TUE’s are Bullshit

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This TUE (therapeutic use exemption) thing that keeps popping up in cycling is complete utter bullshit.  When you are so sick that you need a medication that is banned to compete, then you should not be competing.  That isn’t very hard to understand.  These guys all have such horrible lungs that they all need inhalers to compete.  I remember seeing a race where Chris Froome pulled an inhaler out of his pocket just a couple minutes before he shelled every other rider on a climb.  Pretty ill, huh?

Gerry Ryan is the owner of the Orica-GreenEdge team.  He is worried that his rider, Simon Yates’adverse analytic finding for testing positive for terbutaline, with be tried in a “kangaroo court”.  Many that is what this qualified as?

I don’t know shit about Simon Yates, other than what I, and anyone else, can read about him. But he had terbutaline in his system at a dope control test at Paris-Nice.  For some reason, Ryan and his team, think that just because the team’s doctor listed the medicine on the form when Simon did the test that they think that excuses him for having it in his system.  Hardly.

I don’t know the protocol of how Orica-Greenedge handles their rider’s TUE’s, but the rider is responsible for the medicine within his body, no one else.  It isn’t that hard of a concept to understand.  And it isn’t that hard of a task for a rider.  I assume that Simon isn’t taking a couple page list of medications that are all banned for competition.  I hoping it is just this, or maybe two. Which is two more than I approve of.

Isn’t it great that Orica is taking full responsibility for this “mistake”.  Orica’s statement -“In this case the team doctor made an administrative error by failing to apply for the TUE required for the use of this treatment. The use of Terbutaline without a current TUE is the reason it has been flagged as an adverse analytical finding. This is solely based on a human error that the doctor in question has taken full responsibility for.” That the rider isn’t at fault at all?  I disagree.  The rider is ultimately at fault here.  He is the responsible party.

And what they all don’t understand is the process.  You don’t administer medicine and then apply for the TUE.  You apply for the TUE and then, if approved, get the medicine.  Pretty simple. Guess they missed that memo.

Lots have been written about cyclists taking asthma medication.  Seems like it is pretty suspicion.  I saw this comment at this article at Cyclingnews.

And in the case of inhaled terbutaline, this recently published study suggests that high-dose usage is performance-enhancing in trained athletes:

“High-dose inhaled terbutaline increases muscle strength and enhances maximal sprint performance in trained men.” (Hostrup et al./Eur J. Appl/2014).


“High-dose inhaled terbutaline elicits a systemic response that enhances muscle strength and sprint performance. High-dose terbutaline should therefore continue to be restricted in competitive sport.”

So, this drug can be used to treat asthma or can be used to increase muscle strength.  I guess it probably does both.  Seems like it shouldn’t be used in competion at all, TUE or not.

My view is pretty simple.  If you are healthy, race your bike.  If you are sick and need banned medicine to compete, you shouldn’t be.  Of course there are going to be a few exemptions to this simple statement, but if you are a professional athlete and you need an exemption for a banned substance to compete constantly, then you probably are in the wrong occupation.  Get another job.

I feel badly for Simon if he is truly “innocent” here. But like I stated above, ultimately he is responsible for what is in his body.

I’ve had a hard time breathing recently.  Maybe this stuff would help me out some.  I think I’ll try it for a little while and if it works, then I’ll apply for a TUE.  Think that is prudent?


Pick your poison.

Pick your poison.

Tucker is getting big. He is 36 pounds now. He needs his beauty sleep often.

Tucker is getting big. He is 36 pounds now. He needs his beauty sleep often.


45 thoughts on “TUE’s are Bullshit

  1. De Flahute

    Agreed; TUE’s are a clever workaround. FWIW, to combat bronchitis, I’m on 30 day corticosteroid inhaler. Lungs better & feeling a bit more power in the engine room. So maybe every rider should get an inhaler in his musette…

  2. Paul

    I said this to a leading doping lawyer this morning, surely, as a professional athlete, on being prescribed a new drug, you would be saying;

    “Can I see the TUE, can I see the TUE, can I see the TUE, can I see the TUE’ before it went anywhere near you.

    Unless, of course, you can’t keep track.

