Updated June 2025

NCAA Banned Substances

What drugs are banned by the NCAA?

The NCAA bans drugs by class, along with any substance chemically/pharmacologically related to those classes. The NCAA banned drug classes align with the World Anti-Doping Agency’s list of prohibited classes (with the exception of the glucocorticoid and cannabinoid classes). Additional information related to removal of the cannabinoids class can be found in the Cannabinoid FAQ.

How can a student-athlete find out whether a medication they are using contains a banned substance?

A student-athlete should consult with their primary athletics health care provider (e.g., athletic trainer, team physician) about all medications and other products prior to use. Student-athletes should discuss their use of medications with their primary athletics health care provider when filling out pre-participation physical forms or during their mandatory medical examination.

Drug Free Sport AXIS™ is available to answer questions regarding NCAA banned substances at 816-474-7321 or axis.drugfreesport.com (access code: ncaa1, ncaa2 or ncaa3).

How can a student-athlete find out whether the nutritional/dietary supplement they are using or planning to use contains a banned substance?

A student-athlete should consult with the appropriate athletics staff about all products prior to use.

Many nutritional/dietary supplements are contaminated with banned substances not listed on the label. The U.S. Food and Drug Administration (FDA) does not review or approve nutritional/dietary supplements for safety or effectiveness. Because the regulation of nutritional/dietary supplements is limited, any nutritional/dietary supplement or other product that may unknowingly contain a banned ingredient is taken at the student-athlete’s own risk.

Drug Free Sport AXIS™ is available to answer questions regarding NCAA banned substances at 816-474-7321 or axis.drugfreesport.com (access code: ncaa1, ncaa2 or ncaa3).

Are certain supplements approved by the NCAA for use by student-athletes?

No. The NCAA does not approve the use of any specific nutritional/dietary supplement even if it is available over the counter. Student-athletes have tested positive and lost their eligibility using nutritional/dietary supplements and other products that contain banned substances. Use of any nutritional/dietary supplement or other product that may unknowingly contain a banned ingredient is taken at the student-athlete’s own risk.

Does the NCAA approve medical exceptions for NCAA banned substances?

Yes. The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports medical review panel may approve a medical exception request if the following criteria are met:

• The student-athlete has a medical condition that requires treatment with the banned substance to restore them to their normal baseline health.
• All medical therapies that are not banned have proven to be ineffective or there is an evidence-based contraindication for unbanned therapy or therapies.
• The use of the banned substance does not increase the student-athlete’s performance above their normal (baseline) state of health.

When should schools submit medical exception requests?

• Medical Exception Pre-Approvals (must be submitted prior to athletics participation). Before the student-athlete participates in athletics (e.g., practices, competition, out of season conditioning, voluntary/individual workouts), a request for a medical exception pre-approval (MEPA) for the student-athlete’s use of an anabolic agent, hormone and metabolic modulator, peptide hormone, growth factors, related substance and mimetics must be submitted.
• Medical Exceptions (submitted after a positive NCAA drug test). For all other medical exceptions, a school should submit only after the student-athlete tests positive during an NCAA drug test. Additional information can be found in the Medical Exceptions Procedures resource.

Medical Exception Pre-Approvals

What are anabolic agents and why are they banned?

Anabolic agents generally refer to drugs that increase protein synthesis and tissue building, specifically muscle building and repair. Anabolic steroids like testosterone are the prototype of anabolic agents. 

Due to the performance-enhancing properties (e.g., increased strength and power, shortened recovery time) of this class of drugs, use of any anabolic agent including testosterone and other anabolic steroids in NCAA athletics participation is banned. 

The student-athlete must have an NCAA approved MEPA for the use of the anabolic agent before they are allowed to participate (practice or competition) while taking these medications.

Does a doctor’s prescription for testosterone and/or other anabolic steroids adequately satisfy the criteria for a MEPA?

No. A doctor’s prescription or attestation for the need for testosterone therapy or other forms of androgen therapy is insufficient. In general, the NCAA will not approve use of anabolic steroids such as testosterone for student-athletes that do not have evidence of confirmation of the identifiable, irreversible cause of disease of the hypothalamus, pituitary and/or testicles.

MEPAs for testosterone therapy to treat legitimate medical diagnosis (e.g., hypogonadism, gender-affirming therapy) may be approved if the following criteria are met:

• The student-athlete must have consistently (at least two) low-blood testosterone concentrations measured on samples drawn between 7 - 10 a.m.
• The blood sample must be drawn when the student-athlete is at baseline health.
• The testosterone concentration must be measured by an accurate assay laboratory test.
• The student-athlete may be asked to have repeat testing with a certified and harmonized testosterone assay. Such assays are available widely across the United States (e.g., U.S. Centers for Disease Control and Prevention). 
• The student-athlete may be asked to have repeat testing after fasting for at least six hours.
• The student-athlete may be asked to have repeat testing that includes measurement of sex hormone binding globulin, albumin, hematocrit that is within normal limits of cisgender men, calculated free testosterone, and/or measurement of free testosterone by equilibrium dialysis. 
• Student-athletes competing in NCAA men’s sports must have an identifiable cause of testosterone deficiency. Examples include congenital anorchia (lack of testes at birth), a tumor affecting the hypothalamus or pituitary, or a disease and/or disorder that affects both testicles.
• The disease and/or disorder must not be a cause of testosterone deficiency that is likely to be reversible.
• The student-athlete and their doctor may be asked for evidence of confirmation of the identifiable, irreversible cause of testosterone deficiency due to a disease or disorder of the hypothalamus, pituitary, and/or testicles.
• Documentation of an appropriate physical examination that includes evaluation for Cushing syndrome and a thorough genital exam, including measurement of testicular volumes. 
• Such evidence would include measurement of blood concentrations of luteinizing hormone (LH) and follicle stimulating hormone (FSH).
• Additional tests might include measurement of blood concentrations of prolactin or other hormones and special imaging studies (MRI or CT) of the pituitary and hypothalamus in the brain.

