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April 2, 2008
NCAA Committee on Competitive Safeguards and Medical Aspects of Sports -- Medical Exceptions
and Banned Drug Classes.
The NCAA Committee on Competitive Safeguards and Medical Aspects of
Sports in conjunction with the NCAA Health and Safety staff has issued the following educational article
on medical exceptions and banned drug classes.
Please contact Mary Wilfert, associate director, health and safety at 317/917-6319 or
with any comments or questions.

Medical Exceptions.

The NCAA list of banned drug classes is composed of substances that are generally reported to be
performance enhancing and harmful to one's health. The NCAA bans performance enhancing drugs to
protect student-athlete health and safety and ensure a level playing field, and it also recognizes that some of
these substances may be legitimately used as medications to treat student-athletes with learning disabilities
and other medical conditions.
Accordingly, the NCAA allows exceptions to be made for those student-athletes with a documented
medical history demonstrating the need for regular use of such a drug. The benefit of a medical exception
procedure is that in most cases the student-athlete's eligibility remains intact during the process.
Exceptions may be granted for substances included in the following classes of banned drugs: stimulants,
beta blockers, diuretics, anti-estrogens, anabolic agents (steroids)*, and peptide hormones* (NCAA Bylaw
) [*anabolic agents and peptide hormones must be approved by the NCAA before the athlete is
allowed to participate
while taking these medications. The institution, through its director of athletics,
may request an exception for use of an anabolic agent or peptide hormone by submitting to The National
Center for Drug Free Sport (Drug Free Sport) any medical documentation it wishes to have considered.]

In all cases, a student-athlete, in conjunction with his or her physician, must document that other
nonbanned alternatives have been considered prior to requesting the medical exception for the use of
a medication containing a banned substance
. It is the responsibility of the institution to educate student-
athletes about this policy, and to follow-up with any student- athlete who identifies the use of a banned
medication to determine if standard nonbanned medications have been pursued and documented.
In order for a student-athlete to be granted a medical exception for the use of a medication that contains a
banned substance, the student-athlete must:
1. Have declared the use of the substance to his or her athletics administrator responsible for keeping
medical records;
2. Present documentation of the diagnosis of the condition; and
3. Provide documentation from the prescribing physician explaining the course of treatment and the current
Requests for medical exceptions will be reviewed by physicians who are members of the NCAA
Committee on Competitive Safeguards and Medical Aspects of Sports. Medical exceptions will be granted
if the student-athlete has presented adequate documentation noted above. Unless requesting a review for the
medical use of an anabolic agent or peptide hormone, a student-athlete's medical records or physicians'
letters should not be sent to the NCAA unless requested by the NCAA. Also, the use of the substance need
not be reported at the time of NCAA drug testing. Following are three treatment issues to help illustrate the
medical exception procedure:
Attention Deficit/Hyperactivity Disorder (ADHD) – is one of the most common neurobehavioral
disorders of childhood and can persist through adolescence and into adulthood. ADHD is generally
diagnosed in childhood, but sometimes not until college or later. The most common medications used to
treat ADHD are methylphenidate (Ritalin) and amphetamine (Adderall), which are banned under the
NCAA class of stimulants. In order for a medical exception to be granted for the use of these stimulant
medications, the student-athlete must show that he or she has undergone standard assessment to identify
ADHD. Frequently a student-athlete may find that the demands of college present difficult learning
challenges. They may realize that some of their teammates are benefitting from the use of these
medications, and figure they should ask their team physician or family doctor to prescribe the same for
them. If they do not undergo a standard assessment to diagnose ADHD, they have not met the
requirements for an NCAA medical exception.
Most colleges provide these types of assessment through
their student support services or counseling and testing centers. The student-athlete should either provide
documentation of an earlier assessment, or undergo an assessment prior to using stimulant medication for
ADHD. If the diagnosis is ADHD, the student-athlete may then pursue treatment with the team physician
or family physician for a prescription for stimulant medication, and provide all documentation to the
appropriate athletics administrator to keep in the file in the event the student-athlete is selected for drug
testing and tests positive. At that point, the athletics administrator will be instructed to provide the
documentation for review by the medical panel, and if all is in order, the student-athlete's medical
exception is granted.

Male-Pattern Baldness
– Androgenic alopecia is a common form of hair loss in both men and women. In
men, this condition is also known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning
above both temples. Over time, the hairline recedes to form a characteristic "M" shape. Hair also thins at
the crown of the head, often progressing to partial or complete baldness. Nonbanned medications are
available to treat this condition. Finasteride (trade name Propecia), which is prescribed in some cases to
treat male-pattern baldness, is a banned substance under the class of masking agents, as it interferes with
the ability to identify steroid use. Before using finasteride, a student-athlete must exhaust other standard
medications and document this effort. All documentation should be submitted to the sports medicine staff
to review and maintain in the student-athlete's record. In the event a student-athlete tests positive for the use
of finasteride, the institution will then submit the full record for a medical exception review.

– Or testosterone deficiency, results either from a disorder of the testes (primary
hypogonadism) or of the hypothalamus or pituitary glands (secondary hypogonadism). Causes of primary
hypogonadism include Klinefelter's syndrome, undescended testicles and hemochromatosis. Secondary
hypogonadism can be due to aging, increasing body mass index and/or type 2 diabetes mellitus. Treatment
for hypogonadism may include testosterone medication. Testosterone falls under the banned drug class
"anabolic agents". A student-athlete must request approval to use medication with testosterone prior to
while using this substance. A full medical documentation of the diagnosis, course of
treatment and prescription history must be provided by the institution prior to allowing the student-athlete
to compete on this medication. If a student-athlete tests positive for testosterone and has not obtained prior
approval to use this substance, the case must go to appeal.
In all cases, if a student-athlete does not meet the criteria for a medical exception, the student-athlete may
request an appeal hearing of the positive drug test. In this case, the student-athlete's eligibility will be
suspended pending the outcome of the appeal. Questions about this policy may be directed to Mary Wilfert,
associate director, health and safety, or 317/917-6319.
David Klossner, PhD, ATC
Director of Health & Safety
317- 917- 6332 (p)
> Academics & Athletes > Personal Welfare > Health & Safety


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