Glucocorticoids, also known as cortisone, corticosteroids or glucocorticosteroids, are active substances derived from the body's own hormone cortisol and mimic its action. In medicine, in particular their anti-inflammatory effects and suppressive effects on the immune system are used to treat a wide range of diseases. In Germany, most glucocorticoid preparations require a prescription. Some types of use (e.g., as tablets or as injections) are also on the so-called Prohibited List, published by the  World Anti-Doping Agency (WADA), and may constitute an anti-doping rule violation with serious consequences if the applying rules are not followed.

A high concentration of glucocorticoids in the body can not only bring serious side effects, but also lead to an unacceptable increase in performance. For this reason, WADA's anti-doping regulations prohibit the administration of glucocorticoids in-competition via certain routes that can lead to high glucocorticoid concentrations in the body.

The most commonly used glucocorticoids include, for example: Beclometasone, betamethasone, budesonide, ciclesonide, dexamethasone, fluticasone, hydrocortisone, methylprednisolone, mometasone, prednisolone, prednisone or triamcinolone acetonide. In addition, numerous other glucocorticoids are used as medications. If you are unsure whether a medicine contains a glucocorticoid, check with your doctor or pharmacist.

With the WADA Prohibited List 2022 coming into force on 01/01/2022, the following applies: All glucocorticoids are prohibited in-competition if they are administered via the following routes:

• oral (by mouth). This includes, but is not limited to, oromucosal (via the oral mucosa), buccal (in the cheek pouch), gingival (on the gums) and sublingual (under the tongue) administration.
• rectal (via the rectum),
• any injectable routes. These include intravenous (into the vein), intramuscular (into the muscle), intra-articular (into the joint), periarticular (around the joint), peritendinous (around the tendon), intratendinous (into the tendon), or subcutaneous (under the skin) injections.

"In-competition" means the period of time commencing at 11:59 p.m. on theday before a competition in which the athlete is scheduled to participate through the end of such competition and the sample collection process related to such competition. Provided, however, WADA may approve, for a particular sport, an alternative definition. Out-of-Competition use of glucocorticoids is permitted as described above.

Intravenous infusions and/or injections of more than a total of 100 mL per 12-hour period are prohibited in- and out-of-competition, except for those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations. Please also refer to our information flyer on infusions in sports for more information.

Until 31/12/2021 applied:
All glucocorticoids are prohibited in-competition when administered by the following routes:

• oral (by mouth),
• rectal (via the rectum),
• intravenous (into a vein),
• intramuscular (into a muscle)

All types of application other than those listed above are permitted at all times, both in-competition and out-of-competition. These include dermal (on the skin), inhalational (by inhalation), nasal (in the nose) or ophthalmic (on the eye) application.

With these types of application, it can be assumed that no high glucocorticoid concentrations are reached in the body.

Out-of-competition use of glucocorticoids is permitted, regardless of the route of administration. However, depending on the route of administration, some glucocorticoids can be detected in urine samples over a longer period of time after use. The detection of glucocorticoids in urine samples collected during competitions may constitute an anti-doping rule violation!

Therefore, an administration of glucocorticoids prohibited in-competition should be performed in the out-of-competition period with sufficient temporal distance to the next competition.

To estimate the required distance to the next competition, WADA has published so-called washout periods, which should be observed after the last use of glucocorticoids until the next competition. If these washout periods are observed, the probability of a positive urine sample collected in-competition is very low. The washout periods depend on the active substance used and the type of application (see table "Washout periods for glucocorticoids (source: WADA)").

No washout periods have been specified by WADA for rectal and intravenous use. For safety reasons, however, athletes should also keep a sufficient time interval of several days between the last application and the next competition. 

If a glucocorticoid is used outside the washout period, the probability of positive urine sample collected in-competition is very low. In principle, however, we recommend that you always have the name of the drug, the dosage, the type of application, the time or period of application and a contact to the attending physician ready in case of any queries.

If a glucocorticoid must be used within the washout period, a positive urine sample collected in-competition becomes very probable.

In this case, you should keep a detailed report on the treatment from the treating physician, including additional information on why permitted alternatives cannot be used. Please keep this report together with any other available medical documents (e.g. X-ray findings, laboratory diagnostics, etc.).

If you are selected for doping control in-competition, you should indicate the treatment on the doping control form. If glucocorticoids are detected in your urine sample, you must apply for a retroactive Therapeutic Use Exemption after being requested to do so by NADA Germany. For this purpose, you must submit to NADA Germany, among other documents, the medical report referred to above.

For athletes who are member of a testing pool, as well as for athletes of certain professional leagues, the following applies:
If you use glucocorticoids via a route of administration prohibited in-competition during a longer-term therapy and want to participate in one or more competitions during this time, you must apply for a Therapeutic Use Exemption (TUE) to NADA Germany.

For athletes who are not member of any testing pool or a professional league, the following applies:
If you use glucocorticoids as a long-term therapy via a route of administration prohibited in-competition and want to participate in one or more competitions during the therapy, this is initially possible without a Therapeutic Use Exemption. Should you be subject to a doping control, you must apply for a retroactive Therapeutic Use Exemption as part of the result management process. This regulation is only valid for national competitions in Germany. For participation in international competitions or competitions abroad, you should inquire in advance with your international sports federation whether other regulations apply there.

If you receive a glucocorticoid on the day of the competition due to an emergency treatment (e.g. in case of an allergic reaction) via a prohibited route of application, you must report this to the responsible anti-doping officer before participating in the competition. If this person is not available at the competition site, you must report the emergency treatment to the competition court. If the treatment takes place during the competition, it must be reported immediately after the end of the competition. 

In addition, the following applies to athletes who belong to a NADA Germany testing pool, as well as for athletes of certain professional leagues:
After emergency treatment with a glucocorticoid on the day of competition, you must apply for a retroactive Therapeutic Use Exemption (TUE) to NADA Germany within seven (7) days of use. This is independent to whether you have been subject to a doping control in-competition or not.

In addition, the following applies to athletes who are not part of any NADA Germany testing pool:
Should you be subject to a doping control on the day of competition after emergency treatment with a glucocorticoid, you must apply for a retroactive therapeutic use exemption as part of the result management process. This regulation is only valid for national competitions in Germany. For participation in international competitions or competitions abroad, you should with your international sports federation in advance and ask whether other regulations apply there.

If you wish to apply for a TUE at NADA Germany, you and your attending physician must fill in the TUE application form and send the original document to NADA Germany by mail. In addition, for the evaluation of a TUE application, a current medical report by the treating specialist must be submitted, which describes the medical history in detail and comprehensibly and carefully justifies why permitted alternatives cannot be used. Additional diagnostic findings, e.g. for initial diagnosis, laboratory results, tests and reports complete the application. 

For assistance with the requirements for applying for TUEs for various medical conditions, you can also refer to WADA's "TUE checklists". These can also be found in German.