What should be included in the medical documentation provided for the use of testosterone for gender affirming care for trans men?

The medical records should include the following clinical criteria:

• Comprehensive history and physical that includes documentation of the athlete’s history of onset of gender identification; behavioral or testimonial information that supports the athlete’s long-term (years-long) self-identified gender, previous history of gender-affirming hormone therapy; breast and genital exam (or documentation of declination) and skin exam.
• Documentation of gender identity and medical necessity that includes documentation of the athlete’s goals for gender-affirming hormone therapy (e.g., psychological affirmation of gender, breast development).
• Relevant lab values pre- and post-therapy (including blood sex steroid hormone results and hematocrit for trans men only).
• Contraindications and psychological readiness.
• Notably, strong rationale is required for the administration of testosterone dosages to trans men that exceed typical dosages for hypogonadal (testosterone-deficient) cis men.

Can anti-estrogen medications in the hormone and metabolic modulator class qualify for a MEPA?

Anti-estrogens such as clomiphene, anastrozole and letrozole stimulate the production of testosterone (specifically in humans with testicles). In general, treatment with clomiphene, letrozole and other anti-estrogens would not qualify for a MEPA in male student-athletes. However, a MEPA may be approved for student-athletes diagnosed with breast cancer or history of breast cancer.

Does the use of testosterone in conjunction with other banned medications that raise blood testosterone concentration (e.g., anti-estrogens, human chorionic gonadotropin, etc.) to treat androgen deficiency qualify for a MEPA?

There is no evidence of a benefit to using more than one drug to treat androgen deficiency; therefore, in general, more than one drug to treat androgen deficiency will not qualify for a MEPA.

Why are growth hormone, growth factors, peptide hormones, related substances and mimetics NCAA banned substances?

Medications in this banned drug class are classified as performance-enhancing drugs; therefore, student-athletes are required to receive a MEPA prior to athletics participation (practice or competition) while using these medications.

What medical conditions might qualify for a MEPA for the use of growth hormone therapy? What are the criteria for consideration?

Student-athletes with growth-hormone deficiency due to an identifiable, irreversible cause of disease of the hypothalamus and/or pituitary might qualify for a MEPA for growth hormone therapy. The medical documentation may need to include evidence confirming the diagnosis (e.g., evaluation that conforms to most recent national guidelines for growth hormone deficiency). Similarly, those student-athletes that were given growth hormone therapy to treat short stature before the completion of puberty who seek a medical exception pre-approval will need to provide evidence (e.g., evaluations that conforms to most recent national guidelines) confirming the growth hormone deficiency. Additionally, the student-athlete might be required to undergo further testing to confirm persistent growth hormone deficiency.

Medical Exceptions

Why are diuretics and masking agents NCAA banned substances?

Medications in this NCAA banned drug class might be used to hide or “mask” the use of other banned substances.

May diuretics or masking agents qualify for medical exceptions?

Yes, medical exceptions for substances in this drug class should be submitted following an NCAA positive drug test. As with any banned substance, a medical exception will only be approved if the following criteria are met:

• The student-athlete has a medical condition that requires treatment with the banned substance to restore the student-athlete to their normal baseline health.
• All medical therapies that are not banned have proven ineffective or there is an evidence-based contraindication for non-banned therapy or therapies.
• The use of the banned substance does not increase the student-athlete’s performance above their normal (baseline) state of health.

When should a medical exception request be submitted for the use of Spironolactone?

Medical exception requests for Spironolactone should occur following an NCAA positive drug test. 

What should be included in the medical documentation provided for a medical exception for use of Spironolactone?

When submitting a medical exception request for spironolactone schools are required to include medical history documentation that indicates that non-banned medical therapies; oral contraceptives, oral antibiotics and topicals were tried and proven to be ineffective, or there is a contraindication for the non-banned therapy or therapies.

When should a medical exception request be submitted for stimulant medications used to treat Attention-Deficit/Hyperactivity Disorder?

Medical exception requests for stimulant medications prescribed to treat ADHD should only occur following an NCAA positive drug test.

What should be included in the medical documentation provided for a medical exception for stimulant medications used to treat ADHD?

Schools are required to provide written summary of comprehensive clinical evaluation, including original clinical notes of the diagnostic evaluation. The evaluation should include individual and family history, address any indication of mood disorders, substance use, anxiety disorders, and previous history of ADHD treatment and incorporate the DSM criteria to diagnose ADHD. Supporting documentation should include mandatory collateral information from a second source other than the patient (e.g., parent, teacher, report card, etc.). Additional information can be found in the ADHD reporting form.