FAQs About NCAA Banned Substances and Medical Exceptions Procedures (2024)

What drugs are banned by the NCAA?

The NCAA bans drugs by class, along with any substance chemically/pharmacologically related to those classes.The NCAA banned drug classesalign with the World Anti-Doping Agency’s list of prohibited classes (with the exception of the glucocorticoid and cannabinoid classes). Additional information related to removal of the cannabinoids class can be found in theCannabinoid FAQ.

How can a student-athlete find out whether a medication or other product they are using contains a banned substance?

A student-athlete should consult with their primary athletics health care provider (e.g., athletic trainer, team physician) about all medications and other products prior to use.

Many nutritional/dietary supplements are contaminated with banned substances not listed on the label.The U.S. Food and Drug Administration (FDA) does not review or approve nutritional/dietary supplements for safety or effectiveness and it has warned that supplements can have strong unanticipated biological effects that can involve health risks. Products containing hidden drugs are also sometimes falsely marketed as dietary supplements, putting consumers at even greater risk. Because the regulation of nutritional/dietary supplements is limited, any nutritional/dietary supplement or other product that may unknowingly contain a banned ingredient is taken at the student-athlete’s own risk.

Drug Free Sport AXIS™ is available to answer questions regarding NCAA banned substances at816-474-7321 oraxis.drugfreesport.com(access code: ncaa1, ncaa2 or ncaa3).

Are certain over-the-counter supplements approved by the NCAA for use by student-athletes?

The NCAA doesnotapprove the use ofany specific nutritional/dietary supplement. Student-athletes have tested positive and lost their eligibility using nutritional/dietary supplements and other products that contain banned substances. Use of any nutritional/dietary supplement or other product that may unknowingly contain a banned ingredient is taken at the student-athlete’s own risk.

Does the NCAA approve medical exceptions for NCAA banned substances?

Yes. NCAA approved medical exceptions may be granted if the following criteria are met:

• The student-athlete has a medical condition that requires treatment with the banned substance to restore them to their normal baseline heath.
• All medical therapies that are not banned have proven to be ineffective or there is an evidence-based contraindication for unbanned therapy or therapies.
• The use of the banned substance does not increase the student-athlete’s performance above their normal (baseline) state of health.

When should schools submit medical exception requests?

A request for a medical exception for an anabolic agent, hormone and metabolic modulator, peptide hormone, growth factors, related substance and mimetics must be submitted by the school before the student-athlete competes while taking these medications. All other banned classes of medications should be submitted after the student-athlete is drug tested by the NCAA and tests positive for a substance for which the school desires an exception. Additional information can be found in theMedical Exceptions Proceduresresource.

What are anabolic agents and why are they banned?

Anabolic agents generally refer to drugs that increase protein synthesis and tissue building, specifically muscle building and repair. Anabolic steroids like testosterone are the prototype of anabolic agents. Due to the performance-enhancing properties (e.g., increased strength and power, shortened recovery time) of this class of drugs, use of any anabolic agent including testosterone and other anabolic steroids in NCAA athletic participation is banned. The student-athlete must have an NCAA approved medical exception for the use of the anabolic agent before they are allowed to participate in competition while taking these medications.

Does a doctor’s prescription adequately satisfy the criteria to approve an NCAA medical exception for the use of testosterone and other anabolic steroids?

No. A doctor’s prescription or attestation for the need for testosterone therapy or other form of androgen therapy is not sufficient.In general, the NCAA will not grant approval for anabolic steroids such as testosterone for student-athletes that do not have evidence of confirmation of the identifiable, irreversible cause of disease of the hypothalamus, pituitary and/or testicl*s.Medical exceptions for testosterone therapy to treat legitimate medical diagnosis (e.g., hypogonadism, gender-affirming therapy) may be approved if the following criteria are met:

The student-athlete must have consistently (at least two) low-blood testosterone concentrations measured on samples drawn between 7 - 10 a.m.

• The blood sample must be drawn when the student-athlete is at baseline health.
• The testosterone concentration must be measured by an accurate assay laboratory test.
• The student-athlete may be asked to have repeat testing with a certified and harmonized testosterone assay. Such assays are available widely across the United States (e.g., U.S. Centers for Disease Control and Prevention).
• The student-athlete may be asked to have repeat testing after fasting for at least six hours.
• The student-athlete may be asked to have repeat testing that includes measurement of sex hormone binding globulin, albumin, calculated free testosterone and/or measurement of free testosterone by equilibrium dialysis.

