Testosterone is a key hormone for male health, but it is also a banned substance in sports. At Adon Health, we stand for medically sound testosterone replacement therapy in cases of clinically relevant deficiency and take a clear stance against doping.
A medically supervised TRT can significantly improve the quality of life for affected men. However, in competitive sports, testosterone is banned by WADA (World Anti-Doping Agency) both in and out of competition, even with a medical indication and a doctor's prescription. Exceptions are only possible with a medical exemption, known as a TUE.
This article focuses expressly on the sporting and competition-relevant aspect of testosterone use in the context of doping and anti-doping regulations. The following information is intended solely for general orientation and does not replace official information. As anti-doping regulations may change, only the publications of the National Anti-Doping Agency (NADA) are binding. You can find up-to-date and legally reliable information at any time on the NADA website.
Brief overview: Therapy vs. abuse
A medically indicated testosterone replacement therapy is used for the treatment of a proven hormone deficiency (Kanakis et al., 2023). The goal is to restore physiological testosterone levels under medical supervision, including regular laboratory tests and clearly defined dosages (Barbonetti et al., 2020).
In contrast, testosterone is frequently used in bodybuilding without a medical indication and in significantly higher doses to increase muscle mass and performance (Horn, 2023). This abuse is associated with increased health risks and does not constitute a therapeutic measure (Rasmussen et al., 2016).
If you are generally interested in the difference between medical testosterone replacement therapy and testosterone abuse, for example in bodybuilding, we recommend our more detailed article "Testosterone Replacement Therapy and Bodybuilding: TRT vs. Testosterone Abuse".
Legal classification of testosterone therapy in sports
The use of testosterone falls under the World Anti-Doping Agency (WADA) Prohibited List and is, according to The World Anti Doping Code Prohibited List 2025 (World Anti-Doping Agency, n.d.-b) banned both in and out of competition, even with a medical indication and a doctor's prescription.
To protect athletes from legal consequences, careful education and, if necessary, applying for a medical exemption (TUE Therapeutic Use Exemption) are mandatory. The requirements for a TUE vary depending on the level of competition (World Anti-Doping Agency, n.d.-c).
Distinction: Test Pool Membership
a) Athletes in the NADA (National Anti-Doping Agency) Test Pool
Test pool athletes are usually members of national teams or federal squads and are notified by the NADA or the respective sports federation.
Before starting testosterone therapy, a TUE must be applied for with the NADA.
A complete specialist report (andrology or endocrinology) is required, including:
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Medical history and diagnosis
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Laboratory and imaging results
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Therapy recommendation, including active ingredient, dosage, and duration
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Justification for why no alternative therapy is suitable
b) Athletes outside the Test Pool
For national competitions in Germany, no prior TUE is possible. However, in the event of a doping control, the NADA may require a retrospective TUE. This must meet all the medical criteria mentioned above.
Important Note on International Competitions
The regulation described above applies only to national competitions in Germany. Different regulations often apply to international competitions. In many cases, a TUE must be applied for with the international sports federation.
Recommendation: Consult the responsible federation early.
TUE Requirements According to WADA
According to current WADA guidelines, a TUE for testosterone is only permitted in certain exceptional cases, specifically for proven organic hypogonadism (testosterone deficiency).
Potentially Permissible Causes
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Genetic abnormalities such as Klinefelter syndrome
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Traumatic testicular injuries or testicular torsion
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Testicular tumors
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Pituitary adenomas or tumors
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Complications from chemotherapy or radiation therapy
No TUE for Functional Causes
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Aging processes
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Overtraining
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Stress
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Malnutrition
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Obesity
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Previous anabolic abuse
According to NADA, a TUE application without a clearly demonstrable organic cause will highly likely be rejected. If a doping control test comes back positive and the retrospective TUE application is rejected, this constitutes a violation of anti-doping regulations, which can be punished with multi-year bans.
TRT or Competitive Sports: Usually You Cannot Do Both
In the case of functional testosterone deficiency without a demonstrable organic cause, affected athletes must choose:
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Either medical treatment and giving up competitions
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Or competitive sports without TRT
Doing both at the same time is not possible. If testosterone therapy is carried out without a valid TUE and a doping control test comes back positive, consequences ranging up to multi-year sports bans may follow. Although doping controls occur significantly less frequently in lower leagues and amateur sports, they are always possible and cannot be ruled out.
