation, we suggest consulting WADA’s Checklists for TUE applications for guidance and support, and the Medical Information to support the decisions of TUECs for guidance on specific common medical conditions, treatments, substances, etc.
The athlete should keep a complete copy of the TUE application form and all medical information submitted in support of the application, and proof that it has been sent.
WADA TUE Application Checklists and physician guidelines
• ADHD (Attention Deficit Hyperactivity Disorder) in Children And Adults - Checklist | Guidelines
• Adrenal Insufficiency - Checklist | Guidelines
• Anaphylaxis - Checklist | Guidelines
• Asthma - Checklist | Guidelines
• Cardiovascular Conditions: The Therapeutic Use of Beta-blockers in Athletes - Checklist | Guidelines
• Diabetes Mellitus - Checklist | Guidelines
• Female Infertility - Checklist | Guidelines
• Growth Hormone Deficiency in Adults - Checklist | Guidelines
• Growth Hormone Deficiency in Children and Adolescents - Checklist | Guidelines
• Inflammatory Bowel Disease - Checklist | Guidelines
• Intravenous Infusion - Checklist | Guidelines
• Intrinsic Sleep Disorders - Checklist | Guidelines
• Kidney Failure and Kidney Transplantation - Checklist | Guidelines
• Male Hypogonadism - Checklist | Guidelines
• Musculoskeletal Conditions - Checklist | Guidelines
• Pain Management - Checklist | Guidelines
• Polycystic Ovarian Syndrome - Checklist | Guidelines
• Sinusitis/Rhinosinusitis - Checklist | Guidelines
• Transgender Athletes - Checklist | Guidelines
How do I know if my application has been approved
If a TUE has been granted, the athlete will receive confirmation from the IPC and a certificate will be issued. If any of the conditions outlined in the TUE certificate such as dosage, frequency, route of administration and duration for use of the medication should change, the athlete must inform the IPC.
If a TUE is not granted, athletes can ask WADA to review the application or appeal in line with the relevant IPC's Anti-Doping rules.
Renewing an Existing TUE
TUEs are only approved for a specific period of time and will eventually expire. It is the athlete's responsibility to renew the TUE, if required, before it expires. A new TUE application form needs to be completed and submitted, together with a new medical report confirming the diagnosis and the outcome of any further investigations conducted (since the previous application).
Recognising Existing TUEs
When an athlete has a TUE issued by their NADO the TUE is only valid at the national level. If the athlete subsequently becomes an International-Level Athlete or competes in an International Event, the TUE will not be valid unless and until it is recognised by the relevant IF.
For the Paralympic Games, if an athlete has a TUE issued by their NADO or IF, the TUE will not be valid unless and until it is recognised by the IPC.
Where the IPC is the IF or the MEO for the Paralympic Games, a request for recognition must be submitted to the IPC through ADAMS or by email (tue@paralympic.org) quoting the ADAMs TUE reference number. The NADO that approved the TUE needs to make the TUE and supporting materials available to the IPC via ADAMS to enable the IPC to access it. The IPC will only recognise TUEs that are recorded in ADAMS.
The IPC will recognise TUEs as follows:
Except where a TUE is automatically recognised as set out below, the IPC will assess the request and will only recognise TUEs that meet the criteria set out in WADA's International Standard for Therapeutic Use Exemptions (ISTUE).
Provided that the TUE decision has been properly reported in accordance with the ISTUE, the IPC will automatically recognise TUEs issued by the NADOs and IFs listed below, EXCEPT for TUEs for the following substances (which will need to be reviewed and assessed by the IPC as described above):
S0. Non-Approved Substances
S1: Anabolic Agents
S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics
S.8 Cannabinoids
Meldonium
Prohibited Methods: M1, M2 and M3.
P.1 Beta-Blockers in World Shooting Para Sport only
The IPC’s intention is to automatically recognise TUEs from as many NADOs and IFs as possible. Unfortunately, at this time, the IPC does not have sufficient information on many NADOs and IF’s to make that decision. If a NADO or IF wishes to be considered for inclusion on the IPC automatic recognition list below, please submit applicable information to tue@paralympic.org.
IPC TUE Committee
FUNCTION: Evaluating TUE applications in accordance with relevant rules to determine if there are sufficient grounds to grant it.
| FUNCTION | NAME |
|---|---|
| Chairperson | Dr. Jan Lexell |
| Member | Dr. Manos Bogdos |
| Member | Dr. Marcelo Patricio |
| Member | Dr. Harri Helajärvi |
| Member | Dr. Chin Sim Teoh |
