OCB handles theraputic use exemptions for prescribed testosterone due to androgen deficiency in the manner that the World Anti-Doping Agency (WADA) does.
Exemptions are possible in cases where there's a pathological physical change in the structure of an organ or within the hypothalamic-pituitary-testicular axis, such as:
● Genetic abnormalities – Isolated hypogonadotropic hypogonadism (IHH) and variants, Klinefelter’s Syndrome and variants (i.e. 47,XYY/46XY, 46,XX testicular DSD, 45,X/46,XY), dysgenetic testes, myotonic dystrophy.● Developmental abnormalities – cryptorchidism, congenital anorchia.● Metabolic abnormalities – hemochromatosis.● Direct testicular trauma, surgical bilateral orchidectomy, testicular torsion.● Orchitis – severe bilateral with subsequent testicular atrophy due to mumps or other infections.● Radiation treatment or chemotherapy.● Pituitary disorders – hypopituitarism, tumor, infection, hemochromatosis, hyperprolactinemia due to prolactin-secreting pituitary tumor.● Structural and infiltrative effects of systemic diseases – CNS developmental abnormalities, infection, β-thalassemia/hemoglobinopathies, granulomatous diseases, lymphocytic hypophysitis hemochromatosis, sickle cell disease.● Anatomical problems - pituitary stalk section, hypophysectomy, pituitary-hypothalamic disease, traumatic brain injury.
Exemptions are not made in cases where there is no pathological physical change in the structure of an organ or within the hypothalamic-pituitary-testicular axis, such as:
● Overtraining, malnutrition/nutritional deficiency.● Chronic systemic illness (chronic organ failure, diabetes mellitus, malignancy, rheumatic disease, HIV infection, Crohn’s disease, inherited metabolic storage diseases).● Aging/Late onset hypogonadism.
Females - please note WADA guidelines generally require evidence showing a combination of progesterone and estrogen was attempted as an alternative to testosterone when hormone replacement therapy is needed, prior to giving consideration to granting a therapeutic use exemption for testosterone use when applicable conditions for potential exemptions for use of it exist. Females should request of their physicians to attempt use of progesterone and estrogen before considering use of testosterone for applicable circumstances.