Therapeutic Use Exemption in Elite Sport: The Endocrinologist as the Expert for Hormonal Drugs

Elite sport demands a level playing field and doping in sport is one of the main ways that that field is tilted. However, some athletes require “banned” drugs (or methods) to maintain physiological homeostasis, for example, insulin for an athlete with type 1 diabetes mellitus. The diagnosis and therapy of a number of endocrine disorders falls to the adult or pediatric endocrinologist who is the medical expert for conditions of adrenal insufficiency (hydrocortisone and its derivatives are banned). More commonly are GH deficiency and disturbances of the hypothalamic-pituitary-gonadal axis where hGH, IGF-1 and testosterone are banned drugs. During the session I shall review several athlete/patient vignettes and speak about the endocrinologist’s role in role in helping the athlete to obtain a therapeutic use exemption that will permit them to receive these banned substances to bring them back to their physiological state.