THERAPEUTIC USE EXEMPTIONS
IFBB TUE PROCESS
WHAT IS A THERAPEUTIC USE EXEMPTION (TUE)?
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).
WHAT ARE THE CRITERIA FOR GRANTING A TUE?
All of the four following criteria must be met (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;
Important note: The Use of the Prohibited Substance or Prohibited Method may be part of a necessary diagnostic investigation rather than a treatment per se.
- 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;
Important note: The physician must explain why the treatment chosen was the most appropriate, e.g. based on experience, side-effect profiles or other medical justifications, including, where applicable, geographically specific medical practice, and the ability to access the medication. Further, it is not always necessary to try and fail alternatives before using the Prohibited Substance or Prohibited Method.
- 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.
Important note: The granting of a TUE is based solely on consideration of the conditions set out in Article 4.2. of the World Anti-Doping Code (WADC). It does not consider whether the Prohibited Substance or Prohibited Method is the most clinically appropriate or safe, or whether its use is legal in all jurisdictions.
WHO SHOULD APPLY FOR A TUE? WHERE AND WHEN TO APPLY?
Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method. You should verify with IFBB to know to whom you need to apply and if you can apply retroactively.
First, check if the required medication or method you intend to take, or use is prohibited as per the WADA Prohibited List . You may also use a ‘check your medication’ online too or ask your NADO if it has one.
You have a responsibility to inform your physician(s) that you are an Athlete bound to anti-doping rules. You and your physician(s) should check the Prohibited List for the substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives, if there are none, apply for a TUE. Remember Athletes have the ultimate responsibility. Contact your NADO or IFBB if you are having difficulties.
Then, contact IFBB, by e-mail: email@example.com to determine your competition level and TUE application requirements.
If it is determined that you are an International-Level Athlete (Athletes holding a valid IFBB International Card), you must apply to IFBB in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.
For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition, unless one of the exceptions on retroactive TUEs (see below) apply.
If you already have a TUE granted by your National Anti-Doping Organization (NADO):
In such case, please notify IFBB that you have a TUE granted by your NADO.
If your existing TUE does not fall under a category of decision described above, you must submit a request for recognition to IFBB.
Your NADO’s TUE is only valid at the national level, and you must submit a request for recognition to IFBB.
If you are NOT an International-Level Athlete and you have been tested by IFBB:
IFBB recognizes a valid TUE granted by your NADO (i.e., it satisfies the ISTUE criteria for granting a TUE); unless you are required to apply for recognition of the TUE because you are competing in an international event.
If you are NOT a National-Level Athlete as defined by your NADO and you have been tested by IFBB:
In this case, you must apply for a retroactive TUE to IFBB.
For the avoidance of doubt, when a National Anti-Doping Organization grants a TUE to an Athlete, that TUE is valid at national level on a global basis and does not need to be formally recognized by other National Anti-Doping Organizations under Article 7.0 (for example, if the Athlete is granted a TUE by their National Anti-Doping Organization and then trains or competes in the country of another National Anti-Doping Organization, that TUE will be valid if the Athlete is then tested by such other National Anti-Doping Organization).
CAN I GET A RETROACTIVE TUE?
You may only apply retroactively for a TUE to IFBB 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 are a lower-level athlete who is not under the jurisdiction of IFBB or NADO and were 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 as an athlete 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 IFBB’s decision).
HOW TO APPLY TO IFBB FOR A TUE?
IFBB encourages to submit TUE applications via ADAMS, together with the required medical information. If you do not have an ADAMS account yet, please contact, please contact the IFBB to have your account set up.
For technical support please contact the ADAMS Helpdesk:
- North America: 1 866 922 3267
- International: +1 514 904 8800
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.
HOW TO SUBMIT A REQUEST FOR RECOGNITION OF MY NADO’S TUE TO IFBB?
Your request for recognition should be submitted to IFBB in writing quoting your ADAMS TUE reference number.
Keep a complete copy of the proof that your request for recognition has been sent to IFBB.
WHAT HAPPENS AT MAJOR EVENTS?
A Major Event Organization (MEO) requires athletes to apply for the recognition of their TUE if they wish to use a prohibited substance or method in connection with the Event.
If you have a TUE granted by IFBB and you will be competing at a Major Event e.g., the Olympic Games, you should contact the MEO for information on their recognition process.
WHEN WILL I RECEIVE A DECISION ON MY TUE APPLICATION [OR REQUEST FOR RECOGNITION]?
IFBB’s TUEC’s must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application [or request for recognition].
- Each TUE will have a specified duration, as decided by the TUEC, at the end of which the TUE will expire automatically. If the Athlete needs to continue to Use the Prohibited Substance or Prohibited Method after the expiry date, he/she must submit an application for a new TUE well in advance of that expiry date, so that there is sufficient time for a decision to be made on the application before the expiry date.
- A TUE will be withdrawn prior to expiry if the Athlete does not promptly comply with any requirements or conditions imposed. Alternatively, a TUE may be reversed upon review by WADA or on appeal.
- Where an Adverse Analytical Finding is issued shortly after a TUE for the Prohibited Substance in question has expired or has been withdrawn or reversed, the IFBB Anti-Doping Commission that is conducting the initial review of the Adverse Analytical Finding, shall consider whether the finding is consistent with Use of the Prohibited Substance prior to the expiry, withdrawal or reversal of the TUE. If so, such Use (and any resulting presence of the Prohibited Substance in the Athlete’s Sample) is not an anti-doping rule violation.
WHAT IF I NEED TO RENEW MY TUE?
Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information ahead of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.
The presence (following sample collection), use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route or duration of administration, you should contact IFBB, as you may be required to apply for a new TUE. Some substances and dosages, e.g. insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the ADO TUEC.
WHAT IF MY IFBB’S 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 IFBB 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 IFBB’s 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: firstname.lastname@example.org
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).
WHAT IF MY NADO’S TUE IS NOT RECOGNIZED BY IFBB?
You and/or your NADO have 21 days from the date of decision to refer the matter to WADA for review. The email address to enquire and/or send the request for review is: email@example.com. Alternatively, you may send to:
WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
The same information that was provided to your NADO should be submitted to WADA. Please use a secure on-line method unless sending by registered mail.
Pending WADA’s decision, your NADO TUE remains valid for national-level competition and out-of-competition testing only.
If the matter is not referred to WADA for review, your NADO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.
WILL MY MEDICAL INFORMATION BE TREATED IN A CONFIDENTIAL MANNER?
All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE process and in the IFBB’s TUE Application Form. All members of the TUEC and any other authorized recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.
Please review the terms of the Athlete’s Declaration carefully. In particular, note that should you wish to revoke the right of the IFBB’s TUEC to obtain the information related to your TUE in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval [or recognition] being granted.
Your TUE request-related information will be retained by IFBB and any other authorized recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information.
For any further information and questions in relation to IFBB’s personal information practices, please contact firstname.lastname@example.org
If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question about TUEs, please contact: email@example.com
OTHER USEFUL LINKS:
- WADA Checklists for TUE Applications
- WADA Guidelines for the International Standard for Therapeutic Use Exemptions (ISTUE)
- WADA Anti-Doping Education and Learning (ADEL)
- International Standard for Therapeutic Use Exemption (ISTUE)