    Yates has a load of KOMs a few miles from me, guess they are up for grabs now.

  3. RGTR

    I had a nagging feeling in the back of my throat for a couple months. Best I can describe it was it felt like a ‘dry sticky patch’. It was predominately on the left side of my throat. It started out in my sinuses and went to my throat. Then after a couple months, it ended up in my lungs, primarily the left side. For a few months I couldn’t tell if it was in my lung (trachea) or esophagus. I’m very doctor and drug averse so I just let it hang on for 5-6 months and then I started to worry about it being lung cancer. BOOM I was in the doctors office. After an xray she gave me some kind of sampler inhaler that I used twice a day for 5 days till it ran out. It got rid of whatever the hell it was pretty much on the second day.
    Did I apply for a TUE. Fuck no.
    Did I even look up if it was a banned substance. Fuck no.
    Did it make me faster on the bike. Of course – I could fucking breathe again.
    However, I’m still a perma3.

  4. TreyH

    Yates has an established history of struggling with asthma. I’m going to give him the benefit of doubt. I didn’t acquire anything remotely acute with asthma until I was almost 40 years old. I use an inhaler when I exercise so I don’t end up in the emergency room. I work hard to avoid triggers such as smoke during field burning, super high pollen counts, and going too hard in dry-cold air. Not sure that using an inhaler (that until recently required a TUE) constitutes cheating. I also use Flonase (a corticosteroid) in my snout to reduce inflammation from allergens. Is that cheating? How about riding to the left of the center line to draft in a race?

    1. Steve Tilford Post author

      Trey-I agree, breathing has become more difficult as I age. But that is part of it, right? When your body can’t handle the stress or exertions during competition, then is it fair to use drugs that “the rest” of the competition can’t? Like I posted, Froome gets TUE’s for breathing and then goes on to win professional stage races. Fair? Everyone has their Achilles heal. Breathing is just ones of them.

      And comparing the yellow line rule to inhaling steroids is line is comparing apples to peanuts. Not even close to par.

      As far as I know Flonase doesn’t need a TUE, so that is fine by me.

    2. channel_zero

      If it’s true he has asthma, then why isn’t he familiar with the TUE process? I don’t know and am not accusing him of doping.

      According to the UCI’s own CIRC report, the TUE system is abused. It’s amazing they pop him and not the usual third tier athlete. He’s got some very good results.

  5. Wildcat

    Doping post – yawn, move along now; nothing to see here, but I’ll be back like always because I do enjoy your posts on everything else.

  6. James

    I work in a lab. If I get bad allergies or some chest congestion I take meeicine so I’m not coughing and wheezing everywhere.
    Does that mean I should get a new job, Steve?
    Maybe I’m just not healthy enough.
    Oh, I heard eating a lot of fruits and vegetebles and coffee will increase my job performance as well.
    Should I stop eating those as well??
    Relax everybody. Maybe us cyclists need other things to hate and look down on.
    Politicians, bankers, lobbyists, we have a long list of professions a lot dirtier than cycling.

    1. Jake

      Does your lab have rules against the medicines you take? What if you found an illegal drug that helped clear your lungs and your mind, but were subject to your employer’s random drug tests? Should you be allowed to use that drug anyway?

      1. Steve Tilford Post author

        Jake – I’m not sure what you mean by “lab”. Using drugs for athletic purposes isn’t the same as feeling better during a normal job. I’m not sure if you’re taking about illegal recreation drugs or prescription medicine. We’re talking about medication that the average person can use with a prescription, but is against sporting rules. Big difference than normal work-place life.

      2. Jake

        I was responding to James’s comment about how he gets sick when he works in a lab. He wrote that if he needed medication to do his job should he get a new job. Since his employer probably doesn’t have rules against taking cold meds I used an illegal drugs scenario.

  7. josh estes

    While I like the team, mostly due to their youtube videos, I’m getting pissed off with them. This is the second doping positive they’ve had in the last year after their south african impey turned up positive. Also Matt Hayman who just won Roubaix for them was on Rabobank for like a decade, which isn’t a great history to have.

