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TUE Guidelines Medical Information to Support the Decisions of TUECs Major contributors

MAJOR CONTRIBUTORS

Athletes and their seeking Therapeutic Use Exemption (TUE) for the use of prohibited substances deserve the best advice available.

The WADA TUE Expert Group thanks clinicians for their contribution to the development of the WADA Medical Information to Support the Decisions of TUE Committees. Their collaboration has enabled WADA TUE Working Group members to provide an expert contemporary opinion for which they are most grateful.

Adrenal Insufficiency

Professor Martine Duclos Department of and Functional Explorations CHU G. Montpied Clermont-Ferrand France

Dr. Katharina Grimm Member, CAF TUE Advisory Group Chair, FIMS Interfederal Commission Director of Medical Affairs, Aspetar Orthopaedic and Qatar

Dr. Holger S. Willenberg Department of , Diabetes and University Hospital Düsseldorf Düsseldorf Germany

Anaphylaxis

Professor Ken Fitch, M.D. School of Science, Exercise and Health Faculty of Life Science University of Western Australia Australia

© WADA - World Anti-Doping Program 1 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Dr. Margo Mountjoy, M.D., CCFP, FCFP, FACSM, Dip Sport Med FINA Bureau Sports Medicine Liaison IOC Medical Commission – Games Group McMaster University , Department of Rockwood, Ontario Canada

Professor F. Estelle Simons Department of & Child Health, Department of , Faculty of Medicine, University of Manitoba Winnipeg, Manitoba Canada

Androgen Deficiency / Male Hypogonadism

Dr. Richard V. Clark, M.D., Ph.D., FACP Group Director, Discovery Medicine Muscle Metabolism DPU, Metabolic Pathways-Cardiovascular Therapeutic Unit GlaxoSmithKline R & D United States of America

Dr. David Handelsman ANZAC Research Institute University of Sydney Department of , Concord Hospital Sydney Australia

Dr. Robert W. Hudson M.D., Ph.D., FRCPC Professor and Chair, Division of Endocrinology and Metabolism, Department of Medicine, Queen's University and Kingston General and Hotel Dieu Kingston, Ontario Canada

Dr. John Lombardo Medical Director, MAX Sports Medicine Institute Ohio Health United States of America

Dr. Gordon Matheson Professor, Department of Orthopedic , Stanford University School of Medicine Director of Sports Medicine, Head , Stanford University Department of Athletics United States of America

© WADA - World Anti-Doping Program 2 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Dr. Alvin M. Matsumoto, M.D. Professor, Department of Medicine Division of Gerontology & Geriatric Medicine University of Washington School of Medicine Associate Director, Geriatric Research, Education and Clinical Center Director, Clinical Research Unit Seattle, WA United States of America

Professor Robert McLachlan, M.D., Ph.D. Director, Andrology Australia Director of Clinical Research Prince Henry's Institute of Medical Research Clayton Australia

Professor Dr. Med. Dr. h. c. Eberhard Nieschlag, FRCP Centre for and Andrology of the University WHO Collaboration Centre for Research in Male Reproduction Münster Germany

Dr. Ronald S. Swerdloff, M.D. Professor of Medicine David Geffen School of Medicine at UCLA Chief Division of Endocrinology Harbor UCLA Medical Center Torrance, CA United States of America

Dr. Frederick CW Wu Professor of Medicine and Endocrinology Andrology Research Unit Department of Medicine University of Manchester Manchester United Kingdom

Arterial Hypertension

Professor Antonio Pelliccia Scientific Director Institute of Sports Medicine and Science Italian National Olympic Committee Italia

© WADA - World Anti-Doping Program 3 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Dr. Anik Sax , Medical and Sports Department Ministère de l'Éducation Nationale, de la Formation Professionnelle et des Sports Luxembourg

Professor Rob Walker Dunedin School of Medicine University of Otago New Zealand

Asthma

Professor Louis-Phillipe Boulet Université Laval Sainte-Foy, Quebec Canada

Professor Joe Cummiskey, M.D. Dublin Ireland

Professor Ken Fitch, M.D. School of Sport Science, Exercise and Health Faculty of Life Science University of Western Australia Australia

Professor Don McKenzie Allan McGavin Sports Medicine Centre University of British Columbia Vancouver, British Columbia Canada

