The Therapeutic Use Exemption (TUE) is a part of the comprehensive anti-doping strategy developed and promoted by the World Anti-Doping Agency (WADA) for implementation in all Olympic sports, Paralympics and international athletic competition.
Upon the founding of WADA in 1999, a series of protocols were developed by WADA to assist in the world wide combat of doping in sport. A cornerstone of the anti-doping campaign has been the creation and the maintenance of the WADA Prohibited List, which sets out in a definitive fashion every substance that is prohibited for use by athletes in WADA compliant events. The Prohibited List is published annually, after consultation with sports scientists, sport administrators, and national anti-doping agencies. Many of the substances included on the Prohibited List have legitimate medical and therapeutic uses, often available as prescription medication.
WADA established the TUE to allow athletes to participate in competition who were required to take an otherwise prohibited substance for a legitimate medical purpose. A successful TUE application has three aspects: one, that the athlete would experience significant health problems if the subject medication were not taken; two, the athlete would obtain no significant performance benefit from the prohibited substance; three, there is no reasonable therapeutic alternative to the prohibited substance. The athlete's national anti-doping agency is responsible for the determination to grant or refuse the TUE application, with WADA reserving its right to either review the grant of the exemption, or to consider an appeal from an athlete who was refused a TUE. The Court of Arbitration for Sport is usually the final venue of appeals made in relation to TUE applications.
TUE applications are commonly advanced by athletes who use substances such as beta-2 agonists, the active ingredients in the bronchodilator medications used to treat conditions such as upper respiratory tract infections and asthma.
In the lead up to the 2006 Winter Olympics, two prohibited substance cases received prominence in the international media. Jose Theodore, a Canadian ice hockey goaltender, and American skeleton racer Zach Lund each tested positive for the use of a banned substance, finasteride, which each had ingested through their use of a hair restoration product, Propecia. Both Theodore and Lund had used the restorative for a number of years; had these athletes availed themselves of the TUE process, the likelihood of an exemption being granted was high, given that finasteride is only a prohibited substance through its other uses as a diuretic, the substances frequently associated with the masking of steroid use. As neither had applied for a TUE, each was subject to sanction as the WADA philosophy is that athletes must know what they are placing in their bodies, and a failure to take all reasonable steps to confirm the nature of all substances consumed in any fashion, or alternatively, a failure to us the TUE process, will not constitute a defense to a doping allegation.