  8. Clifford

    Into my 20s, I had what doctors called “exercise-induced asthma” which was exacerbated by Kansas allergies. Carried an inhaler with me all the time when riding and probably used it before races. It was Ventolin and I didn’t think anything of it in terms of PEDs, just as something that would help me breathe and not see spots…

    1. Steve Tilford Post author

      Clifford- I hear you here. That is why I seem to struggle all spring and sometimes all fall. The burning on top of the pollen is pretty debilitating. Life I guess.

      1. AKBen

        And no one would mind if you used a prescription inhaler to help you deal with this issue. There does exist medication to help you handle those issues, and it’s perfectly legal and acceptable to do so. You probably would find your racing improved, not because you are taking something to artificially improve your performance, but to address a legit health issue that is interfering with your ability to follow your passion, bike racing. It’s not EPO, or anabolic steroids, it’s an inhaler that allows your lungs to work properly. I think a reason more top endurance athletes are being diagnosed with asthma is that training for those sports is hard on the lungs, leading to to some issues which fortunately can be treated with modern medicine.

  9. devin

    Another “legal shortcut” for cyclists. Phil Gaimon in “Pro Cycling on $10 a day,” describes how inhalers were prescribed liberally on his first pro team and how his team doctor prescribed albuterol for him and teammates from a simple blowing test and a question about being out of breath at the top of stairs, even though he never suffered from asthma.

    1. old and slow

      Which is about how it works at the highest levels of Track and Field for quite a while now. They have raised the TUE process for asthma to something like an art form.

    2. Brian

      I raced for that same team and it was that easy. I was told that albuterol wouldn’t help unless I needed help. I exhaled into a device, took a hit of albuterol, waited 10 minutes and repeated. My numbers improved for the second test and that meant I needed it. What? I used an inhaler, with a TUE in 2007 and 2008. I had never used one before and I have not used one since. It can be hard to tell when the tightness in your chest is from exertion or from asthma-related symptoms.

      I heard of this one guy once that a testicle removed because of cancer. If he needed testosterone because his body didn’t produce as much (I don’t actually know if that’s how that works and I am not going to research it for the sake of this comment so if I am wrong disregard this hypo) as his competitors should he have been able to use testosterone? I don’t know.

      It’s all shtie.

  10. mks

    Just curious Steve – and admittedly, a bit off topic. In a prior post before Joe Martin you said you were going to have a blood test. Why did you do that?

    1. Steve Tilford Post author

      mks – I do a blood test a couple times a year just to compare myself to me. I like to try to correlate how I’m riding to what my blood looks like. Mainly, I look at the red count, oxygen stuff and then the other things that would be spiked by allergies. It’s not like I have any way to manipulate my blood, it is just interesting. And now that you can order the tests yourself, for hardly anything, it is a no brainer. You never know what you might catch yourself with a simple blood test.

  11. DJ

    Steve, you have a typo I presume when you said, “When you are so sick that you need a medication that is banned to compete, then you should be competing. “

  12. Bolas Azules

    This whole sport is getting to be much like the old ‘All-Star Wrestling’ or the new WWE or the NBA.

    Motors in bikes, electromagnetic powered wheels, 45 year old druggies moving in and racing ‘for their health,’ whole multi-million dollar charitable foundations set-up by drug cheats, the petty cat-and-mouse game between the one-step-ahead doctors, trainers and cheats, the lies, the best selling hardcover books created to propagate the lies, the doctor signed medical exemptions so the junkies can continue to “win,” tens of millions of dollars spent on ineffective drug tests and ‘enforcement’ . . . . you can’t make up this crap.

    I guess I’ll continue to watch to see the scenery and the drama played out, the aesthetic beauty of the sport much like the person that watches professional wrestling to see someone dive off of the top rope or a seven foot tall person fly through the air and slam a basketball into someone’s face but it is getting so far away from being an actual competitive sport that it is almost laughable.

  13. Jim

    Did anyone else see the news that, apparently, 70% of the swimmers on the British National team and 1/3 of the cyclists on Team Sky use inhalers??
    If those numbers are anywhere close to correct, maybe they need to look at their health more than they need to be competing.

  14. Nathan Guerra

    Steve, from reading your posts the last few years, I have thought you should look into allergy induced asthma treatments.