Dr. Margo Mountjoy, M.D., CCFP, FCFP, FACSM, Dip Sport Med FINA Bureau Sports Medicine Liaison IOC Medical Commission – Games Group McMaster University Medical School, Department of Family Medicine, Rockwood, Ontario Canada

© WADA - World Anti-Doping Program 4 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Attention Deficit Hyperactivity Disorder (ADHD) in children and young adults

Dr. Lily Hechtman, M.D. F.R.C.P. Professor of and Pediatrics Director of Research, Division of Child Psychiatry, McGill University Montreal Children’s Hospital Montreal, Quebec Canada

Dr. William Mahoney, M.D., FRCPC Developmental Pediatrician, Clinical Associate Professor Department of Pediatrics, Faculty of Health Sciences, McMaster University Canada

Dr. Saul Marks, BScH, M.D., FRCPC, Honorary Secretary, FINA Sports Medicine Committee Executive Board, International Society for Sport Psychiatry North York General Hospital, Lecturer, Health and Disease Department of Psychiatry, University of Toronto Canada

Dr. Margo Mountjoy, M.D., CCFP, FCFP, FACSM, Dip Sport Med FINA Bureau Sports Medicine Liaison IOC Medical Commission – Games Group McMaster University Medical School, Department of Family Medicine, Rockwood, Ontario Canada

Diabetes Mellitus

Professor Heather Dean, M.D., FRCPC Assistant Dean (academic), Faculty of Medicine Professor, Department of Pediatrics, Section of Pediatric Endocrinology University of Manitoba Winnipeg, Manitoba, Canada

Dr. Katharina Grimm Member, CAF TUE Advisory Group Chair, FIMS Interfederal Commission Director of Medical Affairs, Aspetar Orthopaedic and Sports Medicine Hospital Qatar

Dr. Sandra Hoffmann, M.D. Associate Clinical Professor and Team Physician Idaho State University United States of America

© WADA - World Anti-Doping Program 5 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Professor Fuminori Katsukawa M.D., Ph.D. Professor, Sports Medicine Research Center, Keio University Yokohama Japan

Professor Patrick Manning, M.D. Department of Medicine University of Otago - Dunedin School of Medicine New Zealand

Professor Ayesha Motala Department of Diabetes and Endocrinology School of Clinical Medicine, Faculty of Health Sciences, Nelson R. Mandela School of Medicine University of KwaZulu-Natal Durban South Africa

Dr. Jake K Powrie, M.D., FRCP Consultant and Honorary Senior Lecturer and Clinical Lead in Diabetes and Endocrinology Guy's Hospital London United Kingdom

Female-to-Male (FtM) Transsexual Athletes

Dr. Alessandra D. Fisher, M.D. Endocrinologist Department of Clinical Physiopathology, and Andrology Unit, Interdepartmental Center for GID Assistance, University of Florence Italy

Professor Louis Gooren Emeritus Professor of Endocrinology VU University of Amsterdam Amsterdam The Netherlands

Dr. Katharina Grimm Member, CAF TUE Advisory Group Chair, FIMS Interfederal Commission Director of Medical Affairs, Aspetar Orthopaedic and Sports Medicine Hospital Qatar

© WADA - World Anti-Doping Program 6 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Dr. David Handelsman ANZAC Research Institute University of Sydney Department of Andrology, Concord Hospital Sydney Australia

Professor Vin Tangpricha Associate Professor Division of Endocrinology, Metabolism and Lipids, Department of Medicine Emory University School of Medicine and the Section of Endocrinology Atlanta VA Medical Center Atlanta, GA United States of America

Growth Hormone Deficiency (Adult / Childhood and Adolescent)

Professor Yves Le Bouc Endocrinologist Director at INSERM Faculty of Medicine Saint Antoine – University Paris VI Paris France

Dr. Tom Parkhill Endocrinologist Independent Consultant San Remo Area Italy

Infertility Polycystic Ovarian Syndrome

Dr. Margo Mountjoy, M.D., CCFP, FCFP, FACSM, Dip Sport Med FINA Bureau Sports Medicine Liaison IOC Medical Commission – Games Group McMaster University Medical School, Department of Family Medicine Rockwood, Ontario Canada

Professor Robert L. Reid Professor & Gynecology Chair, Division of Reproductive Endocrinology and Infertility Queen's University Kingston, Ontario Canada

