Anti-doping - TUE


TUE application form

Athletes may have an illness or medical condition that requires a particular medication. If this medication contains a banned substance (one that appears on the WADA Prohibited List), they may need to apply for a Therapeutic Use Exemption (TUE). This gives the athlete an exemption to take the medication, while competing in sport.

Any athlete who may be subject to testing (doping control) must obtain a TUE if they are taking a prohibited substance or using a prohibited method. 

A TUE application should be submitted as soon as possible. For substances banned in-competition only, athletes should apply for a TUE at least 30 days before their next competition, unless it is an emergency or exceptional situation. In such cases, a TUE may be applied for retroactively.   

IMPORTANT: It is the athlete’s responsibility to find out if any medication they want to take contains a banned substance (on the WADA Prohibited List). 

If an athlete is being prescribed a medication or undergoing a medical procedure, they must ask their doctor if it involves any banned substances.  Where a banned substance is involved, the doctor should then assess if there is an alternative medication (or procedure) that can be administered that does not contain a banned substance.  If there is no suitable alternative, 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). 

As the MEO for major multi-sport events such as the Paralympic Games, the IPC manages the TUE approval 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 before taking the medication. Athletes should contact their NADO for advice if unsure of their status and about the application process.

International Level Athletes 

The IPC receives and processes TUE applications from International Level athletes for the IPC Para sports for which it is 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: 

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.

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:

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.

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 TUEs 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 approved, 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.

If a TUE is not granted during a Major Event such as the Paralympic Games the athlete may appeal the decision to the TUE tribunal in line with the relevant IPC 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 its National Anti-Doping Organisation (NADO) it is only valid at the national level. When competing internationally, the NADO TUE needs to be submitted to the responsible IF for recognition – or in the case of a major event, the TUE needs to be sent to the responsible MEO for recognition.

An athlete who has received a TUE from her/his NADO, must submit a request for recognition of the TUE in writing to the IPC ( quoting the ADAMs TUE reference number. The National Anti-Doping Organisation (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.

Note: TUE recognition by the IPC remains subject to Article of the 2021 World Anti-Doping Code, which requires that “the TUE meets the criteria set out in the International Standard for Therapeutic Use Exemptions”. The IPC may request extra supporting documentation.

Therefore, the IPC will recognise TUEs as follows:

TUEs that meet the ISTUE requirements issued by NADOs and IFs listed below will be eligible for automatic recognition, EXCEPT for TUEs for the following substances, which will require review by the IPC TUE Committee:

S0. Non-Approved Substances
S1: Anabolic Agents
S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics
S.8 Cannabinoids
Prohibited Methods: M1, M2 and M3.
P.1 Beta-Blockers in World Shooting Para Sport only
The IPC’s intention is to automatically recognise Therapeutic Use Exemptions (TUEs) from as many National Anti-Doping Organisations (NADOs) and International Federations (IFs) as possible. Unfortunately, at this time, the IPC does not have enough information on many NADOs and IF’s TUE Committees and their processes to make that decision. 

If a NADO or IF wishes to be included on the automatic recognition list below, please submit applicable information to and we will gladly review this information.

International federation list - automatic recognition
Alpine skiing FIS | Clean Sport (
Archery World Archery (WA)
Badminton Badminton World Federation (BWF)
Biathlon Anti-Doping – Biathlon Integrity Unit
Boccia Boccia International Sports Federation (BISFed)
Canoeing International Canoe Federation (ICF)
Cross Country Skiing FIS | Clean Sport (
Curling World Curling Federation (WCF)
Cycling International Cycling Union (UCI)
Equestrian International Equestrian Federation (FEI)
Football 5-a-side International Blind Sport Federation (IBSA)
Football 7-a-side International Federation of Cerebral Palsy Football (IFCPF)
Goalball International Blind Sport Federation (IBSA)
Judo International Blind Sport Federation (IBSA)
Rowing World Rowing Federation (FISA)
Snowboard FIS | Clean Sport (
Table Tennis International Table Tennis Federation (ITTF)
Taekwondo World Taekwondo (WT)
Tennis International Tennis Federation (ITF)
Triathlon International Triathlon Union (ITU)
Volleyball (Sitting) World Para Volley (WPV)
Wheelchair Basketball International Wheelchair Basketball Federation (IWBF)
Wheelchair Fencing International Wheelchair and Amputee Sport Federation (IWAS)
Wheelchair Rugby International Wheelchair Rugby Federation (IWRF)
NADO List - Automatic recognition
Country NADO
Australia Sport Integrity Australia (SIA)
Austria Nationale Anti-Doping Agentur Austria (NADA)
Azerbaijan Azerbaijan National Anti-Doping Agency
Belgium (Flanders) NADO Vlaanderen
Belgium (French Community) French Community NADO
Bermuda Bermuda Sport Anti-Doping Authority (BSADA)
Brazil Autoridade Brasileira de Controle de Dopagem (ABCD)
Canada Canadian Centre for Ethics in Sport (CCES)
China China Anti-Doping Agency (CHINADA)
Croatia Croatian Institute of Public Health (CIPH)
Czech Republic Anti-Doping Committee of the Czech Republic
Denmark Anti-Doping Denmark (ADD)
Finland Finnish Center for Integrity in Sports (FINCIS)
France Agence française de lutte contre le dopage (AFLD)
Georgia Georgian Anti-Doping Agency (GADA)
Germany Nationale Anti-Doping Agentur (NADA)
Greece Hellenic National Council for Combating Doping (EOKAN)
Hungary Hungarian Anti-Doping Group (HUNADO)
Ireland Sport Ireland
Italy NADO-Italia
Japan Japan Anti-Doping Agency
Kazakhstan Kazakhstan National Anti-Doping Organization
Kenya Anti-Doping Agency of Kenya
Korea Korea Anti-Doping Agency (KADA)
Latvia Anti-Doping Bureau of Latvia
Lithuania Anti-Doping Agency of Lithuania
Luxembourg Agence Luxembourgeoise Antidopage (ALAD)
Netherlands Doping Autoriteit – Doping Authority Netherlands
New Zealand Drug Free Sport New Zealand (DFSNZ)
Norway Anti-Doping Norway
Peru Comisión Nacional Antidopaje del Peru
Poland Polish Anti-Doping Agency (POLADA)
Portugal Autoridade Antidopagem de Portugal (ADoP)
Romania National Anti-Doping Agency of Romania
Serbia Antidoping Agency of Serbia (ADAS)
Singapore Anti-Doping Singapore
Slovakia Slovak Anti-Doping Agency (SADA)
Slovenia Slovenian Anti-Doping Organisation (SLOADO)
South Africa South African Institute for Drug Free Sport (SAIDS)
Spain Agencia Española de Protección de la Salud en el Deporte (AEPSAD)
Sweden Swedish Sports Confederation
Switzerland Antidoping Switzerland
Tunisia Agence Nationale Antidopage (ANAD)
Turkey Turkish Anti-Doping Commission
United Kingdom United Kingdom Anti-Doping (UKAD)
United States of America United States Anti-Doping Agency (USADA)
Uruguay Organización Nacional Antidopaje del Uruguay (URU-NADO)