Human GH Use By Athletes With Short Stature Without GH Deficiency: Therapeutic Use Exemptions

Organized sports are governed by specific rules that aim to create or preserve fair play. An unfair advantage can be obtained by the use of specific substances or methods, also referred to as doping. The World Anti-Doping Agency leads the international doping-free sport movement and annually publishes the List of Prohibited Substances and Methods (List), which is used by most sport federations and organizations around the world. However, some athletes have legitimate medical conditions that require treatments that are included on the List. These athletes may apply for a Therapeutic Use Exemption (TUE), which, if approved, would allow them to take the required prohibited treatments. A challenging scenario concerns adolescents with short stature receiving treatment with human GH (hGH) who are not GH-deficient. Such treatment for short stature conditions is an approved indication for GH therapy in only a few countries, including the United States. Development of TUE Physician Guidelines for hGH for adolescent athletes with short stature required determining whether and to what extent such treatment constituted medical therapy or "enhancement." The group of experts contributing to the TUE Physician Guidelines concluded that hGH treatment for athletes with non-GH-deficient short stature could be considered therapeutic-and could be granted a TUE if they are below 2.25 SD on the growth curve-until the athlete reached a height at the 5th percentile of adult normal range on the appropriate growth chart pertaining to a specific country or region or another relevant chart. Beyond that point, a TUE for hGH treatment is not medically necessary and a TUE should no longer be considered.