Therapeutic Use Exemptions (TUEs) are a category of medical exemption that allows an athlete to use a prohibited substance and/or method for therapeutic reasons, following the approval of their application. It could be for a short-term illness, injury or emergency, or for treatment of an ongoing condition (e.g., diabetes, ADHD).
Athletes who need a TUE must apply for it and the application will only be approved if it meets specific conditions and is supported with medical documentation. The conditions are defined in Article 4.4 of the World Anti-Doping Code and the International Standard for Therapeutic Use Exemptions (ISTUE). It applies to all athletes who are subject to the Code, including the Canadian Anti-Doping Program (CADP). For more information, visit the World Anti-Doping Agency’s (WADA) TUE page.
Who needs to apply for a TUE?
Athletes who need a TUE prior to a doping control test are:
- In the CCES National Athlete Pool (NAP)
- In the CCES and/or an international federation Registered Testing Pool (RTP)
- Competing at Major Games and international events as required by the sport federation (e.g., Olympic or Paralympic Games)
Athletes who compete at the national level but don’t meet the requirements above can apply for an exemption retroactively.
Does this apply to you?
If you aren’t sure whether you should apply for a TUE, consult the Medical Exemption Wizard to determine your requirements or email the CCES at [email protected].
What’s included in a successful TUE application?
In general, a TUE application will be approved if it includes:
- A complete and legible application form,
- A physician’s letter that outlines the diagnostic criteria and a treatment plan, and
- Clinical evidence or documentation to support this diagnosis, as outlined in the checklists (e.g., lab results, diagnostic scales, specialist reports).
The TUE application must demonstrate that the prohibited substance or method:
- Is needed for therapeutic treatment,
- Won’t provide a performance-enhancing effect, but the treatment will allow the athlete to return to a normal state of health, and
- Is the best course of treatment and there isn’t a suitable permitted alternative.
Refer to section 4.2 of the ISTUE to review the specific criteria for granting a TUE.
Which organization should I apply to?
When you complete the Medical Exemption Wizard, your selections will determine whether you should apply to the CCES, your international federation or retroactively. Article 6.3 of the ISTUE explains that athletes should only apply to one organization. If you are ever unsure who to apply to, contact us at [email protected].
Are you in the CCES National Athlete Pool (NAP)?
Contact your national sport organization (NSO) for clarification, or email [email protected] and make sure to state your name, your sport, and any event you’re going to compete in.
Are you an international-level athlete?
Visit the anti-doping section of your international federation’s website for their definition of an international-level athlete.
How to apply to the CCES for a TUE
Step 1: Confirm your exemption requirement.
- Make sure you are required to submit a TUE application by using the Medical Exemption Wizard. If you are unsure about your requirements, you can also email the CCES ([email protected]).
- It can take up to 21 days to review a TUE application once received if the application is considered complete.
Step 2: Complete a TUE application form.
The TUE form is only one part of your application! Fill out the form but continue through all the steps to ensure your application is complete before submission. Download the document here.
- All fields on the form must be complete, legible, and it must be dated and signed by the athlete and the prescribing physician. Typed or block letters are preferred. Illegible and/or incomplete forms will be returned to the athlete.
- The "Retroactive” section of the form should only be filled out if there is a need for the application to be considered retroactively. Please consult the Retroactive TUE page for more details.
- An application submitted on the CCES TUE form or an international federation’s TUE form will be accepted providing it is complete, legible, and filled out in English or French.
Step 3: Ask your physician(s) for a letter.
The letter from your physician(s) should:
- Confirm that you were seen in the last 12 months,
- Confirm the diagnosis and treatment plan (i.e., the medication prescribed and the dosage), and
- Describe why the prohibited medication/method is needed, how it has helped therapeutically, and that there hasn’t been a suitable, permitted alternative.
Click here to review and download an example of a physician’s letter.
Step 4: Select the appropriate checklist and assemble your medical file.
The checklist identifies the documents that should be included in your medical file to confirm your diagnosis and treatment plan.
- Consult the conditions/diagnoses listed in the table below and identify which one is appropriate for you.
- Assemble all of the documents listed on the checklist before you submit. It’s important to include them all because missing documents may result in an incomplete application.
- Incomplete applications will be returned to the athlete and not sent for review. It’s better to submit more information than not enough.
- Share the WADA TUE Physician Guidelines associated with your condition/diagnosis with your physician to help them understand the TUE process.
Note: The CCES is not responsible for any medical costs related to the completion of the TUE application form, including additional investigations, examinations, or imaging studies required.
CCES TUE Checklists and WADA TUE Physician Guidelines
Conditions/Diagnosis | CCES TUE Checklist | WADA TUE Physician Guidelines |
|---|---|---|
ADHD/ADD |  |  |
Adrenal Insufficiency | |  |
Anaphylaxis |  |  |
Asthma |  |  |
Cardiovascular Conditions |  |  |
Diabetes Mellitus |  |  |
Female Infertility |  |  |
Growth Hormone Deficiency (GHD) (children and adult) |  |  |
Inflammatory Bowel Disease (IBS) |  |  |
Intravenous Infusion |  |  |
Intrinsic Sleep Disorders |  |  |
Male Hypogonadism |  |  |
Musculoskeletal Conditions |  |  |
Pain Management |  |  |
Polycystic Ovarian Syndrome (PCOS) |  |  |
Renal Transplantation (kidney failure and kidney transplantation) |  |  |
Sinusitis/Rhinosinusitis |  |  |
Transgender Athletes |  |  |
Step 5: Submit your complete TUE application to the CCES.
