In the ever-changing landscape of athletics, change is always a constant. For Australian swimmer Kyle Chalmers, he used his platform to call for change in the disclosure of Therapeutic Use Exemptions (TUEs), which allow athletes to take particular medication for the use of treating a certain condition that may contain a substance that is on the List of Prohibited Substances and Methods by the World Anti-Doping Agency (WADA)
TUEs have existed since the 1990s, at the time under the term ‘Medical Exemptions’. In 1999, the International Olympic Committee’s medical commission officially recognized that some athletes had illnesses or conditions that needed medications that were not legal for use within athletic competition; therefore, WADA established the International Standard for Therapeutic Use Exemptions (ISTUE), which was first adopted in 2004, before going into effect in January of 2005
According to WADA’s website, a TUE allows an athlete to use a particular “medication or method” as it will not give an athlete a competitive advantage, but instead allow an athlete to compete in “a proper state of health”
The process in which athletes apply for a TUE is complex, as TUEs are only granted by Anti-Doping Organizations (ADOs), International Federations (IFs), National Anti-Doping Organizations (NADOs), and Major Event Organizers (MEOs), following a review process that is outlined and set by the ISTUE, and an evaluation from several physicians specialized in sports medicine
- Read more about Understanding TUEs and the application process here.
A direct contradiction to the privately held information and use of TUEs can be seen in the form of the Enhanced Games, which openly encourages and medically supervises the use of performance-enhancing substances through individualized athlete protocols
At the inaugural Enhanced Games, it was reported that 91% of its athletes who participated in a study were taking testosterone, while 79% of athletes used human growth hormone, among several other enhancements
- Read more about the performance-enhancing usage at the Enhanced Games here.
One of the biggest names in the sport to openly reject an offer from the Enhanced Games was Kyle Chalmers of Australia, who was offered a multi-million-dollar deal to join the Enhanced Games
Chalmers took to his Instagram to share his thoughts on TUEs, calling for information about TUEs to be shared publicly rather than kept private
According to WADA, all information contained in an application for a TUE must be “handled in accordance with the strict principles of medical confidentiality.” ADOs also must sign confidentiality agreements, where then the ADO implements tight” privacy and security measures to protect athlete’s personal information
Below is what Chalmers had to say about TUEs:
A Therapeutic Use Exemption (TUE) is an official medical document that gives an athlete permission to use a banned medication or method for a real health problem. It stops a positive drug test from counting as a rule break if the treatment follows anti-doping rules
I understand and accept that athletes can have health conditions requiring medication
However, if that medication contains a banned performance enhancing substance, I believe this should be publicly disclosed rather than kept hidden. Transparency and consistency are essential if people are expected to have confidence in the integrity of sport
In 2016, acyber espionage group known as Fancy Bear attacked WADA’s website, leaking several top athletes’ medical information, including the likes of Simone Biles, Serena Williams, and Venus Williams; all three had been granted medical exemptions for drugs that were on the banned substances list. Biles was granted the exemption for the use of medication to treat her ADHD, while the Williams sisters were both approved to take anti-inflammatory medication for chronic injuries
In 2024, WADA announced its findings from a study on TUEs in Olympic and Paralympic athletes, with the results showing that across four Olympic Games, TUEs were present in 0.90% of athletes, while only 2.76% of Paralympic athletes competed with a TUE
