I'm kind of surprised there isn't an exception for medically necessary use of substances on the list (at least, that I can find). Obviously, medically necessary

I'm kind of surprised there isn't an exception for medically necessary use of substances on the list (at least, that I can find). Obviously, medically necessary drugs can still give you a advantage, but taking a substance your body would typically produce seems a reasonable exception. For example, trans men don't produce significant amounts of testosterone, so they need to take it both to transition and to be competitive. That exception wouldn't technically cover trans women because we often take spironolactone to totally eliminate testosterone rather than because it's missing. Apparently, it's banned because it's used by athletes to hide their past usage of forbidden steroids.