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 for clinically relevant deficiency and take a clear stance against doping.
Medically supervised testosterone replacement therapy (TRT) can significantly improve the quality of life for affected men. However, in competitive sports, testosterone is prohibited by the World Anti-Doping Agency (WADA ), both in and out of competition, even with a medical indication and prescription. Exceptions are only possible with a Therapeutic Use Exemption (TUE).
This article focuses specifically on the sporting and competition-related aspects of testosterone use in the context of doping and anti-doping regulations. The following information is for general guidance only and does not replace official information. Since anti-doping regulations are subject to change, only the publications of the National Anti-Doping Agency (NADA) are legally binding. You can find current and legally sound information at any time on the NADA website .
Brief overview: Therapy vs. abuse
Medically indicated testosterone replacement therapy is used to treat 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 misuse 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 further reading article “ Testosterone Replacement Therapy and Bodybuilding: TRT vs. Abuse of Testosterone ”.
Legal classification of testosterone therapy in sports
The use of testosterone is on the World Anti-Doping Agency's (WADA) prohibited list and is listed in The World Anti-Doping Code Prohibited List 2025 ( World Anti-Doping Agency, nd-b ). Prohibited both inside and outside of competitions , even with medical indication and doctor's prescription.
To protect athletes from legal consequences, thorough education and, if necessary, the application for a Therapeutic Use Exemption (TUE) are mandatory. The requirements for a TUE vary depending on the level of competition ( World Anti-Doping Agency, nd-c ).
Distinction: Test pool affiliation
a) Athletes in the NADA (National Anti-Doping Agency) testing pool
Athletes in the test pool are usually members of national teams or federal squads and are notified by NADA or the respective sports federation.
Before starting testosterone therapy, a TUE must be applied for at NADA .
A complete specialist medical report (andrology or endocrinology) is required, including:
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Medical history and diagnosis
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Laboratory and imaging findings
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Therapy recommendation including active ingredient, dosage and duration
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Explanation of why no alternative therapy is an option
b) Athletes outside the testing pool
For national competitions in Germany, a prior TUE (Therapeutic Use Exemption) is not possible . However, in the event of a doping control, NADA (National Anti-Doping Agency) can require a retroactive TUE . This TUE must meet all the aforementioned medical criteria.
Important information regarding international competitions
The regulation described above applies only to national competitions in Germany . Different regulations often apply to international competitions . In many cases, a Technical Exemption (TUE) must be applied for with the international governing body.
Recommendation: Consult the relevant association early on.
TUE requirements according to WADA
According to current WADA guidelines, a TUE for testosterone is only permitted in certain exceptional cases, specifically in cases of proven organic hypogonadism (testosterone deficiency) .
Possible 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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Consequences of 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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Zn Anabolic steroid abuse
According to NADA, a TUE application without a clearly verifiable organic cause is highly likely to be rejected. If a doping control test yields a positive result and the retroactive TUE application is rejected, this constitutes a violation of anti-doping regulations, which can be punished with bans of several years.
TRT or competitive sports: Usually, you can't have both.
Athletes with a functional testosterone deficiency without a detectable organic cause must decide:
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Either medical treatment and abstaining from competitions
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Or competitive sport without TRT
It is not possible to do both at the same time . If testosterone therapy is carried out without a valid Therapeutic Use Exemption (TUE) and a positive doping test results, consequences up to and including multi-year sports bans are possible. While doping controls are significantly less frequent in lower leagues and in purely recreational sports, they are still possible and cannot be ruled out.
Detection of TRT in a doping control
When testosterone is administered exogenously as part of testosterone therapy, characteristic changes appear in the urine that make the testosterone administration detectable.
Important changes in urine
1. Elevated testosterone
The absolute testosterone level in urine may be slightly elevated, but is not conclusive on its own due to high individual variations.
2. Testosterone-Epitestosterone Ratio
Normal range approximately 1 to 1
Significantly increased after exogenous administration
Ratios above 4:1 or 6:1 are considered unusual.
Epitestosterone is not replaced, therefore the ratio shifts.
Properties of epitestosterone
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It is produced in the testes and adrenal glands.
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It has no known biological function
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It has no androgenic effect.
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It is mainly excreted in urine
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It is present physiologically in a similar concentration to testosterone.
Following exogenous testosterone administration, testosterone levels in urine increase, while epitestosterone remains unchanged. This significantly alters the ratio ( Andersson et al., 2022 ).
3. Isotope ratio IRMS
If the testosterone ester ratio is abnormal, an IRMS test can be performed. This test detects whether the testosterone is of plant-based synthetic origin ( World Anti-Doping Agency, nd ).
4. Metabolite profiles
Elevated concentrations of certain testosterone metabolites such as androsterone or etiocholanolone may indicate TRT or abuse.
TRT: Medical help in cases of genuine need
Our medically supervised testosterone therapy is exclusively for men with a deficiency requiring treatment. The benefits of correctly administered TRT are well-documented scientifically ( Morley, 2009 ).
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More energy, drive and libido
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Improved muscle strength and bone health
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Positive effect on mood and cognitive performance
Medical TRT is not legalized doping, but a therapeutic intervention to restore hormonal balance, not to enhance performance ( Corona et al., 2014 ).
Further information can also be found in the EAU guideline “Male Hypogonadism” , a standard work on indications, benefits and risks of TRT ( MALE HYPOGONADISM - UROWeB , nd ).
Learn more about medical TRT in our article “ Is testosterone replacement therapy (TRT) right for you? ”.
Testosterone doping: Risks and consequences
The non-indicated, uncontrolled use of testosterone or anabolic steroids can cause serious health problems:
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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 severe physical “crash” after discontinuation
Exiting doping: Medically supervised
Many men who have abused anabolic steroids eventually seek a way back. We offer medically sound help:
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Blood analysis: Determining whether the hormonal balance is disrupted
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Diagnostics: Clarification of whether hypogonadism is present
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Medically supervised therapy by independent cooperating physicians
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Structured hormone regulation
Your body. Your responsibility. Our support.
At Adon Health, your long-term health is our priority, not performance enhancement. We provide information, offer medically sound support, and maintain a clear distinction between therapy and doping.
If you are unsure whether you are suffering from a genuine deficiency or want to stabilize your health after years of abuse – we are here for you.
Instructions for treating physicians
Documentation and patient protection
We recommend:
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Documentation of the investigation into the relevance of doping
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Reference to relevant resources
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Consult with the association or NADA if you have any questions.
Criminal relevance
Providing or prescribing prohibited substances to athletes without a medical indication can be a criminal offense under anti-doping law. Therefore, due diligence and thorough documentation are essential, also from a liability perspective.
Trusted contact points for doping prevention
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NADA Germany – www.nada.de
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NADAMED – Drug database on doping relevance: www.nadamed.de
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Help with doping – German Sport University Cologne (anonymous counselling)
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BZgA & Pro Jugend – Education & Prevention in Sport
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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 now with a medical testosterone check at Adon Health.
