Once a burning issue for Major League Baseball, the number of suspensions for players using performance-enhancing drugs – as well as therapeutic use exemptions for banned substances – has dropped dramatically in recent years. An annual report for 2025 shows that trend continuing.
If you don’t recall Alex Sanchez of the Tampa Bay Rays in 2005, you’d be forgiven. But Sanchez has a unique place in the history of Major League Baseball. On January 3, 2005, he became the first player in history suspended for a violation of MLB’s drug testing policy, serving a 10-game suspension. In the first year of the Major League Drug Prevention and Treatment Program, which was reached between MLB and the MLB Players Association, a total of 12 players were suspended for PEDs. It would not be until the Biogenesis scandal of 2013 that the likes of Alex Rodriguez, Nelson Cruz, Ryan Braun, Jhonny Peralta, and more would push MLB PED suspensions to a historical high of 16.
The specter of performance-enhancing substances will never leave the sport, but in recent years, there has been a significant decline in not just suspensions, but also in the allowance of therapeutic use exemptions (TUEs) for the use of what would usually be banned substances.
Each year, MLB and the MLBPA release an annual report on drug testing in the league. The report is issued by an Independent Program Administrator; this year, Thomas M. Martin, Ph.D.
For 2025, the total number of drug tests that were conducted totaled 11,700. Of those, 9.400 were urine samples. The number of dried blood spot samples that were collected and analyzed for the presence of human growth hormone (hGH) was 2,300.
Of those tests, two resulted in adverse findings that led to suspensions. In all cases, players are retested if there are adverse findings. Should the findings remain and fall under the substances that result in suspension, a player can appeal the suspension. Therefore, when a suspension is announced, it is a considerable period of time after the player tests positive for PEDs.
For 2025, there were two players suspended for violating the drug program:
On May 18th, José Alvarado received an 80-game suspension without pay after testing positive for exogenous Testosterone. On May 31st, Jurickson Profar received an 80-game suspension without pay after testing positive for Chorionic Gonadotrophin (hCG). In both cases, the suspensions were for performance-enhancing substances.
Therapeutic Use Exemptions For Otherwise Banned Substances
The league and MLBPA have allowed a system in which players, through a doctor’s care, and apply for what is called a Therapeutic Use Exemption, or TUEs. The TUEs is granted after comprehensive medical documentation to prove the medical need for the medication and demonstrate that the treatment only returns the athlete to a normal level of health, rather than providing an unfair advantage. In the vast majority of the TUEs granted each year, the exemption is made for Attention Deficit Hyperactivity Disorder (ADHD) medications. These medications are often amphetamine derivatives, and given that amphetamines are banned in MLB, the player would need an exemption to use such meds to address ADHD.
In years past, the number of ADHD TUEs has reached over 100, which raised the question as to whether there was a fundamental loophole in the drug testing program.
But over the years, these numbers have declined dramatically. For 2025, there was a total of 57 TUEs granted, with 54 for ADHD, along with one each granted for hypertension, sleep disorder, and hormone function. In all cases, the players granted TUEs are not released in the annual report. The drug testing program does not allow for therapeutic use exemptions for human growth hormone.
The 57 total therapeutic use exemptions in 2025 is a -37% drop from the 91 granted in 2020, and shows the drop over just the past six years. While there will likely never be a day when there are no suspensions and no therapeutic use exemptions, for now, at least within the drug program, Major League Baseball is about as free from PEDs as it may ever be.
The table below shows the number of PED suspensions, the total number of therapeutic use exemptions, and the number of those that are ADHD related from 2020 to 2025.