© WADA - World Anti-Doping Program 7 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Professor Timothy Rowe Professor Obstetrics & Gynecology Head, Division of Reproductive Endocrinology and Infertility University of British Columbia Vancouver, British Columbia Canada

Professor Heather Shapiro Professor Obstetrics and Gynecology Reproductive Endocrinology and Infertility Mount Sinai Hospital Associate University of Toronto Toronto, Ontario Canada

Inflammatory Bowel Disease

Professor Dr. David Gerrard Associate Dean, University of Otago Medical School New Zealand

Dr. Martin Schlup Gastroenterologist Department of Medicine, University of Otago, Dunedin School of Medicine New Zealand

Intravenous Infusions

Professor Dr. David Gerrard Associate Dean, University of Otago Medical School New Zealand

Dr. Ola Rønsen Chief Medical Officer Corporate HSE Aker Solutions Holding Norway

Musculoskeletal Conditions

Professor Dr. David Gerrard Associate Dean, University of Otago Medical School New Zealand

© WADA - World Anti-Doping Program 8 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Dr. Chin Sim Teoh, MBBS (S’pore), MSS(SpMed)(Hons), GDAcu,GCertSpNutr, GDBA Director and Senior Consultant, Sports Medicine Centre Khoo Teck Puat Hospital Singapore

Narcolepsy-Cataplexy

Dr. Bertrand Carlander, M.D. Montpellier France

Dr. Susan White Chair, Australian Sports Drug Medical Advisory Committee Sports Physician, AOC Medical Commission Melbourne Australia

Neuropathic Pain

Mr. Matt Fedoruk Science Director, USADA Colorado USA

IPC Medical Committee (2014)

Dr. Matthias Strupler, M.D. Head of Sports Medicine, Swiss Paraplegic Center CMO Swiss Paralympic Committee IPC Medical Committee Nottwil Switzerland

Dr. Chin Sim Teoh, MBBS (S’pore), MSS (SpMed)(Hons), GDAcu, GCertSpNutr, GDBA Director and Senior Consultant, Sports Medicine Centre Khoo Teck Puat Hospital Singapore

Dr. Mark Ware, MBBS MRCP(UK) MSc. Associate Professor, Family Medicine and , McGill University Director of Clinical Research, Alan Edwards Unit, McGill University Health Centre Co-Director of the Quebec Pain Research Network, and Executive Director of the non-profit Canadian Consortium for the Investigation of Cannabinoids Montreal, Quebec Canada

© WADA - World Anti-Doping Program 9 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Post Infectious Cough

Dr. Louis-Philippe Boulet Université Laval Sainte-Foy, Québec Canada

Professor Ken Fitch, M.D. School of Sport Science, Exercise and Health Faculty of Life Science, University of Western Australia Australia

Dr. Richard S. Irwin UMass Memorial Medical Center United States of America

Dr. Don McKenzie University of British Colombia Vancouver, British Columbia Canada

Dr. Margo Mountjoy, M.D., CCFP, FCFP, FACSM, Dip Sport Med FINA Bureau Sports Medicine Liaison IOC Medical Commission – Games Group McMaster University Medical School, Department of Family Medicine, Rockwood, Ontario Canada

Renal Transplantation

Professor Robert Walker Renal Physician Dunedin School of Medicine, University of Otago New Zealand

Sinusitis

Professor Louis-Phillipe Boulet Université Laval Sainte-Foy, Quebec Canada

© WADA - World Anti-Doping Program 10 Version 6.0 May 2015 TUE Physician Guidelines Medical Information to Support the Decisions of TUECs Major contributors

Professor Martin Desrosiers Clinical Professor, Division of Otolaryngology, Centre Hospitalier de l'Université de Montréal (CHUM), Department of Otolaryngology Montreal General Hospital, McGill University Montreal, Quebec Canada

Professor Ken Fitch, M.D. School of Sport Science, Exercise and Health Faculty of Life Science University of Western Australia Australia

Dr. Richard S. Irwin UMass Memorial Medical Center United States of America

Dr. Margo Mountjoy, M.D., CCFP, FCFP, FACSM, Dip Sport Med FINA Bureau Sports Medicine Liaison IOC Medical Commission – Games Group McMaster University Medical School, Department of Family Medicine, Rockwood, Ontario Canada

© WADA - World Anti-Doping Program 11 Version 6.0 May 2015