UPDATE 3 January 2026: With the start of a new year and cycling season here is a refresher article originally published in March 2024 on Therapeutic Use Exemptions and why every competitive cyclist should be familiar with the TUE process to avoid unfortunate outcomes.

In some situations, an athlete may have an illness or condition that requires the legitimate use of medication listed on the World Anti-Doping Agency (WADA) Prohibited List. A National Anti-Doping Organization (NADO) may grant a Therapeutic Use Exemption (TUE) in these situations.

The TUE application process is thorough and designed to balance the need to provide athletes (professional, elite and amateur gran fondo racers) access to medication while protecting the rights of all athletes to compete on a level playing field.

Many amateur athletes believe that if a physician prescribes medication to treat an illness or condition then a NADO will simply approve and issue a TUE that protects the athlete from anti-doping sanctions.

Nothing could be further from reality.

Obtaining a TUE is a complicated, confusing, lengthy and costly undertaking that must be completed at least 30 days prior to competition. The athlete must have a physician complete a TUE form including complete medical history and multiple test results showing the athlete needs the drug to treat their medical condition and an alternative non-banned drug is not available or insufficiently treats their condition. In addition, the drug cannot increase the likelihood that the athlete will perform beyond their normal ability.

In some circumstances athletes may apply for a retroactive TUE if 1) They required emergency or urgent treatment of a medical condition, or 2) There was insufficient time, opportunity or other exceptional circumstances that prevented the athlete from obtaining a TUE before getting tested. In retroactive TUE scenarios where an athlete has already submitted a test sample, they are strongly encouraged to have complete medical documentation ready to submit to a NADO for evaluation.

TUE applications (pre-competition or retroactive) are reviewed by medical committees, which either approve the athlete to take the drug while competing or deny the athlete’s request – most requests are denied.

Take the case of 47 year-old Italian amateur Mirko Talignani who tested positive for Testosterone in 2021. Gran Fondo Daily interviewed Talignani, analyzed official medical documents and reviewed the NADO Italia court proceedings that ultimately resulted in his suspension for 2 years.

In early 2021 Talignani was medically diagnosed with Hypogonadism (low Testosterone) by local doctors at a state run Italian hospital. A treatment plan was recommended including Testosterone medication. With an official state issued medical diagnosis and various test results performed by specialists, Talignani felt the medical information could be provided to NADO if required.

On 24 April 2021 Talignani won the amateur G.P. Cicli Caroli race. Although it was not his first victory, nor inconsistent with past results, he was selected by NADO for in-competition testing which he completed as requested, listing his medical condition and prescribed Testosterone medication on the required forms.

NADO informed Talignani on 20 May that his submitted test sample was positive for Testosterone and requested he immediately submit a valid TUE or documentation to be granted one.

Talignani submitted a retroactive TUE request along with his medical documentation, which was deemed insufficient by the NADO medical committee. He then submitted additional documentation, but the committee once again confirmed its refusal to grant a retroactive TUE.

Multiple anti-doping court hearings were then held, with Talignani hiring lawyers and spending over 15,000 euros to defend his position that using Testosterone to treat a state diagnosed medical condition was not an intentional act to fraudulently improve sports performance – in other words he was not a doper.

NADO Italia held firm in its refusal to grant a TUE and banned Talignani for two-years, stating “It is the personal responsibility of the Athlete to ensure that he/she does not take any [WADA] prohibited substances.” Adding “The fault must be considered attributable to the athlete for having participated in the race without previously requesting the TUE and for having assumed that due to a medical diagnosis they would certainly have been granted one.”

WADA TUE Checklist for Hypogonadism HERE

Complete WADA TUE Rules and Process HERE

Photo Credit: WADA

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