The procedures for applying for and awarding a TUE are outlined in the International Standard for Therapeutic Use Exemptions (ISTUE)

The Therapeutic Use Exemption (TUE) process is a means by which an athlete can obtain approval to use a prescribed prohibited substance or method to treat a legitimate medical condition.

In some cases, an athlete may suffer from an illness or condition that requires the use of the drugs on the World Anti-Doping Agency (WADA) banned list. EGY-NADO can grant a Therapeutic Use Exemption (TUE) in these situations in accordance with the International Standard for Therapeutic Use Exemptions (ISTUE). The TUE application process is comprehensive and designed to balance the need to provide athletes with access to critical medicines while protecting the rights of clean athletes to complete in an equal playing field.

The TUEs awarded by EGY-NADO TUEC are only valid for national competition and out-of-competition testing.

ISTUE is the reference standard for the TUE application process of the Egyptian  Anti-Doping Organization  (EGY-NADO) 

Important note

Using a prohibited substance or method without a TUE may result in an   Anti-Doping Rule Violation.

Athletes who are subject to anti-doping rules need to apply for a TUE to take a banned substance or use a prohibited method.

First, check if the required substance / method you intend to ingest / use is banned according to WADA prohibited List  .
Then check who needs to apply for a TUE in advance and who can apply retroactively

You may also call if you are having difficulties determining the condition of the material / method. If the substance / method is prohibited, contact EGY-NADO to determine the level of competition and requirements for TUE application.

It is your responsibility to inform your doctor (s) that you are an athlete who is bound by the anti-doping rules. You and your physician (s) should check the prohibited list for any substance / method prescribed to you. If the substance / method is prohibited, discuss with your doctor (s) the option of using non-prohibited alternatives. If none, apply for a TUE. Remember that athletes have the ultimate responsibility for any substance that enters their bodies.

If you are determined to be National-LevelAthlete, you must apply to EGY-NADO for a TUE in advance, as soon as the need for treatment arises, unless it is an emergency or there are other exceptional circumstances. A definition of an athlete at the national level can be found on the “Who needs to apply for a TUE in advance” page.

For substances banned in competition only, you must apply for a TUE at least 30 days before the next competition. Please refer to the section “How to apply to EGY-NADO to obtain a TUE?” Below.

If your level is below the “National Level” as defined in the link above, you are classified as another athlete and you should apply for a TUE retrospectively only after you have been tested by EGY-NADO or any other anti-doping organization (ADO) ). The definition of “other athlete” can be found on the “Who needs to apply for a TUE in advance” page.

All of the following four criteria must be met (for further details, please refer to the International Standard for Therapeutic Use Exemptions for WADA 2021 (ISTUE), Article 4.2):

1. The athlete has a diagnosed medical condition, which requires treatment using a prohibited substance or method;

2. The therapeutic use of the substance will not, on the balance of probabilities, produce any additional enhancement of performance beyond what might be anticipated by a return to the athlete’s normal state of health;

3. The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative;

4. The necessity to use that substance or method is not the consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.

You may only apply retroactively for a TUE to EGY-NADO if:

  • 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.
  • As per the EGY-NADO Anti-Doping Rules you were not permitted or required to apply for a prospective TUE.
  • You are a lower-level athlete who is not under the jurisdiction of an International Federation, EGY-NADO or of the National Anti-Doping Organisation that tested you.
  • You tested positive after using a substance Out-of-Competition that is only prohibited In-Competition (for example, glucocorticoids).
  • 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” as it could be a useful information for your athletes who could be in such a situation.

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for, and be granted retroactive approval for the therapeutic use of a prohibited substance/method if, considering the purpose of the World Anti-Doping Code, it would be manifestly unfair not to grant a retroactive TUE. The World Anti-Doping Code (Code) is the document that harmonises regulations regarding anti-doping in sport across all sports and all countries of the world. The Code provides a framework for anti-doping policies, rules, and regulations for sport organisations and public authorities.

The granting conditions for this retroactive TUE are unique.

  • This TUE will only be granted if the EGY-NADO TUE Committee is satisfied that all the criteria set out in the ISTUE are met and its granting receives the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the EGY-NADO decision).

Where you are aware of the requirements for the application of a retroactive TUE, EGY-NADO recommends that you gather the relevant medical information in advance, in case you need to apply for a retroactive TUE. Where you are not aware of the requirements, EGY-NADO will communicate with you to inform you of what is required as well as the associated timelines.