    I do not think a TUE is out of the question. The difference for me in a race situation when it comes to asthma and allergies is winning by minutes and losing by minutes. Overcoming physical ailments should be celebrated, especially since these specific ones are looking to be caused by the ways we have seriously screwed with our food sources. Yea people will take a good thing and twist it for evil, but the broad strokes you have taken here I think may be reactionary to abuses in a another arena of doping.

    The data is out there to show how seriously athletes can be impacted by these conditions. Indoors during the exact same allergy season an athlete can perform up to 15% or better on threshold power tests, even though indoor riding tends to lower power output. The only changed factor seems to be the introduction of the allergen in the environment.

    I think this post jumped the gun on Yates, just like the conviction methods & media of our sport.

  15. Neil Kopitsky

    I’m a little confused by this post. Is your concern about the TUE RULE, or the riders who use/abuse the TUE rule? Sport is about performing at the highest possible level while conforming with the rules. If a cyclist, ESPECIALLY a professional cyclist, benefits from a product, doesn’t he have a duty to himself, his team, and sponsors to take that product?

    It’s fine to criticize the rule. And it’s fine to criticize riders who break the rules. But I don’t think it is fair to at least implicitly criticize a cyclist who benefits from a legally prescribed medical treatment. Maybe you should see an allergist about your season/burning issues and utilize the medically appropriate remedy yourself?

    Just my two cents. I always enjoy and appreciate your writing.

  16. DP

    I think your post and some comments show a misunderstanding of what asthma is. Just because you have trouble breathing when there’s smoke or pollen in the air doesn’t mean you have asthma. Have you ever been diagnosed with asthma? It is a specific medical condition in which the airways physically close making breathing difficult to impossible. It varies in severity and can even be deadly. The irritants that lead to an asthma attack vary between people (e.g. exercise, smoke, pollen), and can indeed be the same irritants that cause allergic responses. However, allergies and asthma are NOT the same thing. Furthermore, asthma is a chronic, often life-long condition. I wouldn’t call a person with asthma “sick” at any one time, but they do have a long-term risk of having an asthma attack. I think its a bit ridiculous to say that someone with asthma should never be able to compete in sport, or risk a deadly asthma attack by competing without their medication.

    It seems your attitude is “sometimes I have trouble breathing, and you don’t see me using an inhaler.” Well, you also probably don’t have asthma. It’s like saying to someone with brain cancer “sometimes I have headaches too, what’s the big deal?” Not the same thing bro. Next time you’re in the ER, check out the line of kids on nebulizers because they literally can’t breath and maybe you’ll gain an understanding of what asthma is.

    On the other hand, I completely agree that TUEs are misused, particularly in the case of asthma meds. Does it make sense that asthma is more common in elite athletes than in the general population? I don’t think so. There’s obviously widespread abuse of asthma meds. But, I think the answer is to make the TUE process more legitimate instead of the farce that it is right now (as the example in Phil Gaimon’s book shows), instead of vilifying any one pro athlete for using a TUE. We aren’t the ones to judge whether that person has a legitimate need for a TUE or not.

    I agree with you about Yates – his case isn’t really about whether he has asthma, or whether TUEs for asthma medications should exist, its simply about the fact that he didn’t go through the proper process and for that he should be penalized.

    1. Gary

      Fact-Asthma is the leading medical condition that children miss school for. I know that was Random but DP’s post inspired me to share this.

  17. Steve Tilford Post author

    Guys- How about these statistics? A study shows-

    As for the origins of the mysterious “asthmatic advantage,” the leading theory is that prolonged training, particularly in certain endurance sports, can eventually damage the airways. As a result, the athletes with asthma are generally the ones who’ve been training longest and hardest — and thus, are more likely to medal. For example, 17 percent of cyclists and 19 percent of swimmers in Beijing reported asthma diagnoses; those athletes won 29 and 33 percent of the medals in those sports, respectively.

    So, aging athletes, are at a disadvantage because they have damaged their lungs by training. If true, and TUE’s are the answer, then I am aging and produce less testosterone than a 18 year old you I should be able to get a TUE to use synthetic testosterone? I could keep giving examples of this all day.

