IMPORTANT! Changes in Glucocorticoids' administration

Glucocorticoids and the List of Prohibited Substances

As of the 2022 Prohibited List, GCs are prohibited in-competition when administered by all injectable, oral, or rectal routes. 

Examples of injectable routes of administration include intravenous, intramuscular, periarticular, intraarticular, peritendinous, intratendinous, epidural, intrathecal, intrabursal, intralesional (e.g., intrakeloid), intradermal, and subcutaneous. 

It should be noted that all oral routes of administration of GCs remain prohibited including oromucosal, buccal, gingival, and sublingual routes.

 All other routes of administration including inhalation, intranasal spray, ophthalmological drops, perianal, dermal, dental intracanal application and topical applications are permitted at all times and do not require a TUE.

Glucocorticoids and TUE Applications

If a GC is used therapeutically, exemption through the TUE pathway is appropriate. It is acknowledged that GC treatment is often in response to an unpredictable exacerbation of chronic disease or in acute or recurrent musculoskeletal injury. In these cases, the TUE application will, of necessity, be retroactive. GC use may often occur outside the competition period yet still result in an in-competition AAF. As of 2021, the International Standard for Therapeutic Use Exemption (ISTUE) specifically addresses this, permitting retroactive application where:

ISTUE 4.1e: The Athlete Used Out-of-Competition, for Therapeutic reasons, a Prohibited Substance that is only prohibited In-Competition.

The success of any TUE application rests upon the quality of the accompanying clinical justification. All treating physicians are strongly encouraged to keep full and accurate clinical records, including time and dose of administration when treating athletes liable to doping control, even when the administration of GC occurs prior to the in-competition period. Physicians are encouraged to familiarize themselves with the GC “wash-out periods” described in the WADA 2022 Prohibited List Explanatory notes.