Important Note

Using a prohibited substance or method without a TUE may result in an Anti-Doping Rule Violation.

EGY-NADO encourages you to submit TUE applications via ADAMS (Anti-Doping Administration and Management System).

ADAMS is a clearinghouse where all doping control data can be stored, in particular laboratory results, Therapeutic Use Exemptions (TUEs) and information on Anti-Doping Rule Violations (ADRVs). It facilitates the sharing of information amongst relevant organisations and promotes efficiency, transparency and effectiveness in all anti-doping activities.

An application consists of a completed TUE application form together with the required medical file. You require a username and password to access ADAMS. If you do not have an ADAMS account, please contact EGY-NADO to have it set up, otherwise, please download the EGY-NADO’s TUE Application Form and, once duly completed and signed, send it together with the required medical file to EGY-NADO

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.

Please note that all costs incurred in relation to the completion of the TUE application are the responsibility of the Athlete, including any required additional medical examinations, tests, imaging studies, etc.

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

See the next section below on what medical information would be important to apply  your TUE application.

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.
  • To assist you and your doctor in providing the correct medical documentation, we recommend that you consult the following WADA Documentation:
    • Medical Information to Support the Decisions of TUECs – the Medical Information to Support the Decisions of TUECs should be read in conjunction with the principles set out in the ISTUE regarding the granting criteria for TUEs (Article1 to 4.3). The objective is to guide and assist TUECs in the decision-making process for TUE applications for the most commonly seen conditions. TUEs for any other medical condition not listed under these links may be considered based on the principles of the ISTUE.
Keep a completed copy of the TUE application form and all medical information submitted in support of your application and proof that it has been submitted.

The EGY-NADO TUEC must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application that includes all required medical information.

A decision to deny a TUE application includes a written explanation of the reason(s) for the denial. If it is not clear to you, please contact EGY-NADO to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, or laboratory results missing, etc. in which case, you should re-apply to EGY-NADO.
Furthermore, a failure to render a decision within a reasonable time on a properly submitted application for the granting or recognition of a TUE or for the review of a TUE decision by WADA shall be considered a denial of the application, thus triggering the applicable rights of review/appeal.
You may appeal the denial decision of a TUE to the EGY-NADO Appeal committee

Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance/method, it is your responsibility to submit a new application for a TUE with updated medical information ahead of 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/method shall be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route, or duration of administration, you should contact EGY-NADO, as you may be required to apply for a new TUE. Some substances and dosages, e.g., insulin, are often modified during treatment, and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the EGY-NADO TUEC.


A TUE granted by EGY-NADO is only valid at the National level.

If you are or become an International-Level Athlete or compete at Major Games, that TUE will not be valid unless it is recognised by the relevant International Federation (IF) or Major Event Organisation (MEO). It is your responsibility to check if a EGY-NADO’s TUE is automatically recognised by such IF or MEO. MEOs are the continental associations of National Olympic Committees and other international multi-sport organisations that function as the ruling body for any continental, regional or international event, e.g., African Games, Commonwealth Games etc.

EGY-NADO can assist you in the determination of your level as per the EGY-NADO Anti-Doping Rules and the resulting TUE application requirements, and, should the need occur, assist you in presenting your EGY-NADO’s TUE to an IF or MEO for recognition. Please contact EGY-NADO for assistance.

You or EGY-NADO have 21 days to refer the matter to WADA for review after notification of the non-recognition. You should send the same information that you submitted to EGY-NADO, and on which their TUEC based their decision, via a secure on-line method or by registered mail at:

WADA Medical Department     World Anti-Doping Agency

Stock Exchange Tower 800  Place Victoria (Suite 1700)  P.O. Box 120 Montreal (Quebec) H4Z 1B7 Canada

The e-mail address to enquire and/or send the request for review is:

Pending WADA’s decision, EGY-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, EGY-NADO must determine whether the original TUE that was granted should remain valid for national-level competition and out-of-competition testing.

All the information contained in your TUE application, 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 EGY-NADO’s TUE Application Form. All members of the TUEC and any other authorised 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 announcement carefully. In particular, note that if you wish to revoke the right of the  EGY-NADO’s TUEC to obtain information related to your TUE application in accordance with the athlete’s acknowledgment, your TUE application will be considered withdrawn without consent being granted.

Information related to your TUE application will be retained by EGY-NADO and any other approved recipients that are not more than necessary for the purposes set out in the sports announcement, in accordance with the international standard for protecting privacy and personal information.

For any question. Please call


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