    Somewhere it just needs to stop. We need to decide what is natural and what isn’t. This TUE thing has been abused by so many athletes historically, it has to be readdressed seriously.

  18. chiefhiawatha

    For a long time, until my late 30s, I couldn’t do a thing without an inhaler. Couldn’t go camping, couldn’t ride, etc. You’re off base with the legit use of a TUE, and there are legit uses. That’s why they exist.

  19. mv

    I’m with Steve on this.
    Sven Nys said it exactly like him “do away with TUE’s”
    “If you’re not healthy enough for racing, you should not be racing”.

    1. Mike Rodose

      So Team Type One shouldn’t be racing because they need diabetes medication injections?

  20. Dog

    I wonder what % of xc skiers have TUE for asthma? I am on inhaled steroids and some rescue inhalers year around for the last 30 years or so. i have pretty good control, but get me out on the xc skis breathing hard in 10 degree weather and I have almost no control over my symptoms.

  21. John Hawkins

    A lot of the reason people with asthma participate in cycling and swimming is that it has been recommended to them as capable of improving their symptoms, if the acute attack risk is managed properly with medication. They come to the sport because they have the condition, rather than claiming to have the condition to improve their performance in the sport..

    I get sporadic EIA, generally worse when I’ve had a recent cold or chest infection. I have been instructed by my GP to continue with my preventer (inhaled corticosteroids) for both my lungs and sinuses year round, and he is strongly encouraging of my continuing to cycle and exercise vigorously. This includes racing MTB. (He does take the piss when I fall off, however.) I also have a skin condition that needs to be managed with a steroid lotion occasionally.

    If tested I would get pinged. None of the medications are remotely performance enhancing in my case – I’m lucky to threaten the middle of the field in Super Masters. Is it worth the hassle of getting a TUE? In theory yes, but testing is non-existent at local club level and at races run by event companies. I have never bothered with a TUE. I would need to use the meds whether I raced or not.

    I race because it is good for my health, and having a race to aim for helps make the suffering worthwhile,. I like going fast and the competitive atmosphere. The intensity of racing and training to race is proven to maintain heart and cardiovascular health for senior athletes and prevent the normal losses associated with ageing among those who participate socially only, let alone those who don’t exercise vigorously at all.

    So I think the premise that if you need a TUE you shouldn’t race is itself bullshit.

  22. Steve Tilford Post author

    John – I think you are comparing apples to oranges here. We are talking about the guys that are Olympic and Tour Champions.

    You say that “none of the medications are remotely performance enhancing….” That obviously can’t be true. Do they not help you breathe? Isn’t breathing essential to athletics?

    I just commented above that 60% of the athletes in Lillehammer Olympic were taking asthma medications. Do you think that 60% of them had asthma? I argue that everyone has asthma going full on at 0 degrees.

    Those guys/women that should win the WINTER Olympics are the ones that can deal with breathing cold air better than the others. Everyone shouldn’t get to take medication to deal with the problem. It is what differentiates us from each other.

  23. John Hawkins

    “You say that “none of the medications are remotely performance enhancing….” That obviously can’t be true. Do they not help you breathe? Isn’t breathing essential to athletics?”

    Really? I thought breathing was only essential to other activities. Like … living. Let’s work that through… Since not being dead is essential to athletics, I guess that means any drug that helps keep you alive must be performance enhancing. Yep, you’re probably right.

    The reason a lot of these elite level athletes got involved in their sport as kids in the first place was because their parents were told by their paediatricians it would help with their asthma or diabetes. It is one of the main reasons asthmatics are over-represented among swimmers in particular. Cyclists, similarly but less so.

    Does that not make sense?

    Yes it TUEs are no doubt being gamed. But banning TUEs would take a lot of people out of sport and remove valuable role models who inspire kids with these conditions to achieve full and productive lives.

    The role modelling aspect of sport is one of the reasons we ban PEDs, so that kids don’t have to make those awkward and terrible choices past generations of cyclists have had to face: sacrifice your future health or give up your much loved sport.

    The TUE is a valuable balancing mechanism and it needs to stay. It does need to be made to work better though.


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