Gather your application form, physician's letter, and medical file, and send it to the CCES. Keep a copy of your application form and medical file for your records.
Fax to 613-521-3134
Email to [email protected]
Mail to Attn: Athlete Services, CCES, 201-2723 Lancaster Road, Ottawa, ON, K1B 0B1
Step 6: Complete any necessary follow-ups.
- The CCES will send you an email confirming receipt of your TUE application. If you do not receive it within two business days, please contact the CCES.
- The confirmation email will state whether your application is complete and has been sent for review, or if more information or documentation is needed.
Step 7: Receive the decision.
Once a decision has been made to approve or deny the application, the CCES will inform you about the decision.
- An approval will include a letter of approval and a TUE certificate. The certificate will state: TUE number, athlete’s information, duration of approval (effective and expiry dates), and the approved medication and dosage.
- A denial will include a letter that details why the application was denied (e.g., which conditions of the ISTUE were not met) and suggestions for future applications. A denial will also include information about the appeal process.
A medical exemption is only valid once it has been approved, and there is no guarantee a TUE application will be approved. That is why it is important to apply early and to provide as much information as possible.
Questions? Contact the CCES:
- Email: [email protected]
- Phone: 1-800-672-7775 or 613-521-3340
FAQ
First – don’t panic! This is a very common experience. Often, athletes will start a course of treatment for long before they need to apply for a TUE (e.g., when added to the NAP or meet the IF’s definition of an international-level athlete).
Submit an application as soon as possible once you are required to do so. Use the Medical Exemption Wizard to determine your medical exemption requirements.
If your TUE application is denied, it means that your application doesn’t currently meet the criteria outlined in the ISTUE, not necessarily that your treatment isn’t considered valid.
The decision letter provided by the CCES will explain why it was denied and which criteria were not met. The letter will also list which elements were missing and could be submitted in a new application to be reconsidered by the TUE Committee (TUEC). Under the rules of the CADP, you may appeal a denial decision.
Your health and safety come first. Decisions regarding your treatment plan should be made in consultation with your physician. Once your treatment is being managed, use the Medical Exemption Wizard to determine your medical exemption requirements, and to download the application form if required.
Your health and safety come first. With the advisement of your medical team, get the medical help you need, and after your treatment has been managed, consult the Medical Exemption page to determine whether you need a medical exemption.
If the application is for emergency or acute treatment, or for a surgery requires you to apply for a TUE, you might be eligible for the Retroactive TUE process.
Your medical exemption requirements may change when your level of competition changes. An approved CCES TUE is valid only in Canada, so if you’re going to compete internationally, consult your international federation’s (IF) anti-doping rules.
If you are added to your IF’s RTP or compete at an international level (e.g., a world cup, world championships, major games), you may be required to have your TUE recognized by your IF before this competition. Contact the CCES or the IF to determine if and how you should seek recognition for your TUE at the international level.
The duration of your TUE is determined by the CCES TUEC and varies from case to case. The duration and expiry date will be clearly stated on your TUE certificate.
Your TUE will expire after the date indicated on the TUE certificate. It is your responsibility to know when your TUE certificate expires, and to submit another application in advance of the expiry date if you are still using the prohibited medication.
The CCES’s TUE approval letter will outline the medical documentation required for subsequent applications. We strongly recommend that you submit a renewal application within three months of the expiry date (e.g., if your TUE expires on April 1, 2026, submit a new application by January 1, 2026).
If you are taking prohibited medications for more than one diagnosis or condition, then you must submit a separate application for each condition. For example, if you use medications to treat ADHD and diabetes, you will submit one TUE application for the diabetes treatment, and a second one for the ADHD treatment. List all prohibited medication(s) that you are using for treating your condition on the TUE application form.
If the substance name (i.e., the active ingredient in your medication) listed on the TUE certificate is the same, then you do not require a new TUE.
If you are switched from one prohibited medication to a different one, with a different active ingredient, you would need to apply for a new TUE.
If the type of medication and/or dosage changes before your TUE expires, you must contact the CCES to request a new TUE, because a TUE is only valid for the specific substance(s), dosage, route of administration, frequency, and duration. If you have been issued a TUE by the CCES, the letter of approval will highlight what elements should be submitted in the event your medication and/or dosage changes.
The TUE process is very rigorous, and some athletes may go through multiple rounds of submitting additional information or seeing specialists to get appropriate documentation before their application is considered complete. It can be a long, challenging process.
The goals of the TUE are twofold: first, to ensure that athletes have access to the medical treatments they need, even if those treatments are prohibited, without being punished with a positive test. And second, to make absolutely sure that the system is not being used to cover for doping.
The TUE process is thorough, but it’s thorough with good reason – to demonstrate beyond a shadow of a doubt that the athlete is competing clean.