Student-athletes competing in NCAA men’s sports must have an identifiable cause of testosterone deficiency. Examples include, congenital anorchia (lack of testes at birth), a tumor affecting the hypothalamus or pituitary or a disease and/or disorder that affects both testicl*s.

• The disease and/or disorder must not be a cause of testosterone deficiency that is likely to be reversible.
• The student-athlete and their doctor may be asked for evidence of confirmation of the identifiable, irreversible cause of testosterone deficiency due to a disease or disorder of the hypothalamus, pituitary and/or testicl*s.
  • Documentation of an appropriate physical examination that includes evaluation for Cushing syndrome and a thorough genital exam, including measurement of testicular volumes.
  • Such evidence would include measurement of blood concentrations of luteinizing hormone (LH) and follicle stimulating hormone (FSH).
  • Additional tests might include measurement of blood concentrations of prolactin or other hormones and special imaging studies (MRI or CT) of the pituitary and hypothalamus in the brain.

Can student-athletes receive a medical exception for anti-estrogen medications in the hormone and metabolic modulator class?

Anti-estrogens such as clomiphene, anastrozole and letrozole stimulate the production of testosterone (specifically in humans with testicl*s). In general, treatment with clomiphene, letrozole and other anti-estrogens does not qualify for a medical exception in male student-athletes. However, a medical exception may be approved for student-athletes diagnosed with breast cancer or history of breast cancer.

Will the NCAA approve a medical exception for the use of testosterone in conjunction with other banned medications that raise blood testosterone concentration (e.g., anti-estrogens, human chorionic gonadotropin, etc.) to treat androgen deficiency?

There is no evidence of a benefit to using more than one drug to treat androgen deficiency; therefore, in general, the NCAA will not approve a medical exception for more than one drug to treat androgen deficiency.

Why are growth hormone, growth factors, peptide hormones, related substances and mimetics NCAA banned substances?

Medications in this banned drug class are classified as performance-enhancing drugs; therefore, student-athletes are required to receive a medical exception approval prior to participation in NCAA competition while using these medications.

What medical conditions might a medical exception be approved for the use of growth hormone therapy and what are the criteria for consideration?

Student-athletes with growth-hormone deficiency due to an identifiable, irreversible cause of disease of the hypothalamus and/or pituitary might qualify for a medical exception for growth hormone therapy. The medical documentation may need to include evidence confirming the diagnosis (e.g., evaluation that conforms to most recent national guidelines for growth hormone deficiency). Similarly, those student-athletes that were given growth hormone therapy to treat short stature before the completion of puberty who seek an NCAA medical exception will need to provide evidence (e.g., evaluations that conforms to most recent national guidelines) confirming the growth hormone deficiency. Additionally, the student-athlete might be required to undergo further testing to confirm persistent growth hormone deficiency.

Why are diuretics and masking agents NCAA banned substances?

Medications in this NCAA banned drug class might be used to hide or “mask” the use of other banned substances.

Are medical exceptions approved for use of diuretics or masking agents?

Yes, medical exceptions for substances in this drug class should be submittedfollowingan NCAA positive drug test. As with any banned substance, an NCAA-approved medical exception will only be granted if the following criteria are met:

• The student-athlete has a medical condition that requires treatment with the banned substance to restore the student-athlete to their normal baseline health.
• All medical therapies that are not banned have proven ineffective or there is an evidence-based contraindication for unbanned therapy or therapies.
• The use of the banned substance does not increase the student-athlete’s performance above their normal (baseline) state of health.

When should a medical exception request be submitted for the use of Spironolactone?

Medical exception requests for Spironolactone should occurfollowingan NCAA positive drug test.

What should be included in the medical documentation provided for a medical exception for use of Spironolactone?

When submitting a medical exception request for spironolactone schools are required to include medical history documentation that indicates that non-banned medical therapies;oral contraceptives, oral antibiotics and topicalswere tried and proven to be ineffective or there is a contraindication for the non-banned therapy or therapies.

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