Antidoping/True Ski

Therapeutic Use Exemptions (TUE)

What is a Therapeutic Use Exemption (TUE)?
Athletes, like all people, may have illnesses or conditions that require them to take particular medications or undergo procedures. If the medication or method an athlete is required to take to treat an illness or condition happens to fall on the World Anti-Doping Agency’s (WADA) Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take a substance or use a method that is prohibited. Applications for TUEs are reviewed by a panel of experts, the TUE Committee (TUEC) who may give such permission:
Carron Scrimgeour, MD
Marija Andjelkovic, MD, PhD
Nenad Dikic, MD, PhD
What are the criteria for granting a TUE? 
All four following criteria must be met:

  • The athlete has a clear diagnosed medical condition which requires treatment using a prohibited substance or method;
  • The therapeutic use of the substance would not produce significant enhancement of performance;
  • There is no reasonable therapeutic alternative to the use of the prohibited substance or 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.


Who should apply for a TUE to ISMF, where and when? 

First, check if the required medication or method you intend to take or use appears on the Prohibited List or use ‘check your medication’ online tool

You have the responsibility to inform your doctors that you are an athlete subject to doping control, and your doctors should check the Prohibited List whenever they prescribe a medication / method to you. If the substance / method is prohibited, check with your doctors if there are any alternative treatments that are not prohibited. If not, you have to apply for a TUE.

Second, check your competition level to determine to which organization, and when to apply for a TUE.

==> If you are an International-Level Athlete you must apply to ISMF in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.

The following Athletes shall be considered to be International-Level Athletes for the purposes of Anti-Doping Rules, and, therefore, the specific provisions in these Anti-Doping Rules applicable to International-Level Athletes (e.g., Testing, TUEs, whereabouts, and Results  Management) shall apply to such Athletes: Athletes who participate in the following ISMF International Events: World Cups, Continental Championships, and ISMF series as published by ISMF on its website at

For substances prohibited In-Competition only, you should apply for a TUE at least 30 days before your next competition.

Please refer to the section “How to apply to ISMF for a TUE?” below.

If you already have a TUE granted by your National Anti-Doping Organization (NADO):

Your NADO’s TUE is only valid at the national level, and you must submit a request for recognition by ISMF. Please refer to the section “How to submit a request for recognition of your NADO’s TUE to ISMF below.

==> If you are NOT an International-Level Athlete and you have been tested by ISMF, ISMF recognizes a valid TUE granted by your NADO. If, moreover, you are also NOT a National-Level Athlete as defined by your NADO and you have been tested by ISMF you must apply for a retroactive TUE ISMF.


Important note on retroactive TUEs:

Unless your competition level requires or permits that you apply for a TUE retroactively, using a prohibited substance before being granted a TUE could result in an Adverse Analytical Finding and potential anti-doping rule violation. However, as stated above, a retroactive TUE may be granted when:

  • 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 ISMF 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 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 ISMF’s decision).

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 to ISMF for a TUE?
Please download the ISMF’s TUE Application Form and once duly completed and signed, send it together with the required medical file to
Your TUE application must be submitted in legible English or French using capital letters or typing.
Please find here the 2021 WADA template to be filled out as TUE application form. The medical file includes:

  • 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.
  • If the medical file is not in English or French, a summary explaining, in English or French, the key elements of the diagnosis, clinical examinations, medical tests and treatment plan must be provided.

Any TUE application that is not complete or legible will not be accepted 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 your NADO’s TUE to ISMF?

Your request for recognition must be submitted using the copy of your NADO’s TUE certificate, application form (in English or French) and supporting medical file. Please send it to

It is not necessary to translate all medical information into English or French. However, an English or French summary explaining the diagnosis and key information about medical exams, medical tests and treatment plans is required.

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

Keep a complete copy of the proof that your request for recognition has been sent to ISMF.

You can also simply submit your request for recognition to ISMF, quoting your ADAMS NADO’s TUE reference number, if provided.


When will I receive a decision on my TUE application [or request for recognition]?

ISMF’s TUEC’s decision will be communicated in writing to you within 21 days from the date of receipt of the complete TUE application [or request for recognition], including the required medical information, by ISMF.


How about the renewal of 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 the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.


Important note:

The presence (following sample collection), use, possession or administration of the prohibited substance or method shall be consistent with the terms of your TUE. Therefore, in the event that, after your TUE is granted, you require a materially different dosage, frequency, route or duration of administration, you must apply for a new TUE.


What if my ISMF’s TUE application is denied?

A decision to deny a TUE application includes an explanation of the reason(s) for the denial. If it is not clear to you, please contact ISMF to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, other. Failing this:

You and/or your NADO may refer the matter to WADA for review no later than 21 days after the decision was rendered by the TUEC by sending the same information that you submitted to your TUEC and on which they based their decision to deny the TUE via registered mail at:

WADA Medical Director
World Anti-Doping Agency
800 Square Victoria
Montreal H4Z 1B7, QC

However, WADA is not obliged to proceed with such 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 ISMF?

You and/or your NADO have 21 days to refer the matter to WADA for review. You can appeal the decision by sending a registered letter together with the same information that was submitted to your TUEC and on which they based their decision to deny the TUE via registered mail at:

WADA Medical Director
World Anti-Doping Agency
800 Square Victoria
Montreal H4Z 1B7, QC

Pending WADA’s decision, your NADO’s TUE remains valid for national-level competition and Out-of-Competition testing only.

If the matter is not referred to WADA for review, the TUE becomes invalid for any purpose when the 21-day review deadline expires.


How about confidentiality?

All the information contained in a TUE application and file 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 ISMF’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, please note that should you wish to revoke the right of the ISMF’s TUEC to obtain the information related to your TUE request 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 ISMF 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.


Contact information

For any further information and questions in relation to the ISMF’s personal information practices, please contact

If you have a doubt as to which organization you should apply for a TUE, or as to the recognition process, or any other question with regard to TUEs, please contact


Other useful links: 

WADA International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Guidelines for Therapeutic Use Exemptions

WADA Q&A on Therapeutic Use Exemptions

Wada athlete consent form