Evidence of TRT in a Doping Control
Exogenous testosterone administration as part of testosterone therapy causes characteristic changes in urine that make testosterone administration detectable.
Important Changes in Urine
1. Elevated Testosterone
The absolute testosterone level in urine may be slightly elevated, but this alone is not conclusive due to high individual fluctuations.
2. Testosterone-epitestosterone Ratio
Normal range is approximately 1 to 1
Significantly elevated after exogenous administration
Ratios above 4 to 1 or 6 to 1 are considered abnormal
Epitestosterone is not substituted, so the ratio shifts.
Properties of Epitestosterone
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Produced in the testes and adrenal glands
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Has no known biological function
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Does not have androgenic effects
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Excreted mainly in urine
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Physiologically present in a similar concentration to testosterone
After exogenous testosterone administration, the testosterone level in urine rises, while epitestosterone remains unchanged. This significantly shifts the ratio (Andersson et al., 2022).
3. IRMS Isotope Ratio
If the T-E ratio is abnormal, an IRMS test can be performed. This detects whether the testosterone is of plant-based synthetic origin (World Anti-Doping Agency, n.d.).
4. Metabolite Profiles
Elevated concentrations of certain testosterone metabolites, such as androsterone or etiocholanolone, may indicate TRT or abuse.
TRT: Medical Help for Genuine Deficiency
Our medically supervised testosterone therapy is intended exclusively for men with a deficiency requiring treatment. The benefits of a correctly performed TRT are well documented scientifically (Morley, 2009):
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More energy, motivation, and libido
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Improved muscle strength and bone health
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Positive effect on mood and cognitive performance
A medical TRT is not legalized doping, but a therapeutic intervention to restore hormonal balance, not to increase performance (Corona et al., 2014).
Further information can also be found in the EAU Guideline “Male Hypogonadism”, the standard reference for the indications, benefits, and risks of TRT (MALE HYPOGONADISM - UROWeB, n.d.).
More about medical TRT in our article "Is Testosterone Replacement Therapy (TRT) Right for You?".
Doping with Testosterone: Risks and Consequences
The non-indicated, uncontrolled intake of testosterone or anabolic steroids can cause serious health damage:
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Hormonal dysregulation (secondary hypogonadism) (Rasmussen et al., 2016)
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Infertility and loss of libido (Osta et al., 2016)
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Cardiovascular risks (heart attack, thrombosis, stroke) (Vanberg & Atar, 2009)
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Psychological side effects (depression, aggression, instability) (Hall et al., 2005)
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Gynecomastia, acne, liver damage (Pahlavani & Veisi, 2025)
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Development of dependence with a severe physical “crash” after discontinuation
Quitting Doping: Medically Supervised
Many men who have abused anabolic steroids eventually seek their way back. We offer medically sound help:
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Blood analysis: determining whether the hormone balance is disrupted
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Diagnosis: clarifying whether hypogonadism is present
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Medically supervised therapy by independent cooperating doctors
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Structured hormone regulation
Your body. Your responsibility. Our support.
At Adon Health, the focus is not on increasing performance, but on your long-term health. We educate, provide medically sound support, and stand for a clear separation between therapy and doping.
If you are unsure whether you suffer from a genuine deficiency or want to stabilize your health after years of abuse – we are here for you.
Information for Treating Physicians
Documentation and Patient Protection
We recommend:
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Documentation of education regarding doping relevance
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Reference to relevant resources
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Consult your sports association or NADA if you have any questions
Criminal Law Implications
Providing or prescribing prohibited substances to athletes without a medical indication may be a criminal offense under the Anti-Doping Act. Medical diligence and proper documentation are therefore essential from a liability law perspective as well.
Trusted Resources for Doping Prevention
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NADA Germany – www.nada.de
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NADAMED – Medication database for doping relevance: www.nadamed.de
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Help with Doping – DSHS Cologne (anonymous consultation)
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BZgA & Pro Jugend – Education & prevention in sports
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“Together Against Doping” – Prevention program for clubs and schools
Conclusion: Knowledge protects. Therapy helps. Doping harms.
Medically indicated testosterone therapy is legal, safe, and beneficial for men with a genuine deficiency.
Doping remains a health and legal risk factor.
👉 Want to know where you stand? Start with a medical testosterone check at Adon Health now.
