Therapeutic Use Exemptions (TUE)

Professional cyclists face extreme physical demands. Injuries, chronic illnesses, and acute infections are part of everyday life – yet many effective medications are on the WADA prohibited list. The Therapeutic Use Exemption (abbreviated TUE) is the official way to use a banned substance for medically justified reasons under strict conditions, without violating anti-doping rules.

What is a TUE?

A TUE allows an athlete to use a otherwise prohibited substance or method for a limited period when a medical indication strictly requires it and no permitted alternative exists. It is not a free pass for performance enhancement, but a controlled exception within the framework of the WADA Code.

Basic principle: Without a valid TUE, any detectable prohibited substance in the body is considered a doping violation – regardless of whether the athlete took it for medical reasons.

The Four Criteria for TUE Approval

According to the International Standard for Therapeutic Use Exemptions (ISTUE), all of the following conditions must be met:

1. The athlete would experience a significant impairment of health without treatment.
2. The therapeutic use does not produce any significant performance enhancement beyond a return to normal health.
3. There is no reasonable therapeutic alternative that is not prohibited.
4. The use of the substance is not a consequence of prior unauthorized use.

Who Decides on TUE Applications?

Responsibility depends on the athlete's status:

In professional cycling, the UCI processes TUE applications for riders in the Registered Testing Pool (RTP) and the international testing program. National federations are responsible for licensed riders outside these pools.

The TUE Application Process in Detail

Step-by-Step Procedure

1. Medical diagnosis: A licensed physician establishes the diagnosis and comprehensively documents the need for treatment.
2. Review of alternatives: It must be demonstrated that no permitted therapy is available.
3. Application form: Complete the official TUE form via ADAMS (Anti-Doping Administration and Management System) or the national portal.
4. Medical records: Attach physician letters, test results, imaging, treatment history, and dosing schedule.
5. Submission: Submit the application to the responsible body (UCI or NADA) before treatment begins.
6. Review: A medical expert panel evaluates the application according to ISTUE criteria.
7. Decision: Approval, rejection, or request for additional information with a deadline.
8. Documentation: If approved, keep the TUE certificate on hand; present it during controls.

Required Documents

• Complete medical report with diagnosis and medical history
• Justification why no permitted alternative exists
• Exact substance, dosage, route of administration, and duration
• Signature of the treating physician
• For renewals: updated treatment history

Common TUE Cases in Cycling

In cycling, certain medical situations occur regularly. The following overview shows typical – not automatically approved – applications:

Asthma and Inhalers – A Special Case

Asthma is one of the most frequently discussed topics in the peloton. Many inhaled beta-2 agonists are permitted in limited doses without a TUE. If an athlete exceeds the threshold values or requires stronger medications, a TUE becomes necessary. The exact limits are documented in the current WADA Prohibited List – see also Prohibited Substances.

TUE and Doping Controls

During a doping control, any detected prohibited substance is initially treated as a potential violation. The athlete must then prove that a valid TUE exists for exactly that substance, dose, and the time of the sample.

Important rules during controls:

• Always have the TUE certificate (digital or printed) readily available
• Substance, dosage, and time of administration must exactly match the TUE
• Deviations – even minor ones – can be treated as violations
• The testing procedure does not distinguish between intentional doping and faulty TUE documentation

Renewal, Revocation, and Appeal

Renewing a TUE

TUEs have an expiration date. For renewals, a new application with updated medical records must be submitted – ideally six weeks before expiration.

Revocation

A TUE can be revoked if:

• new medical findings call the approval into question
• the athlete does not comply with the conditions
• the substance is no longer medically required

Appeal Against Rejection

Rejected applications can be appealed to the responsible TUE Committee or to WADA. The appeal must be submitted within 21 days of rejection.

TUE Debates and Criticism in Cycling

Therapeutic use exemptions have been criticized for years. Skeptics argue that the system can be exploited and that prohibited substances could reach elite sport under the guise of medical necessity.

Common points of criticism:

• Lack of transparency: TUE data was not published for a long time
• Unequal standards between nations and federations
• Suspicion of "TUE shopping" – applications in more lenient countries
• ADHD diagnoses in adult elite athletes under suspicion

Since 2018, the UCI has published anonymized TUE statistics. Well-known cases – such as those involving Chris Froome (salbutamol) or Bradley Wiggins (triamcinolone) – have fueled the public debate about TUE abuse and are documented in Famous Doping Cases.

Checklist for Cyclists: Applying for a TUE Correctly

Before the Season

• Discuss pre-existing medical conditions with the team physician
• Set up ADAMS account and verify access credentials
• Download the current WADA Prohibited List
• Check whether medications require a TUE

When Starting a New Medication

• Clarify WADA status of the substance (S0–S5, P1–P3)
• Before taking: submit TUE application, not after
• Collect and attach all medical findings
• Coordinate dosage exactly with physician

During the Season

• Carry TUE certificate digitally and physically
• Mark expiration date in calendar
• Submit renewal application in good time
• Present TUE immediately during doping control

In an Emergency (Accident, Acute Illness)

• Do not refuse treatment – health takes priority
• Inform team physician and anti-doping officer immediately
• Apply for retroactive TUE within the 20-day deadline
• Document all treatment details completely

TUE for Amateurs and Junior Riders

Licensed riders outside the international testing pools may also require a TUE. The application goes through the national federation – in Germany through NADA. The criteria are identical, but processing may take longer.

Special considerations for amateurs:

1. Gran Fondo participants without a UCI license rarely fall under an active testing program – however, controls can still take place at championships
2. For over-the-counter medications, always check ingredients, not just brand names
3. Team physicians in amateur teams are not always familiar with TUE procedures – independent verification recommended

Connection to the Anti-Doping System

TUEs are an integral part of the Anti-Doping system in cycling. They connect medical reality with the demand for fair competition. For athletes, support staff, and fans, understanding TUE rules is essential to distinguish between legitimate medical care and rule violations.

Frequently Asked Questions About TUE in Cycling

• Can I take a prohibited medication before the TUE is approved? No, except in defined emergencies with a retroactive application.
• Is a TUE valid worldwide? Yes, recognized TUEs from the UCI/WADA are valid internationally.
• Do I have to publish my TUE? No, but the UCI maintains internal registers; anonymized statistics are published.
• Can a TUE help during a control if the dose was higher? No, deviations from the approved dose lead to violations.
• What happens if a TUE is rejected? Appeal possible within 21 days; without approval, the substance must not be used.

TUE vs. Doping Violation